HPV Vaccine Information For Young Women

There is now a vaccine that prevents the types of genital human papillomavirus (HPV) that cause most cases of cervical cancer and genital warts. The vaccine, Gardasil®, is given in three shots over six-months. The vaccine is routinely recommended for 11 and 12 year old girls. It is also recommended for girls and women age 13 through 26 who have not yet been vaccinated or completed the vaccine series.

Why the HPV vaccine is important

Genital HPV is a common virus that is passed on through genital contact, most often during sex. Most sexually active people will get HPV at some time in their lives, though most will never even know it. It is most common in people in their late teens and early 20s.

There are about 40 types of HPV that can infect the genital areas of men and women. Most HPV types cause no symptoms and go away on their own. But some types can cause cervical cancer in women and other less common genital cancers— like cancers of the anus, vagina, and vulva (area around the opening of the vagina). Other types of HPV can cause warts in the genital areas of men and women, called genital warts. Genital warts are not a life-threatening disease. But they can cause emotional stress and their treatment can be very uncomfortable.

Every year, about 12,000 women are diagnosed with cervical cancer and almost 4,000 women die from this disease in the U.S.

About 1% of sexually active adults in the U.S. (or 1 million people) have visible genital warts at any point in time.
Who should get the HPV vaccine

The HPV vaccine is recommended for 11 and 12 year-old girls.1 It is also recommended for girls and women age 13 through 26 years of age who have not yet been vaccinated or completed the vaccine series.

1 Note: The vaccine can also be given to girls 9 or 10 years of age.

Will sexually active females benefit from the vaccine?

Ideally females should get the vaccine before they become sexually active, when they may be exposed to HPV. Females who are sexually active may also benefit from the vaccine, but they may get less benefit from it. This is because they may have already gotten an HPV type targeted by the vaccine. Few sexually active young women are infected with all HPV types covered by the vaccine so they would still get protection from those types they have not yet gotten. Currently, there is no test available to tell if a girl/woman has had HPV in the past, or which types.

Can pregnant women get the vaccine?

The vaccine is not recommended for pregnant women. There has been limited research looking at vaccine safety for pregnant women and their unborn babies. So far, studies suggest that the vaccine does not cause health problems for pregnant women or their developing child. But more research is still needed. For now, pregnant women should wait until their pregnancy is over before getting the vaccine. If a woman finds out she is pregnant after she has started getting the vaccine series, she should wait until her pregnancy is over before finishing the three-dose series.

Should girls/women be screened for cervical cancer before getting vaccinated?

No. Girls/women do not need to get an HPV test or Pap test to find out if they should get the vaccine. Neither of these tests can tell the specific HPV type(s) that a woman has (or has had in the past), so there’s no way to know if she has already had the HPV types covered by the vaccine.

Why is the HPV vaccine only recommended for girls/women through age 26?

The vaccine has been widely tested in girls/women 9 through 26 years of age. New research is being done on the vaccine’s safety and efficacy in women older than 26 years of age. The FDA will consider licensing the vaccine for these women when there is enough research to show that it is safe and effective for them.
What about vaccinating boys and men?

We do not yet know if the vaccine is effective in boys or men. It is possible that vaccinating males will have health benefits for them by preventing genital warts and rare cancers, such as penile and anal cancer. It is also possible that vaccinating boys/men will have indirect health benefits for girls/women. Studies are now being done to find out if the vaccine works to prevent HPV infection and disease in males. When more information is available, this vaccine may be licensed and recommended for boys/men as well.
Effectiveness of the HPV Vaccine

This vaccine targets the types of HPV that most commonly cause cervical cancer and genital warts. The vaccine is highly effective in preventing those types of HPV and related diseases in young women.

The vaccine is less effective in preventing HPV-related disease in young women who have already been exposed to one or more HPV types. That is because the vaccine does not treat existing HPV infections or the diseases they may cause. It can only prevent HPV before a person gets it.
How long does vaccine protection last? Will a booster shot be needed?

Research suggests that vaccine protection will last a long time. More research is being done to find out if women will need a booster vaccine many years after getting vaccinated to boost protection.

What does the vaccine not protect against?

