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Take a shot at cervical cancer

by Archives November 8, 2006

It’s been four months since Gardasil, the first vaccine against the Human Papilloma Virus (HPV) and cervical cancer, was approved by Health Canada.

But with no mass immunization in sight, should you take the steps to get it?

You may have seen the commercials, but you’d probably never heard of HPV before.

Yet, it is the most widespread sexually transmitted disease in the world; between 2.7 and 4.5 million women are thought to be infected worldwide, according to Public Health Agency of Canada.

HPV is often asymptomatic, but some aggressive strains of the virus can lead to cervical cancer and other diseases in women.

If you are a young woman between the ages of 20 and 24, you are at the highest risk of contracting the virus.

In fact, some experts think that half of all sexually active North American women between the ages of 18 and 22 might be infected.

According to the American Cancer Society, there are many factors that can increase a woman’s risk of being infected with a strain of HPV that could lead to cancer.

These include smoking, HIV or Chlamydia infection, diet, weight, age, oral contraceptives, family history and multiple pregnancies.

Much research on HPV and its effects still needs to be done; only 85 out of the possible 200 different strains of the virus have been typed, according to the Public Health Agency of Canada.

HPV can infect the skin, mouth, tongue, throat, tonsils and genitals; genital HPV can be transmitted by skin-to-skin contact with genitalia, including the scrotum and the anus.

Women are most likely to infect their cervix through sexual intercourse, but oral sex can also be a means of transmission.

It is important to note that lesbian intercourse can also transfer the virus.

As recent studies revealed, cervical cancer is not hereditary; it is the result of an untreated HPV infection in 99.7 per cent of cases.

HPV is often contracted by young women, but the cancer can develop up to twenty years after the initial infection.

HPV infection can be detected through Pap tests that are administered by gynecologists.

According to a Health Canada study, cervical cancer is the deadliest cancer for Canadian women aged from 20 to 44, after breast cancer.

One of the main reasons it is so deadly is that women are reluctant to consult a doctor about lesions on their genitalia.

The new Gardasil vaccine, a product of Merck & Co., protects women from four strains of Human Papilloma Virus: types 6, 11, 16 and 18.

These strains cause 70 per cent of cervical cancer cases, as well as vulvar and vaginal cancer and 90 per cent of genital warts.

Gardasil is being touted as protecting from HPV for up to four years, so booster shots may be required in the future.

Sheila Murphy, the public affairs manager of Merck Frosst, says that when Merck introduced Varivax, a vaccine that protects against chicken pox, they thought its effects could last for six years, but six years have quickly turned into 20 years and no booster shots have been needed yet.

The best time to receive the vaccine is before becoming sexually active, since it is most effective in women who have not been exposed to HPV.

Women who have already contracted one of the strains contained in the vaccine will remain infected once they receive the injections, but will be protected against the disease’s progression.

In Canada, Gardasil has been approved for women aged nine to 26.

Merck is still conducting tests to develop a vaccine that will be approved for older women and men, since HPV has also been linked to penile cancer.

Murphy adds that Gardasil is a unique vaccine, because most pharmaceutical companies would have focused on developing a vaccine for men, who act as vectors for the disease.

“Merck decided to focus on women, because they are the most affected by the virus. Men can develop penile or anile cancer, but those cases are very rare,” says Murphy.

Canada’s National Advisory Committee on Immunization is currently reviewing Gardasil and will decide by the end of this year if it will follow in the United States’ footsteps and recommend mass immunization programs.The complete treatment includes three shots given at two-month intervals for a total period of six months.

Getting the vaccine is relatively easy. Go to your family physician or pediatrician if you are under 18 and ask for a prescription.

It is likely that the clinic will have to order the vaccines, but it should be able to get them within a week.

The doses can be given by a physician or a nurse by intramuscular injection.

The vaccine currently costs $134.95 per dose of 0.5 mL, for a total of $404.85 for all three doses.

Expect to pay about $170 per dose if you get the vaccine at your family doctor, a price that includes injection, transportation and storage fees.

If you are covered by Concordia’s Health Plan, you can get $50 reimbursed for one of the three doses.

Mass immunization of preteens could cost the Quebec government about $100 million a year.

This figure might sound high, but the cost of treating cervical cancer patients across the country is about $270 million yearly according to the Canadian Guide to Clinical Preventive Health Care. This figure does not include the costs from treating genital warts and vaginal or vulvar diseases.

When asked why the vaccine is so expensive, Murphy replied that each time a company tries to develop a new drug, it is taking a big risk because it may lose millions if the product doesn’t work out.

When I visited my physician to get the vaccine, I was nervous because I knew intramuscular injections hurt.

And it did hurt; I experienced soreness in my arm for about two days. I also felt weak a couple of hours after getting the shot and experienced a light fever that evening.

My symptoms weren’t uncommon; 80 per cent of the vaccine recipients experienced redness and tenderness at the vaccination site and 60 per cent had headaches.

Fever is a less common side effect, affecting one in ten girls.

The United States National Cervical Cancer Coalition website is filled with the survival stories of women who were diagnosed with cervical cancer.

They recount how the disease itself and their life-saving surgeries were painful, referring to cramps, bleeding and laser treatments.

The organization, which currently has no Canadian counterpart, has been promoting free distribution of Gardasil since December 2005.

Gardasil has been the target of criticism from conservative groups, such as the American organization Focus on the Family. It suggests that the vaccine may encourage promiscuity and a feeling of invulnerability to sexually transmitted diseases.

While it does recognize that Gardasil can save lives, the group stands against mass immunization because it feels such action would rob parents of the right to make decisions about their children’s sexual health.

Around the world, 250,000 women die of cervical cancer each year.

Most of them live in third-world countries and don’t have access to Pap tests, health care or condoms.

Recently, the Bill and Melinda Gates Foundation stepped up by giving almost $28 million US divided among different scientific projects so that an inexpensive vaccine against HPV can be introduced in countries like India, Uganda, Peru and Vietnam.

Muslim women may also get protection from Gardasil since it has received a Halal certification from IFANCA on Oct. 11. This means that the vaccine is in compliance with Islamic law. Another cervical cancer vaccine called Cervarix is being developed by GlaxoSmithKline and could be approved next year.

Practicing safer sex and using condoms are the best ways to help prevent HPV infection, although condoms do not protect from legions that are not located on the penis.

If you have already contracted HPV, experts recommend that you ask your gynecologist for an HPV DNA test to determine which virus type you have and then get Pap tests every six months to keep track of the disease.

For more information visit the Program for Appropriate Technology in Health (PATH) website, www.path.org.

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