By Bill Frist, MD and Saketh Guntupalli, MD
Aug. 15, 2015 | Forbes
In the United States, our health system is far from perfect, but we like to pride ourselves on delivering the highest quality and newest innovations in care. But one area where we lag behind even some African nations is in preventing cervical cancer – the most common gynecologic cancer worldwide.
In Rwanda for example, as breast and cervical cancer rates began to rise in 2010, Rwanda’s Minister of Health, Dr. Agnes Binagwaho, quickly responded by launching a national campaign to vaccinate schoolgirls against HPV—the human papilloma virus that causes nearly all cases of cervical cancer. Among eligible girls, vaccination rates of 93.2 percent and 96.6 percent were achieved in 2011 and 2012 according to the Rwanda Ministry of Health.
The move seems obvious: a proven-safe vaccine can snuff out a virus that we know causes deadly cancer. Yet what was accomplished in Rwanda is still desperately needed across parts of the world—and here at home.
An HPV viral infection causes cancer in over 400,000 women globally each year. In developing countries, a woman dies every two minutes from cervical cancer, with 230,000 lives lost annually. In sub-Saharan Africa, it is the number one cancer-killer of women.
Screening programs, such as the Pap test, have been effective in industrialized countries at catching precancerous lesions before they develop into cancers—thus saving us from the alarming death rates. But a Pap test does nothing to clear the underlying viral infection and prevent cancerous cells from growing in the first place. And as a screening tool, it is hard to enforce in the developing world due to high costs and lack of patient follow-up.
Groups such as the public-private partnership Pink Ribbon Red Ribbon have been seeking to reduce cervical and breast cancer deaths in underdeveloped regions. Soon after Dr. Binagwaho launched the vaccination program in Rwanda, Pink Ribbon Red Ribbon began working to vaccinate over 42,000 girls Zambia and Botswana and perform cervical cancer screening for over 180,000 women for cervical cancer in Zambia, Botswana and Tanzania.
Yet only thirty-five percent of American girls and young women receive the vaccination.
The current vaccine routinely used in the United States, Gardasil, can prevent up to seventy percent of new cases of cervical cancer, and is approved for children and young adults ages 9 to 26. A newly developed European vaccine, effective against nine variants of HPV (the so-called “nine-valent” vaccination) hopes to improve on this further, with an estimated prevention rate of ninety percent. Gardasil has been available in the U.S. for nearly a decade and has been shown to be both safe as well as exceedingly effective. In Australia, for example, uptake rates are as high as 80%.
Why, then, is the U.S. so hesitant to accept a vaccine that could save hundreds of thousands of cancer diagnoses each year? The reasons include safety concerns propagated by the anti-vaccine movement and worries that a cervical cancer vaccination will increase promiscuity.
Neither argument is compelling. The vaccine has been shown to be exceedingly safe with minimal side effects, and is supported by the pediatrics community and the American College of Obstetricians and Gynecologists. It works so well at clearing viral infections that it has also been approved for boys as well, and can prevent penile and anal cancer caused by the same viral infection. The advent of the new 9-valent vaccine from Europe has the potential to truly cure this cancer and eradicate it—a first in human history. Fears of increased promiscuity are a strawman argument at best. The vaccine only addresses one sexually transmitted virus, and protecting women from HPV would in no way suggest other protections.
The U.S. shouldn’t take its access to this cure for granted; we must change our attitude and health practices here at home.
Various programs have been instituted to help in the uptake of the cervical cancer vaccine. The Vaccines for Children (VCF) program, for example, is a federally funded program that offers free vaccines for low-income families, including the Gardasil vaccine. But we need to reach beyond the demographic targeted by VCF.
An educational approach including both schools and healthcare professionals should elucidate what the health benefits of the vaccination are, their indications for administration, and the proven safety data. The lack of education about the advantages of receiving the vaccine among healthcare providers remains one of the greatest barriers to increasing compliance rates. Health care workers must be educated and trained to inform the young women in their care of the availability of a vaccination against HPV.
We also need increased coordination between our nation’s regulatory bodies, such as the Centers for Disease Control (CDC), the National Institutes of Health (NIH) as well as state and local health care agencies. The lack of harmonization in health-care policy among the states, further engenders misinformation and decreased vaccination rates. A coordinated national policy would alleviate these issues. New York is in the process of passing legislation to offer the vaccine through the public school system, while Hawaii and Texas are attempting to legislate an increase in HPV education vaccine awareness as a matter of policy. While these remain important and promising steps in the right direction, more work remains to be done.
In truth, the eradication of cervical cancer from the United States is low hanging fruit. We now have a cost effective, easy method of cancer prevention, and the time for excuses has come to an end. We must ensure that our young women have the chance to enter this century free from preventable diseases such as cervical cancer, so they can realize their maximum potential.