By Katrina Woznicki
Tuesday, December 3, 2002
Women and girls in developing countries are likely to benefit most from the new cervical cancer vaccine, but reaching them will be difficult. Also, advocates spar at the final public hearing on Title IX over the "proportionality" rule.
(WOMENSENEWS)--The recent news that an experimental vaccine is 100 percent effective in preventing a common sexually transmitted virus from causing cervical cancer has public health experts and women's advocates cheering. But it will still be several years before scientists are sure of the vaccine's promise.
Cervical cancer affects approximately 470,000 women every year worldwide and kills 225,000.The disease has been significantly curbed in the United States through use of Pap smears, routine tests that detect trouble at its early stages. Nationally, 13,000 new cases and 4,100 deaths are reported each year.
But in developing nations the disease remains a death sentence, particularly in Southeast Asia, Africa and South America, where screening for the cancer is uncommon. Women in these regions generally do not have access to Pap testing or to any of the typical screening processes women in the developed or industrial world have, said Dr. Eliav Barr, senior director of biologics clinical research and a project leader on the study for Merck Research Laboratories in West Point, Pa. Merck Research Laboratories is a unit of Merck and Company, the pharmaceutical giant that developed the vaccine and financed the research.
"An HPV vaccine for them is truly life-saving," Barr added. HPV is the abbreviation for human papilloma virus, one of the most common sexually transmitted diseases in the world. Some forms of the virus are believed to cause cervical cancer.
The study, led by Merck and directed by Dr. Laura Koutsky of the University of Washington in Seattle, looked at 2,392 young women; half were vaccinated with the HPV vaccine and half received a placebo. They were followed 17 to 27 months after inoculation and scientists reported amazing results: None of the vaccinated women developed any infections or precancerous growths. Forty-one of the women who received placebos contracted HPV infection, nine of whom developed precancerous cervical growths. The research was published in the Nov. 20 issue of the New England Journal of Medicine.
"The results of the study . . . are certainly impressive, and bring considerable hope that an HPV vaccine could have a large impact on preventing invasive cervical cancer worldwide," said Dr. Jennifer Smith, a physician at the International Agency for Research on Cancer's Multicentric Cervical Cancer Study Group in Lyon, France, a division of the World Health Organization. "The study showed exciting results that a prophylactic vaccine given to young women may prevent the persistence of high-risk HPV 16 infection."
HPV 16 is the most common form of the virus, Smith said. The incidence rates of invasive cervical cancer range from 4.8 per 100,000 women in Eastern Asia to 44.3 per 100,000 women in Eastern Africa, according to the International Agency for Research on Cancer.
Smith's research also suggests that HPV isn't the only culprit in cervical cancer. Her study published in the Nov. 6 issue of Journal of the National Cancer Institute suggests that the herpes simplex virus 2, the microorganism that causes genital herpes, can also exacerbate HPV infection and worsen the risk for cervical cancer.
The findings of the vaccine study are being hailed by women's groups everywhere, including the National Family Planning Reproductive Health Association in Washington.
"I think it's tremendous for treating women overseas, especially in countries where they don't have the infrastructure to screen women," said Marilyn Keefe, the organization's vice president of public policy. "That's a huge breakthrough."
Keefe said the vaccine could help shrink the gap between the haves and have-nots among women in industrialized countries and women in developing nations, where cultural beliefs limit women's access to health care, where roads in remote, rural areas also limit women's access to medical treatment, and where many women are too poor to afford basic health needs. "We hope an introduction of this vaccine would level the playing field," she said.
Still, delivering vaccines in these parts of the world is already a challenge, Smith said. For example, countries with the highest rates of liver disease are also the ones with the lowest rates of hepatitis B vaccine, which could help protect against liver disease.
"Clear obstacles in providing the vaccine to developing nations is cost and the necessary infrastructure for vaccine provision at the population level," Smith said. Economics and education are key, she added.
"For example, policies should take into account acceptability . . . when deciding whether an HPV vaccine is introduced as a vaccine against a sexually transmitted disease or against cervical cancer, and whether it may be feasible to vaccinate women in their adolescent years."
Some scientists want to see young girls vaccinated before they become sexually active as part of their routine childhood inoculations. This could be extremely beneficial to young girls in under-developed regions of the world, Barr said. However, women's advocates acknowledge this could potentially be a tough sell to some political and social conservatives around the world who promote abstinence to adolescents. But Keefe said even the most socially conservative leader will recognize the value of the vaccine in saving lives.
