Human Papilloma Virus (HPV) is the main cause of cervical cancer. In addition, HPV is also responsible for many other cancers including vulval, vaginal, anal, penile and oropharyngeal cancers. However, now we have a powerful tool against HPV in the form of a vaccine. Thus, HPV vaccination at a mass scale will not only eradicate cervical cancer but also probably eradicate/substantially reduce a number of other cancers in both men and women.
However, HPV related cancers are more common in low- and middle-income countries (LMICs) and due to prohibitive costs, cultural reasons etc. the access, availability and uptake of HPV vaccine remains low in LMICs. I would welcome your thoughts regarding figuring out ways in which HPV vaccination can be made cheaper and more widely available. We also need ideas which will encourage LMIC governments to include this vaccine in the country immunization programs, and to overcome cultural barriers so that we can imagine a time when cervical cancer (and the other related cancers as well) have been eradicated.
zero. Gardasil only covers 43% of the CIN 3 and 70% of the possible cancers if it lasts long enough to cover a woman throughout her lifetime. Cervarix covers 93% of CIN 3 lesions and close to 90% of cancers due to cross protection and lasts very long due to the very high induced antibody titers. Neither vaccine, nor the upcoming GArdasil +5 vaccine will cover all cancers. Cervical cancer cannot be eradicated by vaccination at this time. The monies are best spent in screening.
None. There is not a chance to eradicate cervical cancer with this vaccine, you have to remember that Gardasil only have antigens to generate protection for HPV 16 and 18 in the cervical cancer theme (and 6 and 11 in the condyloma one). In many parts of the world these high risk types doesn't represent even the 50% of the cervical cancer causes.
Additionally, we still don't know if the protection conferred by the actual vaccination schemes will last for the lifetime in risk of a women. And the cancers that we will see in the next 20 years it will be in women that today doesn't reach the vaccination in the ideal time frame (with the women without sexual activity whatsoever).
Completely agree with Diane, the money is much better spent in screening via Pap and PCR.
Nope. The best studies and historic analysis show that the type 16 is responsible of aprox. 62% while the 18 of 7%, the rest (31% aprox.) of the cervical cancers are historically caused by other types (53, 33, 52 and others) (Int J Cancer. 2013 Nov 28. doi: 10.1002/ijc.28636); additionally, we don't know yet what's gonna be the impact of the vaccines in the distribution and incidence of the others high risk types without changes in the sexual behavior and high risk practices. There is no chance of eradicate cervical cancer with the actual vaccine, that is IMO a commercial missinformation that can cause the deviation of the current low budgets towards non-beneficial or less effective prevention, diagnostic ant therapeutic activities.
The answers so far have just been based on vaccination uptake and the assumption that a multivalent vaccine will be sufficient to eradicate HPV. A most accurate answer is a bit more complicated.
While it is correct that gardasil only protects against the most prevalent hrHPV types (16, 18) as well as 6 and 11, it does not work as an effective immunotherapy for those who already have an HPV infection (a process which takes an estimated 10 years of recurrent infection). In the best case scenario we get >80 percent vaccination uptake in the younger population and generate a herd immunity for that generation and those that will come after, however we still have the older population which did not have that protection and will still go on to develop an HPV-related cancer.
Realistically, if we can succeed at developing an immunotherapy-based vaccine strategy/treatment that takes care of those who have infections as well as generate a greater uptake in number of children vaccinated against the most-prevalent HPV types we could eliminate HPV-related cancers, but it is going to take more than 20 years given the current mis-information and confusing stigma that has been placed on vaccines.
I know I did not address the idea that "another HPV-type will just take 16 or 18's place," however given that more that 60% of cervical cancers are caused by 16 alone this is a great starting point.
I'm disturbed by the number of just keep doing what we are doing answers on this thread. current screening approaches still leave a woman dying of HPV-associated disease every 2-3 minutes. why would you not want to improve this horrific statistic? I cannot more strongly disagree with the "if it's not perfect, don't try it" philosopy being promoted here.
also another angle that is not being considered is that even 100% vaccination combined with a vaccine that covers 100% of disease causing viruses, it is giong to be 20-30 years before hpv-associated disease would be irradicated. you've got to keep screening and ramp up vaccinations.
Mr. Skaete is not correct. Both Gardasil and Cervarix data show that women previously exposed (seropositive) do gain efficacy and increased immune titers after vaccination. Cervarix is better than Gardasil for antibody induction and disease prevention. But the efficacy is less than if the woman had been seronegative and DNA negative at vaccine administration.
A combination of screening (must and is first priority) with vaccination for those who choose to be vaccinated is how the message of cervical cancer prevention (not eradication) can be accomplished.
New screening methods with HPV testing as primary provide the near 100% sensitivity for CIN 3 disease that cytology cannot. Fewer screens in a woman's lifetime with the more sensitive test (and resulting increase in false positives and trips to colposcopy) will allow the rate of cervical cancer to drop below the 2-3/100,000 that is now possible with cytology alone.