The vaccine does not protect against all types of HPV— so it will not prevent all cases of cervical cancer. About 30% of cervical cancers will not be prevented by the vaccine, so it will be important for women to continue getting screened for cervical cancer (regular Pap tests). Also, the vaccine does not prevent other sexually transmitted infections (STIs). So it will still be important for sexually active persons to lower their risk for other STIs.

Will girls/women be protected against HPV and related diseases, even if they don’t get all three doses?

It is not yet known how much protection girls/women would get from receiving only one or two doses of the vaccine. For this reason, it is very important that girls/women get all three doses of the vaccine.
Safety of the HPV vaccine

This vaccine has been licensed by the FDA and approved by CDC as safe and effective. It was studied in thousands of females (ages 9 through 26 years) around the world and its safety continues to be monitored by CDC and the FDA. Studies have found no serious side effects. The most common side effect is soreness in the arm (where the shot is given). There have recently been some reports of fainting in teens after they got the vaccine. For this reason, it is recommended that patients wait in their doctor’s office for 15 minutes after getting the vaccine.
Cost and Paying for the HPV vaccine

The retail price of the vaccine is about $125 per dose ($375 for full series).

Is the HPV vaccine covered by insurance plans?

While some insurance companies may cover the vaccine, others may not. Most large insurance plans usually cover the costs of recommended vaccines.

How can I get help paying for the vaccine?

Children age 18 and younger may be eligible to get vaccines, including the HPV vaccine, for free through the Vaccines for Children (VFC) program if they are: Medicaid eligible; uninsured; or American Indian or Alaska Native. Doctors may charge a small fee to give each shot. However VFC vaccines cannot be denied to an eligible child if the family cannot afford the fee.

Some states also provide free or low-cost vaccines at public health department clinics to people without health insurance coverage for vaccines. Contact your State Health Department to see if your state has such a program.
What vaccinated girls/women need to know
Will girls/women who have been vaccinated still need cervical cancer screening?

Yes, women will still need regular cervical cancer screening (Pap tests) because the vaccine will NOT protect against all HPV types that cause cervical cancer. Also, women who got the vaccine after becoming sexually active may not get the full benefit of the vaccine if they had already acquired HPV.
Other ways to prevent HPV and Cervical Cancer

Another HPV vaccine is now being considered for licensure by the FDA. This vaccine would protect against the types of HPV that cause most cervical cancers, but it would not protect against genital warts.
Are there other ways to prevent cervical cancer?

Regular cervical cancer screening and follow-up can prevent most cases of cervical cancer. The Pap test can detect cell changes in the cervix before they turn into cancer. Pap tests can also detect most, but not all, cervical cancers at an early, treatable stage. Most women diagnosed with cervical cancer in the U.S. have either never had a Pap test, or have not had a Pap test in the last 5 years. The HPV test can tell if a woman has HPV on her cervix. This test can be used with the Pap test to help your doctor determine next steps in cervical cancer screening.
Are there other ways to prevent HPV?

The only sure way to prevent HPV is to abstain from all sexual activity. For those who are sexually active, condoms may lower the chances of getting HPV, if used all the time and the right way. Condoms may also lower the risk of developing HPV-related diseases (genital warts and cervical cancer). But HPV can infect areas that are not covered by a condom—so condoms may not fully protect against HPV.

Sexually active adults can also lower their risk of HPV by being in a mutually faithful relationship with someone who has had no or few sex partners, or by limiting their number of sex partners. The fewer partners a person has had – the less likely he or she is to have HPV. But even persons with only one lifetime sex partner can get HPV, if their partner has had previous partners.
Sources

Food and Drug Administration (FDA). FDA News: FDA Licenses New Vaccine for Prevention of Cervical Cancer and Other Diseases in Females Caused by Human Papillomavirus.

The FUTURE II Study Group. Prophylactic efficacy of a quadrivalent human papillomavirus (HPV) vaccine in women with virological evidence of HPV infection. J Infect Dis. 2007; 196:1438-1446.

FUTURE II Study Group. Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions. N Engl J Med. 2007; 356(19):1915-27.

