STORY BY

Melissa McDonald

It began with a pap smear during a routine well-woman exam. Patricia Boyd started to bleed. Her doctor had a hard time stopping it. It would only be a matter of time before Boyd found out why: She had cervical cancer.

Like her mother, who died of the disease, she began intense radiation and chemotherapy under the care of Lois Ramondetta, M.D., assistant professor of gynecologic oncology at The University of Texas Medical School at Houston.

Now age 44 and in remission, Boyd turns her concerns to her children. “I have three daughters, ages 20, 22, and 24. I don’t want them to get the same disease.”

One way she could help protect them against cervical cancer is through a new vaccine approved this summer by the FDA.

“The vaccine is designed to protect young women against two cancer-causing strains of human papillomavirus (HPV), types 16 and 18,” says Dr. Stephen Tyring. “HPV is the most commonly acquired sexually transmitted disease in the United States. While various strains of HPV cause almost 100 percent of all cervical cancers, HPV types 16 and 18 are responsible for 70 percent of those cases,” Tyring says.

Stephen Tyring, M.D., Ph.D., clinical professor of dermatology at UT Medical School, was a member of the clinical trial team whose research led to vaccine approval. “It’s a big breakthrough in the fight against cervical cancer.”

Cervical cancer kills approximately 3700 U.S. women a year, but “it’s the number-two cancer killer of women around the world,” Tyring says. “Amazingly enough, the vaccine is 100 percent effective in protecting women from HPV — that’s rare.”

Cervical dysplasia

Advanced cancer is not the only worry that the vaccine can minimize. Young women who are diagnosed with “cervical dysplasia” through pap smear and who are HPV-positive must undergo treatment to remove the nefarious cells before they become cancerous. Cervical dysplasia means abnormal cell growth on the surface of the cervix and is considered a pre-cancerous condition.

The current evaluation and treatment for dysplasia can include such procedures as biopsy, cryotherapy (freezing), cold knife cone biopsy and LEEP or LOOP (laser) procedures. “Reduced cervical dysplasia may decrease the need for subsequent evaluation and treatment procedures, which in itself is a desirable outcome,” says Lisa Hollier, M.D., associate professor of obstetrics and gynecology at the medical school.

Last fall, Megan*, 25, went for her annual pap smear and check-up and was told she had cervical dysplasia and was positive for HPV. “At first, I was very confused and upset. I consider myself to be knowledgeable and responsible when it comes to sexual health, but I'd never heard of HPV until I was told that I had it.”

Her doctor performed a LEEP procedure to remove the abnormal cells and her subsequent pap smears have come back healthy.

She also will get the vaccine, she says, “Absolutely. There are a number of strains to this virus. Just because you can have it once and are treated doesn’t mean you can’t become infected by a different strain.”

“I think the vaccine is terrific. It is an incredible tool that I hope will prevent cancer deaths in women,” Hollier adds.

Boyd says even though the virus may not have caused her cervical cancer, she would like to see her daughters take advantage of the new vaccine. “I’m really glad to hear about this breakthrough. If it would help protect my daughters from having to go through what I did, that is great.”

Symptoms

The symptoms of HPV can include genital warts and other lesions, but often a woman can have it and not know it. Men can be asymptomatic or have genital warts as well. (Men infected with HPV also can develop cancer of the penis.) Symptoms can appear weeks to years after a person has been infected. Its long incubation period is what makes the initial exposure to HPV difficult to trace.

Condoms are effective barriers and can reduce the transmission of HPV, but they are not foolproof. Genital warts can reside in areas not protected by a condom such as the anus or the perineum—the area between the genitals and the anus.

As of January 1, 2006, Texas became the third state to approve legislation requiring health insurance companies to cover testing for HPV as part of cervical cancer screening for women age 30 and older.

Tyring adds that none of the women who participated in the study experienced any serious side effects.

Pre-teen use for vaccine

The FDA has licensed Gardasil, the new vaccine, for use in girls and women ages 9-26. The vaccine is most effective when administered before the patient becomes sexually active and is at risk of contracting HPV.

“This vaccine is a fantastic opportunity to encourage parents to talk about sexual activity with their child,” says Michelle S. Barratt, M.D., M.P.H., associate professor of pediatrics at the medical school. “I will definitely be talking to the parents of all of my 9-year-old patients about this vaccine. It’s not just for kids who may become sexually active. It will also protect them in case they are sexually abused.”

The three-shot series would cost about $360.

According to the Centers for Disease Control and Prevention, “Insurance companies usually cover the costs of recommended vaccines. However, while some insurance companies may cover the vaccine, others may not.”

The manufacturer, Merck & Co. Inc., hopes to win worldwide approval to sell the vaccine.

* Name has been changed to protect privacy.

UPDATED: 8-09-2006

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