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Patient management based on HPV status

HPV Vaccines & Screening

A vaccine designed to protect against the two most aggressive types of high-risk HPV – the recognized cause of cervical cancer – was approved by the U.S. Food and Drug Administration (FDA) in June 2006 for use in girls and young women age 9-26. Based on this FDA approval, the CDC's Advisory Committee on Immunization has since recommended that the vaccination series be given to girls aged 11-12. The HPV vaccine, named Gardasil® and developed by Merck & Co., Inc., protects against high-risk HPV types 16 and 18. Another vaccine, called Cervarix™ (under development by GlaxoSmithKline, Inc.), is expected to be reviewed by FDA in 2007.

Both vaccination and ongoing screening – with Pap and HPV testing – will continue to be essential tools in the fight against cervical cancer.

While the vaccine, when administered early in a young girl’s life, has the greatest potential to prevent many HPV infections from occurring in the first place, this will not change the need for screening – including HPV screening -- over the next few decades. One key reason is because while the vaccine may prevent high-risk HPV infection in the future, it does not cure infection that already exists today. But with HPV screening technology currently available, clinicians using an HPV DNA test can identify those women who are at increased risk for cervical cancer and follow-up appropriately.

The most powerful prevention programs for today and tomorrow must include both primary and secondary prevention. Even with a vaccine, experts agree women will still need a regular Pap and, depending on their age, an HPV test. This is because:

  • The overall protection offered by the vaccines is incomplete. There are roughly 15 to 20 types of the HPV virus that have been shown to cause cervical cancer. Gardasil is designed to protect against two of these cancercausing virus types, which are responsible for approximately 70 percent of all cervical cancers. However, the vaccine does not protect the remaining 30 percent of women who develop cervical cancer caused by other "high-risk" types of HPV.

  • Females are not fully protected if they have been infected with high-risk HPV types prior to vaccination.

  • The duration of vaccine efficacy is not known at this time. One of several important unanswered questions is whether or not a "booster" vaccine shot will be needed later in life to ensure continued protection.

  • Experts agree that vaccinating girls will not significantly reduce cervical cancer rates for many years to come, and the actual time it takes to do so will depend on these factors:

    • extent of vaccine implementation

    • the number of high-risk HPV types in addition to 16 and 18 against which future vaccines offer protection

    • the length of time over which vaccines offer protection

    • adherence of women to recommended screening guidelines

Therefore, both vaccination and screening are essential tools in the fight against cervical cancer, with the best routine for each woman determined by her physician depending on her age and personal history. While the HPV vaccine is not approved for women beyond age 26, you can offer your female patients age 30+ an opportunity to understand their HPV status by offering HPV testing.