HPV Vaccine: Can we prevent cancer?
With the roll out of HPV vaccinations across Government schools this March, South Africa joins the global fight against cervical cancer. Should you be booking the jab for your daughters? By Corinne Lamoral

Pull quotes: ‘70 % of cervical cancer cases are caused by HPV’ “In South Africa 1 in every 36 women get cervical cancer” 85% of the global cases of cervical cancer occur in the developing world.

When Maphuti Marogoa went for a health check in 2009 she was feeling healthy and confident. The mother of two was always conscientious about going for annual check ups so she wasn’t concerned when the clinic didn’t immediately phone her with her pap smear results. She decided to go into the clinic to get them. “The sister took me aside and sat me down to tell me that I had tested positive for cancer. My mind went into complete denial. Even as she was telling me that I was lucky because they had caught the cancer in Stage 1, I only felt confusion and anger. I just kept asking: ‘Why me?’”

Over 6 500 women in South Africa will be asking themselves ‘Why Me” this year, according to the World Health Organisation (WHO) figures for cervical cancer in South Africa. Of those, approximately 3 680 will not live to work through the answer to this heartbreaking question. While breast cancer gets more media coverage, figures show that cervical cancer is nearly as deadly. In fact many health officials believe the figures of 1 in every 36 women getting cervical cancer are under reported.

Marogoa knew very little about cervical cancer, which affects the lower part or mouth of the uterus or womb, when first given her diagnosis. Always associated with the precious growth of a child, the thought that the womb could hold a deadly disease is counter intuitive to many women. The good news is that cervical cancer is one of the most successfully treated cancers – if caught in the early stages.

Pap smear tests, which involve taking a small sample of the tissue lining the cervix to check it for any abnormal growths, have always been the first line of defense against cervical cancer. It was in the 1980’s that the focus changed from detection to prevention. German virologist Harald zur Hausen found a link between specific strains - 16 and 18 – of Human Papilloma viruses (HPV) and cervical cancer. His work paved the way for the development of the HPV vaccine and earned him the Nobel Prize.

By 2006 an HPV vaccine was developed and patented by a group of Australian and American researchers. Considering that at least 70 % of cervical cancer cases are caused by HPV, this has given hope that cervical cancer rates could one day be drastically reduced.

Cervical Cancer in South Africa
The importance in targeting cervical cancer in South Africa and Africa is most urgent, says Prof Helen Rees, founder and Executive Director of the Wits Reproductive Health and HIV Institute, because 85% of the global cases of cervical cancer occur in the developing world. “This is partly because of poor rates of screening coupled with high rates of infection and sexually transmitted diseases,’ she says.

There are high risks of patients dropping out at any step of the pap smear process. You need to travel, often far, to get to a clinic, then return to get the results and, If necessary, return for treatment. ‘Locally the incidence of cancers is 40 / 100 000 black women and around 12/ 100 000 white women,’ says Professor Lynette Denny, principal specialist in the Department of Obstetrics and Gynecology at Groote Schuur. ‘In a country such as Australia, with an effective cervical screening programme, the incidence is 6/ 100 000, ‘ she explains. Australia also embraced the HPV vaccine in the early days of its introduction and they have seen reduced rates already.

The HPV vaccination has been available in South African private clinics for a few years now but the uptake has been relatively slow, possibly because of the high costs and lack of public education. “Doctors have not given out a consistent message on the HPV vaccinations,’ believes Angela Ferguson, who founded the charity Dance for a Cure after a friend died from cervical cancer. “I saw for myself the ravages of the disease. Our motto is ‘Why procrastinate – vaccinate.”

South Africa’s Department of Health agree and they have made cervical cancer their focus, allocating 400-million for the HPV vaccination campaign which will vaccinate young girls in Grade 4 at the poorest 80% of schools in South Africa. Health Minister Aaron Motsoaledi explained at the launch in March that the program was the ‘realistion of the need to do something drastic to protect the over 16 million women at risk for cervical cancer in South Africa.’

