Parents can now protect their daughters from cervical cancer through vaccination

Pediatricians are now included in the forefront of battling one more potentially fatal disease. Human Papillomavirus (HPV) causes cancer of the cervix (the lower part of the uterus that connects to the vagina). When a female becomes infected with certain types of HPV and the virus does not go away on its own, abnormal cells can develop in the lining of the cervix. If not discovered early and treated, these abnormal cells can become cervical pre-cancers and then cancer. But HPV affects not only women but also men. Genital warts are usually flesh-colored growths. About 2 out of 3 people who have sexual contact with a person who has genital warts will also get them. And even if the genital warts are treated, 25% of cases come back within 3 months if HPV is still present.

HPV is very easily transmitted. Anyone who has any kind of sexual activity involving genital contact with an infected person can get HPV. Intercourse is not necessary. Many people who may have HPV may not show any signs or symptoms, so they can pass the virus on without even knowing it. According to the Philippine Cancer Society, 7,277 cervical cancer cases were diagnosed in the country in 2005, and 3,807 deaths from the disease were recorded. Those cases that go unreported always outnumber the registered cases by staggering numbers.

The only way you can totally protect yourself against HPV is to avoid any sexual activity that involves genital contact. HPV Types 6, 11, 16, and 18 account for the majority of HPV-related clinical diseases. The types of HPV that cause genital warts are different from the types that can cause cervical cancer. HPV Types 16 and 18 cause 70% of cervical cancer cases, and HPV Types 6 and 11 cause 90% of genital warts cases.

On November 29, 2006, the Philippines’ Bureau of Food and Drugs (BFAD) approved Merck Sharp and Dohme’s (MSD) HPV vaccine Gardasil for use in the country. According to MSD, the vaccine in clinical trials has been shown to be 100% effective in preventing HPV infection with strains 16 and 18, which together cause about 70% of cervical cancer cases, in women who do not already have the virus, and it is about 99% effective in preventing HPV strains 6 and 11, which together with strains 16 and 18 cause about 90% of genital wart cases. Gardasil also protects against vaginal and vulvar cancers, two other gynecological cancers that are linked to HPV, according to a study presented in June at a meeting of the American Society of Clinical Oncology in Atlanta, USA. Gardasil is available only through doctors.

Gardasil is for girls and women ages 9 to 26. It works when given before you have any contact with HPV Types 6, 11, 16, and 18. If you’ve already been infected with HPV, you may still benefit from Gardasil because it is unlikely that you have been infected with all 4 types of the virus covered by the vaccine. It will not treat nor protect against diseases caused by other types of HPV. All statistics added up, the benefits of preventive strategies definitely outweigh the cost in this age of liberal sexual lifestyles among techie savvy adolescents.

I am questioned a lot in my practice on Gardasil and have picked out a couple of common queries.

Q: Why should I get my daughter vaccinated with Gardasil now? Can’t it wait?

A: Like other vaccines your daughter has received, Gardasil works to help prevent illness. Gardasil works when given before there is any contact with HPV Types 6, 11, 16, and 18. That’s why it’s important that you talk to your daughter’s pediatrician about getting Gardasil now, not later. You will be helping protect her future from cervical cancer and genital warts before she’s even old enough to worry about them. Doctors give these as facts to inform the parents and patients. The decision to take my advice is always accompanied with one on one dialogue and written materials that the vaccine is not a passport to explore sex until it is culturally and morally acceptable in our Filipino social tradition.

Q: If I’m vaccinated with Gardasil, will I still need to get Pap tests (cervical cancer screenings)?

A: Yes. Vaccination with Gardasil does not take the place of Pap tests. A Pap test looks for precancerous (abnormal) cells in the lining of the cervix. The more severe the abnormality, the more likely it is that cervical cancer could develop in the future. Having an abnormal Pap test isn’t any reason to panic and have been proven to help save lives. It doesn’t always mean that you are at risk for cancer or even have HPV. Your Gynecologist may repeat the Pap test or do other tests as needed. Remember, Pap tests remain an important part of taking control of your health and basically taking care of yourself.

Dr. Lourdes Ann Dizon-Co is a general and neonatal pediatrician at Makati Medical Center, Cardinal Santos Medical Center, UST Hospital, and the Asian Hospital and Medical Center. She is a fellow of the Philippine Pediatric Society (PPS) and adviser of the PPS’ Committee on Preventive Pediatric Health Care. She is also a fellow and VP of the Perinatal Association of the Philippines.