Vaccine is promising but carries controversy

Once upon a time, cervical cancer was the most common cancer to strike a woman’s reproductive organs.

Then the Pap smear came along, and doctors realized that before a woman developed cervical cancer, there were warning signs — precancerous conditions that could be treated and eliminated before they turned into cancer. Cervical cancer dropped in frequency.

Today, 13,000 women a year are diagnosed with cervical cancer in the United States. Worldwide, 350,000 women are stricken, 80 percent of them in developing countries where routine Pap smears aren’t so easy to get.

Researchers early on surmised that cervical cancer was somehow associated with an infectious agent — one that was sexually transmitted — because women who were celibate didn’t get the disease and women with multiple sexual partners were at increased risk.

After considering, and rejecting, a list of possible suspects, like the herpes virus, they identified the culprit: the human papilloma virus, or HPV. And then the wheels started turning. Could this infection be prevented with a vaccine, just like the polio virus, or measles or chicken pox?

It was an exciting race. Researchers, among them scientists from our own University of Washington, set out to develop and test a vaccine.

In a little more than five years, that process led to the announcement of the Food and Drug Administration’s approval of Gardasil, one of two vaccines expected to gain the agency’s approval this year.

The new vaccine prevents infection from four subtypes of HPV. Think of the HPV family as a large and raucous one. There are more than 120 cousins (subtypes) with the HPV name.

Two of the subtypes the new vaccine targets are the bad boys of the family. They cause cervical cancer. The other two are the rascals. They cause genital warts, annoying as can be, but not deadly.

What is truly remarkable about these vaccines is that they prevent 100 percent of infections by the targeted subtypes. That is not a figure one hears much in the world of medicine.

These vaccines have the potential to prevent 70 percent of cervical cancers (because not all cervical cancers are caused by HPV or the targeted subtypes).

But there is a catch, and one that has raised this vaccine from the realm of almost miraculous to the fuzzy arena of controversy. In order to be effective, these vaccines must be given before a woman is infected with HPV.

And since reports indicate that up to 75 percent of sexually active adults will acquire HPV in their lifetime, the time to strike is before a woman becomes sexually active.

While the mother’s heart within me cringes when I say this, the gynecologist knows the figures: The average age at which a girl becomes sexually active is 16. That’s why the FDA approved the vaccine for females between the ages of 9 and 26.

Interestingly, the FDA did not recommend that the vaccine be given to men. HPV does cause penile cancer, but it is much rarer than cervical cancer.

Still, men probably get HPV at the same rate that women do, and since they are most often asymptomatic, they are ideal carriers of the disease.

Some groups that promote abstinence until marriage worry that vaccination will send a message to young women that sexual activity is “safe” and will undermine the abstinence message. The average age of marriage for women in 2000 was slightly over 25 and for men was 27.

Even if we could get all our young people to abstain from sex until they are married (and I’m sorry, I’m highly skeptical), another statistic comes to mind. One in four American women are raped in their lifetime. How will abstinence protect them?

The controversy will now play out on the state level, where public health officials will decide whether to make this vaccine mandatory.

In the meantime, we can celebrate this wonderful scientific achievement and know that the potential now exists to prevent tens of thousands of women worldwide from getting this killer disease.