Immunisation against cervical cancer?

Imagine a few quick jabs before you leave primary school and no need for Pap smear tests in your adult life. This could be a reality for future generations if hopes for a vaccine program against cervical cancer come to fruition.

Immunisation against the human papillomavirus (HPV), which is present in almost all cases of cervical cancer, could prevent the disease and eventually (some decades) negate the need for Pap screening according to an article published in the current issue of The Medical Journal of Australia.

Cervical cancer is the third most common cancer in the world. For women it is the second most common cancer after breast cancer, claiming 232,000 lives annually.

Eighty per cent of the 466,000 cases diagnosed globally each year occur in developing countries where it is the leading cause of cancer-related deaths among women.

In the recent controlled trial of an HPV type 16 vaccine, vaccinees were provided "with high-level protection for incident and persistent HPV-16 infection and HPV-16-related cervical intraepithelial neoplasia (CIN)," said Associate Professor Suzanne Garland, Director, Department of Microbiology and Infectious Diseases at the Royal Women's Hospital in Melbourne and author of the MJA editorial.

Clinical trials are under way for vaccines for HPV types 6 and 11 (which cause genital warts), 16, and 18.

If these vaccines are as successful as the HPV type 16 vaccine, they have the potential to prevent genital warts and over 70 per cent of cervical dysplasias and cancers. They would also reduce the occurrence of abnormal Pap smear results and the costs of their follow-up and management.

"In Australia, mortality from cervical cancer has been reduced substantially by an effective Pap screening program, but this comes at a considerable cost, both to the health budget and to women who face the psychological impact of having an abnormal Pap smear result," Dr Garland said.

An effective vaccine for the prevention of HPVs could eventually replace the need for Pap smears. An effective therapeutic vaccine could change the way we manage cervical disease.

But lowering the incidence of pre-cancerous cells and cancer will take many years. In the meantime, the various prevention strategies still need to be endorsed and maintained.

An effective vaccine campaign would include public education on HPV, de-stigmatising HPV infection, and getting acceptance for vaccinating adolescents, possibly of both sexes, for a sexually transmitted infection before their sexual debut.

The Medical Journal of Australia is a publication of the Australian Medical Association.

CONTACT: Assoc Prof Suzanne Garland, 0418 170 334

Judith Tokley, AMA, 0408 824 306