Garland SM, Hernandez-Avila M, Wheeler CM, Perez G, Harper DM, Leodolter S, et al. Females United to Unilaterally Reduce Endo/Ectocervical Disease (FUTURE) I Investigators. Quadrivalent vaccine against human papillomavirus to prevent anogenital diseases. N Engl J Med. 2007; 356(19):1928-43.

Harper DM, Franco EL, Wheeler C, et al; HPV Vaccine Study Group. Sustained efficacy up to 4.5 years of a bivalent L1 virus-like particle vaccine against human papillomavirus types 16 and 18: follow-up from a randomised controlled trial. Lancet. 2006; 367(9518): 1247-1255.

Ho GY, Bierman R, Beardsley L, et al. Natural history of cervicovaginal papillomavirus infection as measured by repeated DNA testing in adolescent and young women. N Engl J Med. 1998; 338(7):423-428.

Koutsky LA. Epidemiology of genital human papillomavirus infection. Am J Med. 1997; 102(5A):3-8.

National Institutes of Health (NIH). NIH Consensus Statement: Cervical Cancer. 1996; 14:1-38.

Paavonen J, Jenkins D, Bosch FX, Naud P, Salmeron J, Wheeler CM et al. Efficacy of a prophylactic adjuvanted bivalent L1 virus-like-particle vaccine against infection with human papillomavirus types 16 and 18 in young women: an interim analysis of a phase III double-blind, randomised controlled trial. Lancet 2007;370(9596):1414.

United States Cancer Statistics, National Program of Cancer Registries (NPCR). U.S. Cancers by Type.

Weinstock H, Berman S, Cates W, Jr. Sexually transmitted diseases among American youth: incidence and prevalence estimates, 2000. Perspect Sex Reprod Health. 2004; 36(1):6-10.

Winer R, Hughes JP, Feng Q, et al. Consistent condom use from time of first vaginal intercourse and the risk of genital human papillomavirus infection in young women. N Engl J Med. 2006;354:2645–2654.

How to Get the HPV Test

Women Under Age 30 Women Over Age 30

I was persistent and kept repeating that I wanted
the HPV test for "extra peace of mind."

Read Frances Masterman's story
So, you've decided that you want to take every step possible to make sure you do not get cervical cancer.

Most doctors will honor your wishes on issues such as this. If not, remember that you are the one who is ultimately responsible for your health. You need to decide how important it is to have a healthcare provider who partners with you.

Here are some tips to ensure you get the HPV test:

* Arm yourself with the facts about cervical cancer, HPV and the HPV test. Read the information in this Web site thoroughly. Doctors' offices are very tight on time these days, and they will be more receptive to your requests if they can tell you have "done your homework."
* Call your doctor's or nurse's office before your next exam to find out if the HPV test is offered as part of routine screening for cervical cancer, along with the Pap. Remember: Make sure the office understands that you want the HPV test no matter what the Pap shows. Some doctors and nurses only order an HPV test when your Pap results are inconclusive (called an "ASC-US" Pap).
* If your doctor or nurse says the office does not order HPV testing for all of its female patients who are 30 and older, indicate you'd like them to make an exception for you.
* If your doctor or nurse (or the office staff) responds by saying he/she doesn't think routine HPV testing is necessary, the simplest way to respond is to say that you would still like to have the test "for my extra peace of mind."
* Follow up on test results. Keep calling until you receive an answer regarding your test results.


Do you need to ask your doctor or nurse for the HPV test?

It's a good idea to ask your doctor or nurse for the HPV test. That's because some healthcare providers do not yet order the HPV test as part of routine cervical cancer screening, or offer it only if you ask for it. However, most laboratories can do the HPV test if your doctor or nurse requests it.
Why your doctor or nurse might not automatically order the HPV test for you – and what you should do about it …

*

Unaware of approval of HPV test for routine screening.
*

Thinks the Pap is good enough.
*

Concerned the test will unnecessarily alarm you.
*

Afraid you won't return for your annual visit if HPV testing shows you don't need yearly cervical cancer screening.
*

Believes HPV testing might result in the need for unnecessary further procedures.

Some doctors and nurses are not aware that the U.S. Food and Drug Administration (FDA) has approved the HPV test for use along with the Pap for routine screening of women age 30 years and older. Some still believe that the HPV test should only be given to women if their Pap test results are unclear (called an "ASC-US" Pap). Still others simply aren't familiar with the data supporting the value of the HPV test for routine screening. Medical practice takes a while to change.

