• 3/6/2008
  • Sidney, Australia
  • Fran Molloy
  • Sidney Morning Herald (www.smh.com.au)

In secondary schools across Australia, teenage girls are wincing their way towards the front line of the battle against cancer. A new school year means a new round of vaccinations in a program that many researchers believe has the potential to wipe out cervical cancer within two generations.

The vaccine targets four sub-types of the human papillomavirus (HPV), which is the most common sexually transmitted disease. Two of these sub-types are responsible for about 70 per cent of all cervical cancer.

Girls in their first year of high school will get three jabs under a national immunisation program now in its second year. Until June next year, schoolgirls up to year 12 and women up to the age of 26 will also receive free immunisation under a catch-up program that began last April.

Cervical cancer is the second most common cancer in women worldwide – after breast cancer – and is the leading cause of cancer-related death among women in developing nations, with an estimated half a million women diagnosed each year.

“Eventually, we hope that this disease will be eliminated,” says Professor Jim Bishop, chief executive of the Cancer Institute of NSW.

“In places such as equatorial Africa, this is a major cancer in women. The vaccines may reduce the terrible situation with cervical cancer in the developing world where women present late and very often die.

“There, [the situation with] cervical cancer is quite different [to] this country where it’s now becoming a fairly minor cancer.”

Routine screening through Pap smears and early treatment of pre-cancerous lesions have significantly reduced the number of Australian women who die from cervical cancer. However, there are still about 800 new cases and 300 deaths each year, and screening and treatment are costly.

Human papillomavirus is implicated in more than cervical cancer, however. There are many sub-types and early research suggests they may contribute to less common cancers, such as anal and penile cancers and some head and neck cancers.

“The majority of people who are exposed to HPV don’t get cervical cancer,” Professor Bishop says. “There are usually no symptoms, apart from a few strains that cause genital warts, which are treatable.”

Studies of US college students have shown that within three years of becoming sexually active, about 50 per cent of students had contracted at least one strain of genital HPV. Infection rates in Australia are thought to be similar.

Practising safe sex will have a big impact on HPV rates, says Professor Michael Quinn, the director of the Oncology and Dysplasia Unit at the Royal Women’s Hospital in Melbourne.

“These studies have also shown that if males continually use condoms, women will get the same level of protection against cervical cancer. There are so many HPV sub-types that safe sex is an important strategy, even if you have been vaccinated.”

Two vaccines are now commercially available, following research breakthroughs by Professor Ian Frazer, Australian of the Year in 2006. Gardasil protects against four sub-types, while Cervarix protects against two strains of HPV. Younger people usually acquire stronger immunity from vaccination than older people – and trials suggest that women over 26 may fare better with the less-complex Cervarix.

At present, with the budget for the two-year program set about $530 million, only women under 26 are eligible for subsidised vaccines. However, the HPV vaccines have been approved for use in females aged between nine and 45 and for boys aged 10 to 15 years.

“It’s a cost issue,” Professor Quinn says. “Vaccinating pre-adolescent girls maximises the chances of most of the population achieving immunity before HPV exposure.”

Without the subsidy, the necessary three doses of vaccine costs about $450, a price that some young women are happy to pay to lessen their risk of developing cervical cancer (see box). Professor Quinn says the vaccine would also benefit teenage boys and women up to the age of 45.

“We hear anecdotally that the gay community has taken up this vaccine enthusiastically and that’s terrific,” he adds.

The Department of Health and Ageing reports that 2.2 million doses of the Gardasil vaccine have already been issued, with protection promised for five years. Professor Quinn says it is too early to know if a booster shot will be required, but follow-up research to test immunity levels is already underway.

Protect yourself

At 28, Daniella Kernick falls outside the age range for a federally funded vaccination but she was willing to fork out the money – and put up with the much-hated needles – for something that she believes will reduce her risk of cancer.

Kernick paid more than $400 for a course of three injections of Cervarix, the cervical cancer vaccine that has been approved for women over 26.

“One of my close friends was diagnosed with cervical cancer two years ago,” Kernick says. “We were shocked – she was only 28.”

When Kernick heard the vaccine was available, she emailed her friends urging them to get vaccinated. “Some of my friends were under 26, so they could get it free,” she says.

Kernick says she doesn’t begrudge paying for the vaccine for herself, viewing it as an investment in her health, but she’s concerned that women over 26 who cannot spare the money for a vaccine may risk their health.

“My friend had to have treatment for the cancer and she is doing well now but it brought home to me, yes, cancer does happen to women my age and, when it is something that is now preventable, we should do everything we can to protect ourselves.”

She believes that early detection of the cervical cancer through routine screening probably saved her friend.

Although Kernick will need to continue to have regular Pap tests, she says it is reassuring to know she has probably reduced her risk of contracting the cancer.

“Yes, it is quite a lot of money,” she says, “but it’s a small price to pay for your health.”