Vaccine for Cervical Cancer Has Patients, Medical Industry Hopeful by Anna Gawel In late November, news of a potential vaccine for cervical cancer created quite a stir in the medical community and generated hopeful speculation across the country that the first-ever cancer vaccine might be in the foreseeable future. A study found that the experimental vaccine, which is being developed by Merck Research Laboratories, was completely effective in protecting against human papilloma virus, or HPV, the virus responsible for virtually all cases of cervical cancer. A broader international study is now under way to verify these preliminary findings and is expected to be released next year. In the meantime, the initial success of the vaccine holds very real promise for the approximately 15,000 women in the United States who will be diagnosed with cervical cancer this year, not to mention the more than quarter of a million women worldwide who die from the disease each year. Relatively few women infected with HPV actually wind up developing cervical cancer. HPV is an extremely common infection of the cervix, affecting about half of all women in the United States at some point in their lives. There are some 30 different strains of the sexually transmitted virus, the majo rity of which ultimately prove harmless and do not result in cervical cancer. On the flip side however, nearly all cases of cervical cancer can be traced back to a long-standing HPV infection, and one of the viral strains, HPV-16, accounts for about half of these cases. In the vaccine study, published in The New England Journal of Medicine, about 1,500 sexually active women were given either three shots of the vaccine or three shots of a placebo. None of the women in the vaccine group developed an HPV-16 infection, although 41 in the placebo group did contract HPV-16, with precancerous lesions appearing in nine of those women. The vaccine did not safeguard against other less common types of HPV also associated with cervical cancer, such as types 18, 31, 33 and 45, although researchers say future vaccine combinations are likely to ward off these cancer-causing strains as well. The studyís remarkable results had the health care industry buzzing. ìIn one respect, it was a very big breakthrough,î said Dr. Charles Levenback, deputy chairman of the Gynecologic Oncology Center at the University of Texas M.D. Anderson Cancer Center. ìThe whole idea that somebody can be vaccinated in childhood and prevent themselves from getting cancer is tremendous. It could possibly have the same impact on cancer as the polio vaccine had for infectious diseases.î ìWe canít say we have a definite vaccine, but we can be extremely optimistic from these results,î added Dr. Denise Galloway, head of the Cancer Biology Program at the Fred Hutchinson Cancer Research Center in Seattle. Amid the excitement, however, physicians caution that the highly touted vaccine still has a long way to go before it sees FDA approval. Scientists are now grappling with tough questions, such as when the vaccine would be administered (giving a 2-year-old girl a vaccine against a sexually transmitted disease might seem a bit odd), what are its side effects, how long does it remain potent, and how well does it stack up among different population and age groups. In addition, the vaccine would not translate into a fundamental change in sexual behavior. Even if HPV infection is completely eliminated, ìitís important not to lose sight of the fact that sexually active women still need to practice safe sex to protect against HIV and other sexually transmitted diseases,î Levenback said. Still, the vaccine could have a far-reaching impact on the health care industry both here and abroad. Although widespread Pap smear testing has dramatically cut the number of cervical cancer deaths in the United States, such preventive screening is often sorely lacking in the developing world. ìPap smears require a strong medical infrastructure,î said Levenback, who noted that ìtelephones to make calls, the ability to come in for several visits, an appointment system, reliable transportation to get to the doctor, the ability to receive test results in the mail,î and other basic services may be nonexistent in many developing nations. It is here that vaccines are especially effective because one massive effort is essentially all thatís needed to inoculate an entire population. In the United States, the vaccine could prove to be a boom to a financially ailing health care industry. ìThe amount of money spent on Pap smears, repeat testing for abnormal Paps, biopsies, coloposcopy [pelvic exam] and other such treatments,î said Galloway, ìis also a huge public health concern.î Billions of dollars are spent on these preventive measures each year, and in a world of surging health care costs, the price tag for such expensive testing inevitably trickles back down to the patients. Making an HPV vaccine part of routine health care for young girls could theoretically slash many of these costs. But what does all this mean for other types of cancers? Not much, say most physicians. ìThough this vaccine would be the first of its kind, its immediate application is very, very limited,î said Levenback. Thatís because unlike cervical cancer, most cancers do not have a viral base. In addition to cervical cancer, this vaccine may protect against other cancers that also stem from HPV infections, such as cancer of the vulva and the penisóboth of which are very rareóand down the line it may lead to vaccines for a handful of other virus-related cancers, but the current research has little bearing on breast, lung, colon and other more prevalent forms of cancer. So what area should researchers be looking toward to tackle these types of cancersóa vaccine or a cure? Perhaps neither, said Levenback, who pointed out that many of the advances in cancer research have come not so much in the form of revolutionary new treatments or surgical techniques, but rather in prevention and early detection. ìIn terms of the war on cancer, weíve been fighting this war for a long time, and although weíve made a lot of progress, prevention and early detection, which includes things like Pap smears, is still where we see the real gains,î Levenback said. ìTo make the smoking analogy, if there were no tobacco in the world, a third of all cancers would instantly disappear.î Anna Gawel is the assistant managing editor of The Washington Diplomat.