Share with your doctor or nurse the recent publication on HPV and HPV testing issued by the American Association of Reproductive Health Professionals.

Other healthcare professionals may actually recommend against routine HPV testing because they believe that although the Pap may not be perfect, it is good enough.

Respond that you know the Pap test catches many women with pre-cancerous cells, but that you would feel even more confident if you took an additional step and got the HPV test. You may want to refer your doctor or nurse to the April 2006 issue of the International Journal of Cancer ("Overview of the European and North American studies on HPV testing in primary cervical cancer screening"). This analysis of 11 studies involving more than 60,000 women documented that the HPV test is a more sensitive tool for cervical cancer screening than the Pap alone.

Your healthcare provider may worry that you will be unnecessarily anxious or alarmed if you find out you have a high-risk (potentially cancer–causing) type of the virus. After all, most women fight off the infection before it causes any problems.

Assure your doctor or nurse that you have researched the subject, and that you see the HPV test as a way to increase your peace of mind. Your healthcare provider will be more likely to feel comfortable ordering the test for you if he or she knows you already are educated on the virus and HPV testing. Show him or her the brochure (PDF) on HPV testing, available on this Web site, as evidence that you have educated yourself and know what to expect.

Some doctors and nurses fear that once women learn they do not have HPV, and thus only need another HPV and Pap test every three years, they will not come back for an annual office visit.

Communicate to your doctor or nurse that you understand the need for regular health checks – such as a breast exam – regardless of your HPV status. You can demonstrate this commitment by scheduling your next visit well in advance.

Some healthcare providers may believe the HPV test could result in the need for other, unnecessary procedures (such as a biopsy to remove cervical tissue for analysis).

Respond that you'd rather take the chance of having an extra exam that turns out to be normal, than to risk doing nothing until cervical cancer develops. You also might want to refer your doctor or nurse to an article in the October 2007 issue of the American Journal of Obstetrics & Gynecology titled "Consensus Guidelines for the Management of Women with Abnormal Cervical Cancer Screening Tests." One of the topics covered is how to manage the care of women who have HPV, but whose Pap results are normal or inconclusive. A short summary of these and other guidelines can be found in this brochure (PDF) on HPV testing. Following these guidelines should help assure that women with HPV do not have any more follow-up tests than when the Pap alone is used. Tell your doctor or nurse that you would like to get the HPV test for "extra peace of mind."

HPV testing in combination with liquid-based cytology in primary cervical screening

Prof Henry C Kitchener MD a Corresponding AuthorEmail Address, Maribel Almonte PhD c, Claire Thomson BSc a, Paula Wheeler MRes a, Alexandra Sargent PhD a, Boyka Stoykova MD d, Clare Gilham MSc e f, Helene Baysson PhD e, Christopher Roberts PhD b, Robin Dowie PhD d, Mina Desai MBchB g, Jean Mather MIBMS g, Andrew Bailey FIBMS h, Andrew Turner MB ChB h, Sue Moss PhD f, Prof Julian Peto DSc e f


Background
Testing for human papillomavirus (HPV) DNA is reportedly more sensitive than cytology for the detection of high-grade cervical intraepithelial neoplasia (CIN). The effectiveness of HPV testing in primary cervical screening was assessed in the ARTISTIC trial, which was done over two screening rounds approximately 3 years apart (2001—03 and 2004—07) by comparing liquid-based cytology (LBC) combined with HPV testing against LBC alone.

Methods
Women aged 20—64 years who were undergoing routine screening as part of the English National Health Service Cervical Screening Programme in Greater Manchester were randomly assigned (between July, 2001, and September, 2003) in a ratio of 3:1 to either combined LBC and HPV testing in which the results were revealed and acted on, or to combined LBC and HPV testing where the HPV result was concealed from the patient and investigator. The primary outcome was the detection rate of cervical intraepithelial neoplasia grade 3 or worse (CIN3+) in the second screening round, analysed by intention to treat. This trial is registered with the International Standard Randomised Controlled Trial Number ISRCTN25417821.

