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Reducing the risk

By February 1, 2010News

Irish Independent – 1 February 2010

A new cervical cancer vaccine is said to be most effective when given to girls aged 12. As it becomes available for free, should parents be worried about the effects of such a vaccine?

To vaccinate or not to vaccinate? That's the question that has been occupying the minds of parents of teenage girls all across the country since Mary Harney announced that the HPV vaccination would be offered, free of charge, to approximately 30,000 girls who are now in their first year at secondary school.

Most parents are wondering — is it safe? And what about the thousands of young women not entitled to the free vaccine? As a parent, are you willing to fork out up to €600 to get it administered privately?

Human papillomaviruses (HPVs) are a group of more than 100 related viruses, some of which are the major causes of cervical cancer, a disease which affects the cells of the cervix (neck of the womb).

Cervical cancer is one of the leading causes of mortality among Irish women under 44, with over 90 lives lost to the disease and over 200 new cases diagnosed every year.

Until recently there were just three ways to reduce the risk of getting cervical cancer: regular smear tests, quitting smoking, and having your doctor investigate irregular vaginal bleeding, spotting or discharge.

The introduction of the vaccines Gardasil and Cervarix have changed all that. Both are highly effective at preventing infection with HPV types 16 and 18, which cause 70pc of cervical cancers.

Both have been approved by the US Food and Drug Administration (FDA), and both have been the reasons why thousands of parents have been taking their daughters, some as young as nine, to their GPs in the hope of reducing their risk of developing cervical cancer when they're older.

"Cervical cancer is the only one which has a pre-cancerous phase that can be identified," explains Dr Paul Byrne, consultant obstetrician and gynaecologist at the Rotunda and Beaumont hospitals.

"With regular screening, it can be picked up in the pre-malignant phase. When we find abnormal cells at the neck of the womb, we remove them, even though not all would subsequently have developed into cancer.

"We can't tell which ones will turn malignant, so it's safer to treat them all.

"Studies have found that women who embark on sexual activity early in life are more likely to develop cervical cancer. The more sexual partners a woman has, the higher her risk of developing it. The rationale behind the HPV vaccine is to give it before the onset of sexual activity," he says.

"The time when the cervix is most vulnerable to HPV is in adolescence, as the immature cervix is more susceptible to infection with HPV than the more mature cervix of a woman in her 20s," says Dr Byrne.

As to the ideal age at which to get the vaccine, he says that while women in their late teens and early twenties will benefit from it, "those in early adolescence get a better immune response, so the ideal age to administer it is at the age of 12".

While most of the discussion around the vaccine centres on the fact that it is geared towards young women with no history of sexual activity, Dr Byrne believes that those who have had sex can also benefit from the vaccine and that it would be worth their while getting it.

However, the protection offered may be less than it would for those who had never engaged in sexual activity.

"It would certainly do no harm and would most likely offer some increased protection, so on balance I would recommend it," he says.

What's at the core of parents' concern, of course, is whether the vaccine is entirely safe and whether there are any adverse risks attached to giving it to youngsters.

As a parent of three daughters who's still considering whether to go ahead and get them vaccinated, this was foremost in my mind when I talked to Dr Byrne.

What does he say to the many seeking reassurance on this point? "I've been working in the field of cervical cancer for 25 years, and I've no hesitation whatsoever in recommending the vaccine," he says.

"Because it stops abnormal cells from developing, it prevents the disease before it can get started, and it is undoubtedly the biggest breakthrough in cancer prevention I have seen in my medical career. It is as safe as any vaccine out there and safer than many."

CervicalCheck is the national cervical cancer screening programme which provides free smear tests for women aged 25-60. The organisation's Dr Marian O'Reilly says the death of Big Brother star Jade Goody from the disease last year did much to raise awareness of the importance of screening.

"Last year, we screened nearly 1,000 women a day," she says. "Ninety per cent of those showed no abnormality, 10pc had repeat tests, and half of those were referred to specialists.

"Screening helps save lives, but with the availability of the HPV vaccination as an additional tool of prevention, we have the potential to eradicate this cancer altogether," she adds.

WHAT PARENTS NEED TO KNOW

DR CATRIONA Henchion medical director of the Irish Family Planning Association, answers key questions about the HPV vaccine.

What is the ideal age for vaccination? "While Gardasil and Cervarix are licensed for those aged nine to 26, and 10 to 25 respectively, the ideal age to vaccinate is before the onset of sexual activity."

Are there any side-effects? "One in 10 may develop soreness or redness at the site of the injection or headache of a transient nature. A similar percentage may feel dizzy or faint, or may experience tummy upset."

How long does the vaccine's protection last? "It lasts for at least six years after vaccination. The question of boosters has not yet been addressed."

At what interval is the vaccine administered? "Both Gardasil and Cervarix are administered in three doses over a six-month period."

How much can you expect to pay for your vaccine if you get it done privately? "Between €400 and €600 for the three doses."

What is the difference between Gardasil and Cervarix? "Both protect against the two strains that cause 70pc of cervical cancers. Gardasil also protects against genital warts."

Should parents be concerned about the possibility of tong-term side effects? "No. Cervarix was approved last September by the FDA. Gardasil was approved some time ago."

Is there a similar school vaccination scheme in the UK? "Yes, a scheme was rolled out in UK schools last year and has been very successful. The UK government opted for Cervarix."

If you get the vaccine do you stilt have to be screened? "Yes. At most, the vaccine offers up to 70pc protection from cervical cancer, so it's important to go for regular smear tests from the age of 25."

* Cervical cancer is the most common cancer in women under 44 in Ireland.

HPV is the most common sexually transmitted infection in the world.

Around 50-80pc of sexually active women contract some form of HPV at least once in their life, but only a small proportion develop cervical cancer.

Mortality rates from cervical cancer have increased 1.5pc per year since 1978, with the average age of death from the disease being 56.

Information courtesy of the Irish Family Planning Association