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Wednesday, November 02, 2005
Three doses of prevention for cervical cancer
By Zosimo T. Literatus, R.M.T.
Breakthroughs
“An ounce of prevention is worth a pound of cure,” writes Henry de Bracton in De Liqibus (1240).
In health management, the most difficult part is to find that “ounce of prevention,” effective enough to shield humans from diseases. By far, prevention is the most essential, and yet most challenging aspect of modern medicine. Such a quest had been lost and won in highly modern laboratories world wide, and funded by billions of dollars each year.
Fortunately, certain preventive battles against disease seem to have been won somehow. The latest victory turns out to be against cervical cancers by using the newest vaccine developed by Merck and GlaxoSmithKline. Merck christened its vaccine Gardasil, and GlaxoSmithKline named their version Cervarix.
Cervical cancer claims the lives of 290,000 women worldwide each year. The ongoing Phase III clinical trial already involved over 25,000 women, 16 to 26 in age, in 33 countries. This is so far the largest clinical trial for the vaccine.
In the Phase III clinical trial study, titled Future II, there were involved 12,167 women from study centers in Brazil, Colombia, Denmark, Finland, Iceland, Mexico, Norway, Peru, Poland, Singapore, Sweden, UK, the United States and Puerto Rico. The study was led by gynecologist Kevin Ault, M.D, from Emory University, Atlanta, Georgia, USA. It was funded by Merck.
The participants were allocated into two groups: 6,082 in the Gardasil group and 6,075 in the placebo group. A placebo is a substance that, when taken, has no effect on the body.
Gardasil was designed to target human papilloma virus-16 (HPV-16) and HPV-18, two of the most dangerous strains of HPV and account for 70 percent of cervical cancer cases. HPV-6 and HPV-11 are responsible for 90 percent of cases of genital warts. Both strains are associated with abnormal Pap smear results.
HPV is a sexually transmitted virus that causes most of cervical cancers. HPV has been identified as the cause of cervical cancer, pre-cancers, benign cervical lesions, and genital warts. Ault says that another factor that makes young women vulnerable to cervical is smoking.
In the primary analysis (three-dose) group, Gardasil prevented 100 percent of cases of HPV-16 and HPV-18 associated cervical cancers. There is no report on its effect on HPV-6 and HPV-11. The study followed the women for an average of 17 months after the completion of the three-injection regimen.
In the single-dose (secondary) group, Gardasil was 97 percent effective in preventing cervical cancer for all four HPV types.
The women in this group were followed for about two years after the vaccination.
Gardasil contains empty protein shells of the HPV, which trigger the immune system to generate protective antibodies-proteins that attacks HPV when it enters the human body. Ault says the vaccine can prompt the body to churn out 30-80 times more antibodies than the amount naturally produced by HPV infection.
One impact of this development is the possible outdating of Pap smear as a routine procedure in diagnosing cervical cancer. Another effect is the indirect way it encourages indiscriminate sexual behavior among young women because this will likely be given to girls between 10 to 30 years of age. It is a classic case of a gift and a curse, rolled into one. But there still remains the question of affordability: Would it be accessible to Filipinos? Poverty can sometimes be an unexpected blessing, so to say.
That brings us to the paradox of technology. It gives us the power to prolong life as it gives us the option to change the quality of our lives to the worse. But certainly it is all about decision and responsibility. The power to decide comes with the task to take responsibility for our decisions and actions. It is a God-given freedom to will; a gift or a curse, depending on how we use (or misuse) it. (For comments and suggestions, write to ztliteratus6046@lycos.com.)
(November 2, 2005 issue)
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