Findings
There were 24 510 eligible women at entry (18 386 in the revealed group, 6124 in the concealed group). In the first round of screening 233 women (1·27%) in the revealed group had CIN3+, compared with 80 (1·31%) women in the concealed group (odds ratio [OR] 0·97, 95% CI 0·75—1·25; p>0·2). There was an unexpectedly large drop in the proportion of women with CIN3+ between the first and second rounds of screening in both groups, at 0·25% (29 of 11 676) in the revealed group and 0·47% (18 of 3866 women) in the concealed group (OR 0·53, 95% CI 0·30—0·96; p=0·042). For both rounds combined, the proportion of women with CIN3+ were 1·51% (revealed) and 1·77% (concealed) (OR 0·85, 95% CI 0·67—1·08; p>0·2).

Interpretation
LBC combined with HPV testing resulted in a significantly lower detection rate of CIN3+ in the second round of screening compared with LBC screening alone, but the effect was small. Over the two screening rounds combined, co-testing did not detect a higher rate of CIN3+ or CIN2+ than LBC alone. Potential changes in screening methodology should be assessed over at least two screening rounds.

Funding
National Institute of Health Research Health Technology Assessment Programme.

Hybrid Capture 2 Technology

Hybrid Capture 2 (hc2) technology serves as the platform for QIAGEN’s nucleic acid hybridization assay for detection of human papillomavirus (HPV), Chlamydia trachomatis (CT), and Neisseria gonorrhoea (GC). This diagnostic method allows rapid, standardized testing of genetic material of the infectious agents in virtually any laboratory setting. It employs specific RNA probes, hybridization, antibody capture, and signal amplification that utilizes qualitative chemiluminescent detection.


The digene HPV Test, using Hybrid Capture 2 technology, provides an accurate, cost-effective, user-friendly method by achieving reliable detection without the need for dedicated and isolated lab space, sophisticated laboratory expertise, or concern related to inhibition and contamination.
Benefits of Hybrid Capture:

* Same-day, objective results using a micro-plate test format
* High-throughput automation for handling increasing test volumes
* Minimal required specimen preparation allowing samples to be processed quickly and efficiently
* Less complex workflow than target amplification methods
* Reduced risk of cross-over contamination due to signal amplification instead of target amplification
* Extensive clinical validation data available

hc2 technology superior to PCR methods for HPV DNA testing

For routine HPV diagnostics, it is essential to have a test system at hand which reports clinically relevant results and, hence, can impact clinical decision-making. In contrast to the detection of other infectious disease parameters, a high clinical sensitivity is critical for reliable HPV diagnostics. The hc2 technology fulfills this requirement better than any other method as outlined in multiple clinical validation studies.

In contrast, a high analytical sensitvity as provided by nucleic acid amplification technologies such as PCR is counterproductive for HPV diagnostics as they may detect many transient HPV infections of clinical insignificance. Cervical cancer screening methods require HPV detection correlating to disease and not to the sheer presence of the virus, since 90% of infections is cleared by itself without consequences.

hc2 technology measures sensitivity versus defined clinical endpoints (CIN 3+/SCC) and ensures reporting of positive results only when risk of disease progression exists. QIAGEN’s digene HPV Test has an excellent clinical sensitivity of up to 100% in primary adjunctive screening when combined with a Pap smear test.

* Clinically validated cut-off of 5000 copies/ml
* Proven in extensive multiple trials
* Ensures high negative predictive value

PCR screening can miss severe disease


PCR methods show a high analytical sensitivity with detection limits between 10-400 copies of HPV DNA resulting in detection of clinically irrelevant viral levels as such infections can be cleared off by immune response. Due to viral integration and loss of the targeted regions (L1, E1, E2) or mutation, PCR can miss cases of severe precancer and cancer cases.

* Risk of missing cases of cancer
* Detection of clinically irrelevant viral levels


Hybrid capture (hc2) versus PCR — analytical sensitivity and clinical sensitivity. The analytical sensitivity of hc2 has been adjusted to 5,000 copies of HPV DNA, and the analytical sensitivity of PCR methods can be <10 copies of HPV DNA.
How Hybrid Capture 2 Technology works

The Hybrid Capture 2 System is a signal-amplification assay that uses a technique combining antibody capture and chemiluminescent signal detection. The basic steps of the Hybrid Capture 2 assay are outlined below:

Basic Steps

Clinical specimens are prepared by adding a base solution, which disrupts the virus or bacteria and releases target DNA. Presence or absence of target DNA is read from the results of the chemiluminescent reaction.

