Dr. Anne Zutavern

HPV vaccination against cervical cancer

Cervical cancer is one of the most common malignant tumours in women throughout the world. In western countries, the introduction of gynaecological screening programmes with examination of the cervix and cytological smears has led to a reduction in the diagnosis of this cancer and its mortality by about 70%. At the same time, detection of precancerous conditions has increased. Despite these very positive developments in the morbidity and mortality of cervical cancer in the western world, it is still a very important disease. In Germany in 2003, 2.3% of cancer-related deaths were due to cervical cancer. In developing countries, where cervical cancer is the second most common tumour in women, screening programmes and adequate treatment are rarely available.

In the meantime, it has been established that an infection with human papilloma virus (HPV) is the main risk factor for the development of cervical cancer. HPV is a double-stranded DNA virus, which is transmitted by very close human contact, particularly by sexual intercourse. 70% of sexually active women are infected with HPV during their lifetime. There are many different types of HPV. Types 16 and 18 have been identified as high-risk strains for the development of cervical cancer. Other conditions caused by HPV are genital warts, other neoplasms in the mouth and genital tract, and oral and respiratory tract infections.

A vaccine against four carcinogenic strains of HPV has recently become available and was granted marketing authorisation in Germany in September 2006. Regulatory approval of a further vaccine against two HPV strains is expected in the summer or 2007. Studies show the efficacy and safety of the two vaccines to be excellent. However, there are still no results of long-term observational studies. Since March 2007, the Ständige Impfkommission am Robert Koch-Institut (STIKO) [Standing Committee on Vaccination at the Robert Koch Institute] in Germany has recommended the vaccination for all girls aged between 12 and 17 years, preferably before sexual debut. The American National Center for Disease Control and Prevention (CDC) has been recommending vaccination since the summer of 2006. The costs of vaccination in Germany are EUR 465 at the present time. Many statutory health insurance funds are prepared to bear the vaccination costs, on the assumption that the vaccine will lead to a further significant decrease in cervical cancer. Because of the lack of screening programmes in developing countries, a vaccine, although for them very expensive, would lead to a considerable reduction in this malignancy.