Vaccinate the young against HPV, says Nobel Laureate

Medical Tribune May 2009 SFIII

David Brill

Countries should “seriously consider” offering widespread human papillomavirus (HPV) vaccinations, according to the Nobel Prize-winning scientist who first linked the virus to cervical cancer.

Professor Harald zur Hausen, addressing the media on a recent visit to Singapore, said that boys and girls alike would benefit from the vaccine, but stressed that it should be given prior to the onset of sexual activity.

For older women who are already sexually active, it should be a personal decision whether or not to be vaccinated, he said.

zur Hausen also rejected the argument that effective screening programs can be superior to widespread vaccination.

“I think that’s a mistake because screening and vaccination do something different,” he said. “In screening you discover lesions which need to be removed. In vaccination you prevent the lesions, and therefore you don’t [need] surgical intervention.”

Vaccination has been shown to be safe and highly effective for preventing HPV infections but opinions remain divided about who, when and how to vaccinate. Australia, for example, has approved vaccination of women aged 10 to 45, whereas the US FDA limits approval to 9 to 26 year-olds.

“It would really be something which one should seriously consider – to vaccinate everyone,” said zur Hausen, winner of the 2008 Nobel Prize in Physiology or Medicine.

“[But] let me be quite clear about it – the vaccine is really only protective in preventing the infection. If there has [already] been an infection the vaccine has no effect whatsoever.

“Up to the onset of sexual activity, yes, you can clearly say it’s worthwhile. But subsequently it’s more difficult to make a statement along those lines.”

Neither of the HPV vaccines is presently approved for use in males, but zur Hausen outlined several supporting arguments. Firstly, it would protect women from cervical cancer by reducing HPV transmission. Secondly, men themselves would gain protection from genital warts and other HPV-positive cancers, including anal and oropharyngeal cancers. Upcoming data from the first clinical studies in boys “look very promising,” he said.

zur Hausen also called for reductions in the price of HPV vaccines, which are presently “unaffordable” for parts of the developing world. This would pave the way for global vaccination programs, offering “the theoretical chance to eradicate some of these infections which lead to cervical cancer.”

Professor zur Hausen delivered the 6th Humphrey Oei Distinguished Lecture at the National Cancer Center, Singapore, and the second opening lecture at the Asian Oncology Summit 2009.

Singapore to wait and see on HPV vaccination

Medical Tribune May 2009 SFIII
David Brill

Singapore will not rush to make human papillomavirus (HPV) vaccination part of its national immunization program.

Insteady, the city-state will await the outcomes of vaccination programs in other countries before making its own decision, said Dr. Balaji Sadasivan, senior minister of state, Ministry of Foreign Affairs.

In the meantime, the nation will continue strengthening its Pap smear screening coverage. The HPV vaccine will remain available on an optional basis, giving individual parents the right to choose whether to vaccinate their daughters.

“As a country with a lower incidence of cervical cancer, the risk-benefit ratio will be lower in Singapore. We should therefore be cautious in making any national recommendation with regard to vaccination,” said Balaji at the recent Asian Oncology Summit 2009.

“If we put it in our national immunization program almost every young girl will get vaccinated. That’s a very, very major step, and sometimes … it’s not necessarily the wisest thing to be the first to try something out because you’re basically the guinea pig. It may just be safer to wait and see how other countries proceed with this.”

Balaji singled out the UK in particular as one “for us to watch,” following the September 2008 introduction of a national HPV immunization program for girls aged 12 to 13. “If it turns out to be safe to do it on a national scale then I think it would make sense for us to consider doing the same thing,” he said, adding that it would be “a few years” before any conclusions could be made.

Balaji also expressed clinical concerns about the vaccine, notably that it remains unclear whether immunity is long-lasting. It is also unknown whether other strains of HPV could become dominant if current strains are contained.

“From an ethical standpoint, there is also the issue of consent, which has to be viewed in the local context, where the community’s moral viewpoint is that offering such a vaccination program sends out the wrong message – that teenage sex is condoned by the community,” he said.

“Pap smear screening is one of the most effective ways of reducing the risk of cervical cancer, and we have pretty good coverage of about 60 to 70 percent. We should continue to build on that program and not neglect [it] because of the possibility of vaccination. That is a reasonable alternative while waiting to have better data,” he concluded.

Dr. Balaji delivered the opening address at the Asian Oncology Summit 2009, and spoke directly with the media.

Quick, accurate HPV test for developing countries

Medical Tribune November 2008 SFXIX
Seah Yee Mey and David Brill

A new rapid screening test for the human papilloma virus (HPV), created specifically for use in developing countries, is 90 percent accurate in detecting precancerous cervical disease, a study has shown.

careHPV is a signal-amplification assay adapted from the hybrid capture test, which is widely regarded as the gold standard in HPV DNA screening. Fourteen high-risk types of carcinogenic HPV can be detected using careHPV in about 2.5 hours.

The test takes up only a small area of clean bench-top space, with no need for mains electricity or running water supply. The short assay time allows for testing and clinical follow-up the same day.

careHPV can be operated by non-technical support staff with just 1 or 2 days of training.

The prototype was tested on 2,530 women aged 30 to 54 years in Shanxi province, eastern China, with complete data available for 2,388 women. careHPV correctly indentified precancerous cells in 90 percent of cervical specimens, while 84.2 percent of those without precancerous disease were identified as negative.

The recent publication of the findings online in The Lancet Oncology represents the culmination of a 5-year collaboration between the Program for Appropriate Technology in Health (PATH), a US-based nonprofit organization, and QIAGEN, who manufacture the test.

PATH, who receive funding for the project from the Bill and Melinda Gates Foundation, will now oversee a further 5 years of operational research in public health clinics in India, Uganda and Nicaragua.

The test still needs to be commercialized and undergo registration studies before it will be widely available, said Professor John Sellors, corresponding author of the study.

It is hoped that the 3 test countries will serve as examples for their respective regions, he added, noting that the generation of operational data will enable PATH to work alongside policy makers in other countries and help them to implement their own projects in future.

“From these results in China, careHPV looks very promising as a test that will allow the rapid and highly accurate screening of women in developing regions for cervical cancer,” said Sellors, a professor of family medicine at McMaster University in Canada.

“If women 30 years and older could be screened at least once in their lifetimes with such a test, and appropriate treatment administered at the same visit, public health programmes would be affordable and deaths from cervical cancer would be reduced by a third.”

The cost of careHPV is yet to be confirmed and will be negotiated on an individual basis with each government or organization.

careHPV was designed by Attila Lorincz, professor of molecular epidemiology at Barts and the London School of Medicine and Dentistry, UK. The prototype study in China was led by Professor You-Lin Qiao of the Cancer Institute, Chinese Academy of Medical Sciences, Beijing.

Cervical cancer is the second most common cancer in women, with some 500,000 new cases and 300,000 deaths worldwide every year. Carcinogenic HPV causes almost 100 percent of the cancers.