Hybridize RNA probe with target DNA Hybrid Capture Signal Amplification

Fig 1: Hybridize RNA probe with target DNA. Target DNA combines with specific RNA probes, creating RNA:DNA hybrids


Fig. 2: Hybrid Capture. RNA:DNA hybrids are captured onto a solid phase coated with universal capture antibodies specific for RNA:DNA hybrids.


Fig. 3: Signal Amplification. Capture RNA:DNA hybrids are detected with multiple antibodies conjugated to alkaline phosphatase. The signal resulting from the chemiluminescent reaction is read and results interpreted.

Doctors call for cancer screens

DUBAI // Doctors have called for a national cervical cancer vaccination and screening programme to catch cases earlier and reduce the rate of the second most common cancer found in women, one that has seen progressively higher incidence in the UAE.

Cervical cancer affects 9.9 women in every 100,000, according to figures by Health Authority Abu Dhabi (HAAD), almost twice the incidence in the broader Middle East, which amounts to nearly five in every 100,000.

It afflicts women at a rate second only to breast cancer, but 70 per cent of cases are diagnosed in the late stages. At that point, only one in three women has a chance of survival. There is no co-ordinated screening programme for cervical cancer in the UAE, as there is in countries where most cases are detected in the early stages.

Dr Saad Aswad is a senior consultant gynaecologist and oncologist – the only specialist of his kind in the UAE – at Tawam Hospital in Al Ain. He compiled a detailed report on a proposed screening programme for cervical cancer drawing on the expertise of more than 40 health professionals and forwarded it to the Ministry of Health in 2004. There has still been no move to implement any of the plans. MoH officials were not available yesterday to comment.

“We need to do something to protect the women,” Dr Aswad said. “Cervical cancer is a cancer we can prevent. Why are we not doing this across the country? If the Ministry of Health introduced it, I think everyone would follow.”

While schoolgirls in Abu Dhabi are offered the Gardasil vaccination for up to Dh50 (US$13.60) for the required three doses, it can cost up to Dh1,900 in Dubai and is not as widely available in other emirates.

Dr Aswad said the preventive vaccine should be available across the whole country.

“We must push for this to be nationwide. It is much easier to implement prevention than cure.”

HAAD said in April it planned to build on a successful pilot vaccination programme in schools and make the vaccine available to all schools in the Emirates.

Last year it vaccinated around 6,000 girls aged 17 and has given another 4,000 the first dose this year. There was a 70 per cent uptake during the pilot scheme. Dr Mawahib al Biate, head of the gynaecology department at the GMC Hospital in Ajman, said a national vaccination programme was needed in the UAE.

“Prevention is always better than the cure,” she said. “A national programme would be a very good idea because of the rates here.” She also said it did not make sense for such an important vaccine to be offered cheaply to some but not others.

In 1998 the MoH reported only eight diagnosed cases of cervical cancer in the country. Last year Tawam Hospital alone saw at least 100 cases, Dr Aswad said.

Recent studies into the efficacy of Gardasil, which was approved by the US Food and Drug Administration in 2006, showed it was effective against the human papillomavirus (HPV) type 16 for an average of eight and a half years. The women in the study, by the University of Washington in the US, were vaccinated in 2001, so more follow-up tests are needed to establish the length of protection. HPV 16 and 18 cause 70 per cent of cervical cancer cases worldwide. Gardasil, made by Merck, is licensed in 109 countries, but some of them find it more difficult to implement a vaccination programme, Dr Aswad said.

Health officials estimate one in 10 women will get an HPV infection in their lifetime, but it is more common in women under 30. Some strains are sexually transmitted, and questions have been asked in some countries about the moral issue of vaccinating young girls.

“Here cervical cancer is increasing out of proportion with the population growth,” Dr Aswad said. “It is time to start protecting the women.”

