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Saving daughters worldwide from a preventable cancer
Special to The Times
A NEW vaccine against human papillomavirus (HPV) is going to be available soon to American women. HPV — an extremely common infection that most women acquire at some point in our lifetime — causes cervical cancer. The vaccine is safe and highly effective against two HPV types that are responsible for 70 percent of all cervical cancers worldwide.
As a mother of two daughters, I will be first in line to have them vaccinated. Why wouldn't I? This vaccine prevents a common infection that, over a period of many years, can cause a deadly cancer. Even with the most careful and responsible sexual life, including abstinence before marriage, women cannot fully protect themselves from HPV. Further, vaccination will sharply reduce their need for cervical screening and the discomfort and anxiety associated with diagnosis and treatment of abnormal Pap results.
Our daughters are lucky. They will have access to this safe and effective vaccine. In fact, last week a Centers for Disease Control and Prevention panel recommended routinely administering the vaccine to preteenage girls. Our daughters also have access to well-established Pap screening and treatment services that make cervical cancer an almost completely preventable disease.
Women in the developing world are much less fortunate. Of the almost half million cervical-cancer cases and quarter million resulting deaths each year, 85 percent of them occur in the developing world. Cervical-cancer rates are highest among the poorest women. Each year, 75,000 women die from the disease in India alone.
Why do the women of developing countries bear such a heavy burden of an almost completely preventable cancer? HPV is common everywhere and the developing world is no exception. Further, effective screening and treatment programs are largely unavailable in poor countries, and most women with cervical cancer only reach health centers when their disease is advanced — and incurable.
The deaths of these women — in their 30s, 40s and 50s — leave a hole in their families, villages and communities. In many parts of Africa, their deaths magnify the tragedy of the HIV/AIDS epidemic, as these women often are caring for sick children and orphaned grandchildren.
We now have the tools to change this. Vaccinating most young adolescent girls against HPV could sharply reduce cervical cancer rates over the next several decades. New, simpler approaches to screening and treatment of cervical cancer in the developing world are also crucial to the prevention of the disease.
But will the vaccine be made available to the women who need it most? Initially, it will be expensive, and new delivery systems and educational campaigns will need to be put in place to reach adolescents — a population with very little access to health care in many countries. Further, clear and accurate information needs to be made available at all levels to overcome concerns that may arise about a vaccine for girls that protects against a common sexually transmitted infection.
This is where donors and the global health community come in. It will take resources, commitment and cooperation from many entities to realize the promise of this vaccine in the developing world. In the next few years, developing countries will need help determining how to best introduce HPV vaccine, the international donor community will need to provide support for these efforts, and vaccine manufacturers will need to work with governments and donors to assure an affordable supply of vaccine worldwide.
An important step in this work will be to carefully examine the issues related to providing vaccine to pre-adolescent and adolescent girls, and involving communities and families in determining what it takes to reach as many girls as possible.
Cervical cancer kills tens of thousands of poor women in the developing world each year. Only 10 years ago, there were few options available to address this inequity. Now we have a new vaccine to prevent the infection that causes cervical cancer, and demonstrated approaches to screening and treating older women in remote communities.
It's time to put these tools to work so that daughters around the world can have an equal chance of living their lives free of the specter of pain and early death from a preventable woman's cancer.
Jacqueline Sherris oversees reproductive health activities for PATH, a Seattle-based global health organization. Sherris has been leading expansion of PATH's cervical cancer prevention work, including efforts to increase access to HPV vaccines.
Copyright © 2006 The Seattle Times Company