There are some logistical issues with the HPV program. “I’m cautiously optimistic as it is a huge task. In order for the vaccine to be effective, three vaccines need to be administered to each girl, a few months apart, ‘ says Ferguson. She has first hand experience, having been involved in facilitating vaccinations for disadvantaged children since 2008.

Another reason for the slow uptake in vaccinations may be the conflicting information offered on the Internet, or Dr Google, as it’s known. As with most vaccinations, there are many people who believe HPV vaccinations cause serious adverse effects including deaths. Professor Denny is at pains to reassure that this is all unsubstantiated. “The data on safety are very compelling and have been internationally reviewed and checked and in my opinion this is a very safe and effective vaccine. There are all kinds of wild rumors floating around the Internet but these are not backed up by reliable scientific data nor supported by organisations like the WHO. Not one death has been associated with the vaccine,’ she says.

A lot of the adverse claims have to be viewed according to their sources. Because the HPV vaccination is best administered at a young age, Pro-life and anti premarital sex advocates believe it encourages promiscuity, giving the go-ahead to have sexual relations. When US Republican and conservative Michelle Bachmann claimed that Merck’s HPV vaccine, Gardasil, causes mental retardation, it prompted physician and author Shobha S. Krishnan to write a book: The HPV Vaccine Controversy: Sex, Cancer, God and Politics (Praeger, 2008). “Scaremongering for personal political gain does not bode well for the education and welfare of the public,’ she said.

Frustrated health officials point to the fact that in any group of girls, certain issues and abnormalities will occur, unrelated to any medication they take. ‘If you take one million 14 year olds and follow them for a year some will develop diseases or medical issues because that is life,’ says Prof Rees. ‘What we are always aware of is whether there is a pattern to any of the side effects and from the over 175 million doses administered around the world so far, the WHO Global Advisory Council has no listed serious side effects.’

This is cold comfort to parents of a child who does develop adverse symptoms but it does put the incidence in perspective. While parents understandably need to come to their own conclusions, Prof Rees believes they should be more concerned that their daughter does not contract the HPV virus and develop cervical cancer.

After coming to terms with her diagnosis, Maragoa had a major operation and is currently in remission and optimistic. “I’m still not completely clear, but working through it. My aunt had cancer and she died of it, so I know the reality,’ she says. Marogoa has now become a CANSA representative and does awareness programs to spread the message: “Don’t ignore your health, it can happen to you. Schedule a health check today and take care of your children’s future.’

HPV FACTS
  • Human Papilloma viruses (HPVs) are a group of more than 100 related viruses.
  • Many types cause no symptoms; some can cause warts while others can lead to cancers of the cervix, vulva, vagina, penis, oro- pharynx and anus.
  • HPVs are transmitted via skin-to-skin contact and body fluids. About 40 HPV types are sexually transmitted and spread through genital contact and oral sex.
  • The more sexual partners you have the more likelihood of contracting a genital HPV infection. Having sex with a partner who’s had multiple sex partners increases your risk.
HPV VACCINE FACTS
  • There are two types of vaccine. Gardasil prevents infection with 4 types of HPV – HPV 6 and 11 which cause genital warts (but not cervical cancer) and HPV 16 and 18, which cause cervical cancer. Cervarix only prevents infection with HPV 16 and 18. Which vaccine you chose relates to the disease burden in your community as well as cost.
  • The vaccine is recommended for girls and boys ages 9 to 12 before they have sexual contact. Boys can also be protected from getting and spreading the HPV virus.
  • If the vaccine isn't completed by age 12, girls and women through age 26 and boys and men through age 21 can still receive the vaccine.
  • Once infected with HPV, the vaccine might not be as effective or might not work at all.
  • The vaccine is not advised for pregnant or immune compromised people. Check with your GP first.