Dr Ibrahim Abd Elrahman, a consultant gynaecologist and obstetrician at The City Hospital in Dubai, applauded any effort to introduce a national vaccination programme. He saw many women who had never had a Pap smear. “Often I get someone in their late 20s or early 30s who say they have never had one. I organise one with their consent.”

Mitya Underwood

* Last Updated: May 14. 2009 12:14AM UAE / May 13. 2009 8:14PM GMT

Cervical cancer strikes younger women in UAE

By Nina Muslim, Staff Reporter
Published: May 14, 2009, 10:30
http://archive.gulfnews.com/nation/Health/10313458.html

Dubai: Women in the UAE are dying at a younger age from cervical cancer, about ten years younger than the world average of 49, prompting doctors to call for better awareness and prevention.

Dr Sa'ad Gazzal Aswad, head of obstetrics and gynecology at Tawam Hospital said at a press conference on Wednesday that he was seeing more and more women between the age of 35 and 40, instead of 50 a decade ago.

"I don't know why; we will have to study more. But the point is that it affects young women of childbearing age with children, leaving (the children) when they die," he told Gulf News later.

"The impact is really sad. I had a 32-year old patient who died and she had nine children, the youngest is 2. The cancer affects not just the person but the whole family," he said.

He added the patient, like more than 70 per cent of all cases he has been receiving, was referred to him when her cancer was already considered advanced and had a lower rate of survival. According to Tawam Hospital records, about 100 cases of cervical cancer were recorded last year.

Furthermore, more women in their 20s were presenting with abnormal pap smears, or pre-cancerous lesions.

Cervical cancer is caused by strains 16 and 18 of the Human Papilloma Virus (HPV), which is the same virus (but different strain) that causes genital warts. It is transmitted through sexual contact, which does not necessarily involve sexual intercourse. There are two vaccines available to prevent the cancer, but only one is approved by the US Food and Drug Administration.

Dr Wissam Haddadin, franchise manager of the cervical cancer vaccine Gardasil, produced by Merck, Sharpe and Dohme, said more awareness and prevention were needed to stop the preventable disease from striking women down.

"Some people don't realise (in cervical cancer's case) there is a causative agent," she said.

She added prevention and awareness in the region was very low, saying a 2006 informal survey the company conducted found about 20 per cent of women questioned knew what a pap smear was and only 9 per cent did it.

Pap smear is a screening procedure, in which a cell scraping is taken from the cervix and examined for pre-cancerous lesions.

Some screening programmes are taking place, including at primary healthcare centres under the Ministry of Health. Private medical centres also offer the service. However, there is no comprehensive and uniform policy in place to ensure all women in the UAE are being screened for the cancer.

Do you have regular checkups? Do people avoid being checked for fear of having an illness? Do you know of anyone who had successfully battled cancer due to early detection?
Your comments

The article has definitely created awareness about cervical cancer. More information regarding symptoms, causes and cures would help readers understand the disease better. Also at what age must a woman get herself tested and details could help women to have regular checkups. Generally people avoid checkups either because they are very busy in their family life, they feel fit or they have a fear of having an illness. Women (especially working women) lead a hectic life and have no time for themselves. My cousin?s wife (age 37) was diagnosed with breast cancer last year. She underwent mastectomy and then chemotherapy and radiation and now is leading an almost normal life. She feels weak at times and does not have the energy she had before the illness. Cancer is a killer disease and fighting it is possible if detected in the early stages. Awareness about the disease and its various forms must be spread so that people will not hesitate to go for required tests. Regular exercise and a healthy diet could ward off most diseases. A regular checkup even if a person is perfectly fine and healthy is necessary.
Naina Nair
Sharjah,UAE
Posted: May 14, 2009, 17:23

Doctors should advise the women to do this Pap smear test and should encourage them to do it, there is no harm if the doctor will tell his patient to do this check up test, I told my wife to do a full check up and they didn't even tell her about this test.
Samer K.
Dubai,UAE
Posted: May 14, 2009, 17:20