I was not trying to imply that the immune response is compromised if an individual is already infected with HPV at the time of immunization, but I do not believe it is a standalone method that can be used in an immunotherapy setting. You can stimulate T-cells all you want, but you need infiltration as well in those who develop tumors.
Ultimately I was just trying to build on the idea that vaccination is not enough to eliminate HPV-related cancers due to the fact that you need to address those who are already infected, and those individuals can have their HPV status monitored through DNA screening etc.
Additionally, thank you for the correction!
Screening and vaccination are complimentary and have to go hand in hand. Improvements in both strategies are needed and I am optimistic that this will occur over time. The public health angle ie education, access and compliance to preventive measures are also of paramount importance.
totally agree with Diane. I think none of us will live long enough to see the eradication of HPV nor of cervical cancer. Here in Brazil, we have dozens of women dying each year from cervical cancer and HPV is certainly a problem of public health. Vaccination is important and should be taken with the aim of reducing the number of infected patients, but certainly we are far from significant reduction in cervical cancer, as has been observed in hepatocellular carcinomas that despite the vaccine have already almost 30 years, still have considerable number of people with hepatitis B and considerable number of people with hepatocellular carcinoma.
I am not of the view that cervical cancer eradication can be achieved with HPV vaccination only, particularly with the current once that target only two high risk types. While we wait for the development of the multivalent vaccines, we need to think about how the differences in genotype specific prevalence of these high risk types in different population may influence the success of these vaccines. We have found that HPV16 was the most prevalent and HPV18 the fourth or fifth in the general population but HPV59 and HPV18 as the most prevalent and HPV16 the fifth in cervical cancer cases in the same country. The question to ask is, what will the contribution of the other high risk HPVs be even if HPV16 and 18 are eradicate? I do not think eradicating HPV16 and 18 if it happens will lead to the eradication of cervical cancer.
It is a complex issue that can't be only dealt with by vaccination, particularly against only two high risk types. Vaccination has a very good potential to contribute to reducing cervical cancer but please don't let us think it will do it all.
A screening program that will combine self collections of cervicovaginal swabs and HPV testing, probably in addition to vaccination, as it is now, will be the way to go for LMIC.
I will like to say that - A woman who has been screened is more likely to educate her daughter to get vaccinated.
The current vaccines cover HPV 16 and 18 ( Gardisil covers 6 and 11 as well but these are for genital warts and not cancer). This vaccine will not eliminate cervical cancer as other HPV genotypes can cause cancer (by the way HPV 53 is not a cancer cause type). There are plans to get a vaccine to cover nine genotypes. If this is introduced the problem is then coverage (if coverage is poor then cervical cancer will be with us for a long time). So cervical cancer will not be eradicated in the next few years but in perhaps a few decades.
Brian - you are misinformed. Gardasil +5 will add 5 more oncogenic types but will have no more protection than Cervarix currently has. Cervarix protects against 93% of all CIN 3 regardless of HPV type (and the research shows cross protection from 3-5 more types than just the 16/18 , depending on how one interprets the data). The new Gardasil+5 cannot do better than that and contains nearly 7 times as much foreign protein VLP to cause reactions!!
I totally disagree with Lalitha. If a change in lifestyle could eradicate disease, probably would not have atherosclerosis anymore, since there are more than 40 years we recommend diets rich in vegetables, fat-free, smoke-free and with exercise. In the case of HPV, which we would recommend? No sex? It would not a change in lifestyle just women but all people. I think that the current vaccine is better than nothing, but have no power to eradicate cervical cancer.
HPV is the primary cause of cervical cancer but chlymidia infection have also been indicated in causing cervical cancer. So vaccine against HPV will reduce cervical cancer but not completly eradicate it since there are other causes that are probabily yet to be identified
Subhojit, Its a very valid question as a researcher who spent lot of time on cervical cancer I can tell you Cervical cancer will be eradicated as we have wonderful preventive vaccines like Gardasil and Cervarix. But these are type specific, as we have many types of HPV infecting humans, also I am not sure with current cost of making them they will be economically viable to lot of countries. Unless if they are made cost effective. I had the opportunity to work on vaccines which work on many types of HPV. Again all these vaccines will only prevent, for those who are already infected by HPV we need therapeutic vaccines or medications. I think with a strong public health policy of Governments, educating the masses about this cancer , encouraging them to have healthy habits we surely can eradicate this disease.
In my opinion with current vaccinations, no chance. We must remember that the protection is restricted to types 16 and 18, which are associated with approximately 70% of cases of cervical cancer. There will undoubtedly greatly reduced, but not eradicated.
In my opinion , we can not irrsadicate Ca Cervix with vacinations , even we have vaccine against 4 tyopes of virus, how can we prevent more than a hundred types of HPV. The most important of all, one must consider the large group of high risk women , age 30 -45, who were already infected, you must do the secondary prevention by doing the most cost effective screening for these group of women too. Use the vaccines for prevention of next generation of women.