Schools may offer cervical cancer vaccination to all girls

The Guardian
Oct. 09, 2005

Vaccination against cervical cancer could become as common in schools as jabs against meningitis are now, following the dramatic results of the latest clinical trials. The breakthrough is generally seen as a real victory against one of the commonest cancers and may eliminate it in the UK.

The good news comes as steady but much slower progress is being made against other forms of cancer. Most of the advances are in the treatment of cancer - not in preventing it. In most cancers, the numbers diagnosed continue to rise, even as deaths are falling.

The new vaccine, called Gardasil, gives protection against two strains of the human papilloma virus (HPV) which cause 70% of cervical cancer. But most women who are sexually active become infected with HPV at some time, so girls as young as 10 to 13 will be the target population.

The demise of the smear test, offered to all women every few years from the age of 25, is not imminent. The NHS national screening programme's director, Julietta Patnick, said it could be more than half a century before all sexually active women have been vaccinated as children. By that time, there will probably be an even better vaccine. This one protects against HPV 16 and HPV 18, but not strains responsible for the other 30% of cervical cancers.

Peter Stern of the immunology group at the Paterson Institute for Cancer Research at Manchester's Christie hospital, funded by Cancer Research UK, said it would probably be possible to create a vaccine that would protect against all strains of HPV. "Everything is feasible if you have enough money to pay for it," he said. But a better solution might be to find and attack what the strains have in common.

Kevin Harrington of the Institute of Cancer Research, a clinical oncologist at the Royal Marsden hospital in London, said it was possible the vaccine could stamp out cervical cancer in developed countries. "All the excitement is entirely justified," he said. "Cervical cancer could be eradicated." There are 3,300 cases a year in the UK and 1,300 women die, although screening has reduced the toll enormously. It is a far greater problem in south-east Asia and India, he said. "Often women are presenting at a late stage and they are not curable." As with Aids drugs, it is likely the vaccine will not be affordable where it is most needed.

Other cancers may also succumb to a vaccine against HPV, he said, as the virus also causes penile cancer, anal cancer and cancer of the vulva, and is possibly involved in some head and neck cancers.

John Toy, the medical director of Cancer Research UK, said the breakthrough was "almost a one-off". But he added: "We are beginning to understand the biology of cancer - what it is that differentiates the cancer cell." This has allowed the development of drugs for breast cancer and acute myeloid leukaemia which target cancer cells and avoid the destruction caused by chemotherapy.

Professor Stern said immunology could provide the tools to make still greater advances. "There has been a revitalisation of optimism about being able to harness the immune response to treat cancer," he said. Immunologists hope to teach the immune system to recognise the enemy within - the cancerous cell - and attack it before it causes potentially fatal disease.

Progress report

Bowel cancer The first national screening programme begins in April, offering hope of early detection. Two biological agents are being assessed for general use in the NHS, and chemotherapy is showing good results alongside surgery.

Breast cancer Screening and better drugs have brought down the death rates. New drugs such as Herceptin look set to reduce them still further.

Prostate cancer Hardly off the starting blocks, but various urine tests are in trials.

Lung cancer A vaccine against nicotine addiction would prevent 90% of cases and is being investigated. Research into targeted drugs similar to Herceptin is also under way.