I had been experiencing abnormalities in my menstrual cycle. When I came to Dubai, I decided to visit an OB/Gynaecologist for a check up. I found out that a year after giving birth, I must have a pap test and also that the doctor discovered some infection. And she told me that if I had taken long to seek doctor's advice, it could lead to cervical cancer. So, that is when I realised that a single infection that I didn't mind for a long time could worsen my health. So, now, I do my pap test every year to check the condition of my cervix. It is good for women to be aware and please do not be ashamed of this kind of situation. Doctors are here to understand us and to help us prevent the sickness. Always remember that Prevention is better that CURE.
Mhadzie
Dubai,UAE
Posted: May 14, 2009, 11:44

I am a mother and know how preoccupied my lot is with looking after our young children and families. Most mothers are so busy attending to the needs of the rest of the family members that they hardly have ANY time left for themselves. This lack of time for oneself often does take quite a toll on the mothers. I sincerely appreciate such eye-opening articles by Gulf News. Please continue the good work.
Shiuli Dutt Dey
Dubai,UAE
Posted: May 14, 2009, 11:43

the issue is that most of these tests are not even covered by insurance so unfortunatly people think about the financial aspect. Insurance should cover one test on a regular basis, this would also save them money when curing at an early stage instead of big expenses at a late stage.
From A Reader
Abu Dhabi,UAE
Posted: May 14, 2009, 11:00

There definitely should be more awareness about Cervical cancer, since it is becoming very common among women at a very early age.The worst thing about this cancer is that it is diagnosed at 3rd or 4th stage and it becomes too late to save the patient then. I would like to urge every woman to educate themselves by reading about cervical cancer and to take precautionary measures in advance. Also, it is important to spread the awareness about the disease among my friends and family. Being 23 years old, I would like to get preventive vaccination for the same. I would like to know about hospitals and clinics which would conduct the necessary test. I think the authorities should take measures to spread the awareness among women. Many people haven't even heard about this disease.
Zahrah
Dubai,UAE

How do I talk to my partner about HPV?

You and your partner may benefit from talking openly about HPV. You can tell your partner that:

* HPV is very common. It can infect the genital areas of both men and women. It usually has no signs or symptoms and goes away on its own.
* Most sexually active people get HPV at some time in their lives, though most will never know it. Even people with only one lifetime sex partner can get HPV, if their partner had it.
* There is no test yet for men to find out if they have HPV. But the most common health problem caused by HPV in men is genital warts. The type of HPV found on your HPV test can cause cervical cancer in women; it does not cause genital warts.
* Partners who have been together for a while tend to share HPV. This means that your partner likely has HPV already, even though your partner may have no signs or symptoms.
* Having HPV does not mean that you or your partner is having sex outside of your relationship. There is no sure way to know when you got HPV or who gave it to you. A person can have HPV for many years before it is found.

If your sex partner is female, you should talk to her about the link between HPV and cervical cancer, and encourage her to get a Pap test to screen for cervical cancer.
Common Questions about HPV
Is there a treatment for HPV or abnormal cells?

There is no treatment for HPV (a virus). But there are treatments for abnormal cervical cells, which can be killed or removed. Treating abnormal cells will stop them from growing into cancer. But it may not remove the virus (HPV). That’s why it’s important to go back to your doctor as told, to make sure abnormal cells do not grow back. You may need to get Pap tests more often for a while. But most people do eventually fight the virus off.
Does having HPV or abnormal cervical cells affect my chances of getting pregnant or having healthy babies?

Having HPV or cell changes on your cervix does not make it harder to get or stay pregnant. The type of HPV that is linked to cancer should not affect the health of your future babies. But if you need treatment for your cell changes, the treatment could affect your chance of having babies, in rare cases. If you need treatment, ask your doctor if the treatment can affect your ability to get pregnant or have a normal delivery.
couple Will I pass HPV to my current partner?

If you have been with your partner for a while, your partner likely has HPV too. But your partner likely has no signs or symptoms of HPV. Partners usually share HPV, until your bodies fight it off naturally. There is no way to know if your partner gave you HPV, or if you gave HPV to your partner.
Can I prevent passing HPV to a new partner?

Condoms may lower your chances of passing HPV to your new partner, if used all the time and the right way. But HPV can infect areas that are not covered by a condom—so condoms may not fully protect against HPV. The only sure way to prevent passing HPV to a new partner is to not have sex.