"I'd think they'd be hard-pressed to say no to a vaccine that prevents . . . a cancer," Keefe said, adding that public health advocates will likely publicize the vaccine as a cancer vaccine.
"I would think it would just be promoted, and rightly so, as a vaccine for cancer and that this is an incredible breakthrough and why wouldn't everyone be willing and anxious to have that," Keefe said. She added that most people do not connect sexual activity with cancer.
Barr noted that "a single sexual act with a single sexual partner could lead to transmission" of HPV. And in cases of sexual assault or rape, the vaccine could shield young girls from developing cervical cancer. "It's not possible to do a post-rape protection with this vaccine," he said. Girls ages 10 to 13 would be "best for routine vaccination," since "sexual debut is roughly [at age] 16."
A shortcoming to the study is that while the vaccine targets the most prevalent strain of HPV, it does not eradicate all types and will not wipe out cervical cancer because not all cervical cancers are caused by the virus, said Dr. Yvonne S. Thornton, chair of obstetrics and gynecology at Jamaica Hospital in New York and author of "Woman to Woman: A Leading Gynecologist Tells You All You Need to Know about Your Body and Your Health."
"The vaccine is just a small part of what we should be doing to combat cervical cancer," Thornton said. While the Merck study shows "good progress," she said, scientists still "don't know the risks, the benefits or the side effects of the vaccine."
Also, the vaccine is preventative, but not therapeutic for women who have been exposed to the virus. Cervical cancer grows slowly, Thornton said, sometimes taking up to a decade before becoming invasive, so it's unlikely that the vaccine will push the gold standard Pap smear off its pedestal. "I don't see it going away for another half century," Thornton said.
Katrina Woznicki is a freelance writer in Washington, D.C.
New England Journal of Medicine
"A Controlled Trial of a Human Papillomavirus Type 16 Vaccine":
World Health Organization
"Human Papillomavirus vaccines against cervical cancer":
International Agency for Research on Cancer
Women's Sports Foundation:
U.S. Department of Education--
Secretary's Commission on Opportunity in Athletics:
National Coalition for Women and Girls in Education:
SAN DIEGO (WOMENSENEWS)--The last of four meetings for the public to weigh in on Title IX was also the most contentious as educators, athletes, legislators and parents alternately credited the law for transforming women's lives and blamed it for the demise of some men's sports programs.
At the center of the debate was proportionality, the first of a three-prong test to gauge an institution's compliance with Title IX, the 30-year-old law that prohibits sex discrimination in schools receiving federal funding. That rule requires the proportion of a school's female athletes to be equal the proportion of women enrolled. The other prongs have to do with continuing to add women's teams and assuring schools' athletic programs meet women students' interests and abilities.
Richard Aronson, executive director of the men's College Gymnastics Association, told the panel that the Education Department's enforcement of Title IX has decimated his sport.
Men's college gymnastics programs have declined in the past 30 years from more than 200 in the early 1970s to just 20 today. Gymnastics, Aronson testified, has joined men's wrestling, track and swimming on the "endangered Olympic sports" list.
"I'm all for supporting women's athletics," he said, but added that Title IX's proportionality measure should be loosened.
Critics describe the proportionality measure as an unfair quota system. They point to the numbers of men who are turned away from varsity sports versus women players, some of whom they contend must be vigorously recruited to fill team vacancies.
Some critics proposed that interest surveys be used in determining how many women's teams and scholarships are offered. But women's sports advocates scoffed at the notion of interest surveys and argued that to objectively gauge a school's compliance with Title IX, the proportionality measure must stay intact.
Michael Messner, professor of sociology and gender studies at the University of Southern California, said that recent experiences point to a "reciprocal relationship between interest and opportunity, between supply and demand."
A report this year by the National Coalition of Women and Girls in Education indicates high school girls' participation in sports has increased 847 percent and college women's participation has increased 403 percent since Title IX's implementation.
Yet there are 6 million men and women varsity high school athletes looking to play college-level sports and only 400,000 spots, said Donna Lopiano, executive director of the Women's Sports Foundation. A June report by the National Coalition of Women and Girls in Education agreed, asserting that gender equity in sports has not been realized.
The panel will meet again this month and in January without time for public comment. The panel's recommendations are due at the end of January.
-- Elizabeth Zwerling is a journalism professor at the University of La Verne in Southern California.