by GlaxoSmithkline, is not yet
FDa-approved, but is available in
australia and the European union.
The debate revolves around two
questions: Is vaccination worth the
cost—about $360 for Gardasil’s
three required shots—and do we
know enough to justify large-scale
use. The NEJM study, conducted
by Harvard School of Public Health
researchers Jane J. kim and Sue
J. Goldie, used complex modeling
to project that HPV vaccination
could lower cervical cancer rates in
an economical way if the vaccine
uptake is high among 12-year-old
girls—its target group—and if
the vaccine’s protection against
infection lasts for their lifetimes.
Currently, the Centers for Disease
Control and Prevention (CDC)
recommends “catch-up” vaccines
for 13- to 26-year-olds, but kim
and Goldie found that catch-up vaccination may not make
economic sense for older teens or
women in their 20s.
So far, 1 in 4 adolescents in the U.S. has received at least one dose of Gardasil
The two researchers also
pointed to the importance of
long-lasting vaccine-induced
immunity, wide vaccination among
pre-adolescent girls, as well as
Pap screening for cervical cancer
beginning in the early to mid-20s.
both authors declined to elaborate
on their research for CR.
When considering the vaccine,
“People are beginning to doubt
a little more that this is a good
thing,” says immunologist
Charlotte J. Haug, the editor of
the Journal of the Norwegian
Medical Association, who penned
an editorial accompanying the
NEJM study. “I don’t think we
have enough evidence. It’s
a very promising thing, but I
cannot see why we shouldn’t
get some more answers before
we start large-scale vaccination
of completely healthy girls.” So
far, 1 in 4 adolescents in the u.S.
has received at least one dose of
Gardasil, according to a report
released in October by the CDC.
among the major unanswered
questions, she says, is what will
happen to the natural mix of HPV
types after the vaccines start
to take hold in the population.
Gardasil and Cervarix each protect
against only four of scores of
types of HPV. “Here we have
at least 20 other very similar
strains, very prevalent, all over
the place. It’s absolutely certain
that they will come and take the
place of HPV 16 and 18,” the two
types most commonly linked to
cervical cancer, says Haug. “The
only question is will they be more
or less oncogenic” than their
predecessors.
The NEJM study shows that
how long the vaccine lasts is key
to deciding if it’s cost-effective,
according to Dartmouth Medical
School’s Diane Harper, a cervical
health specialist who participated
in clinical studies of the vaccines.
“as excited as I am about the
vaccine, and as much good as I
think it will do, I think it’s been
oversold,” she says.
“We have to understand that the
vaccine is not going to eliminate
cervical cancer,” she adds, “and
that we don’t really know how long
it’s going to last.”
—Erik Ness
CR | Page No. 9 | www.CRmagazine.org
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HPV and Cervical Cancer
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