top doctors washingtonian Cervical cancer: prevention, HPV vaccine update and nuances (12)

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Exclusive interview / Dr. Anton Titov MD and Professor Dr. Jack Cuzick, world's leading cancer prevention expert, breast cancer, cervical cancer and prostate cancer prevention

Cervical cancer affects young women. There is a famous TV personality, Jane Goody, who at 27 died from cervical cancer. You've done seminal work on cervical cancer prevention. What are the latest developments in that area? How can one potentially prevent cervical cancer from happening in the first place? Cervical cancer is unique amongst the major cancers in that there's one cause for virtually all of cervical cancers - it's the human papillomavirus, which is a sexually transmitted virus. Dr. Harald zur Hausen got the Nobel Prize for his discovery of this particular mechanism, and there's been an enormous amount of work now to take that initial observation and discover how to convert that into clinical benefit. So from going from the most common cancer in women, now it's on the verge of potentially being able to be eradicated. Screening tests have been developed, which are better than the conventional Pap smear, which actually look for the virus in the same material in a cervical sample that we take for Pap smear. It's much more sensitive than cytology for cancer detection, and is now replacing cytology as primary screening test. It also can be scaled and is an automated test, as opposed to risks of being tired or being inattentive in manual testing. There are many advantages for HPV testing, aside from being more sensitive, it's a completely objective automatable test, so it doesn't require hours and hours of looking down a microscope to find abnormal cells. It's a molecular test, it comes directly out of a machine. So the more exciting new development, which began about 10 years ago, is actually vaccinating against the HPV virus, and there have been a number of studies of actually looking at HPV vaccination. There are essentially three commercially available HPV vaccines now. One by GlaxoSmithKline, which is called Cervarix, it protects from two major HPV types causing cancer, 16 and 18. On the other hand, Merck developed initially a vaccine that had those two types, HPV 16 and 18, plus the two types that cause genital warts - that is HPV type 6 and 11, and both of those vaccines have been shown to be virtually a 100% effective at preventing HPV infection, if given before infection occurs. But neither of them are prophylactic in a sense that, once you're infected with HPV virus, it doesn't have any impact on clearing virus, it still requires screening to detect disease, which is currently there. More recently, Merck has also now developed a wider spectrum vaccination, which has 9 HPV types - those original four plus the next five most common types that cause cervix cancer. And with now two types to prevent genital warts, genital infections plus another seven HPV types aimed at preventing the types of HPV that cause cervical cancer, we're looking at potentially 90% reduction in cervical cancer incidence, and then the ability of the HPV test to mop up those few that are actually missed. So there is a potential cervical cancer could almost disappear over next 5 to 10 years.

top doctors washingtonian Cervical cancer: prevention, HPV vaccine update and nuances (12)
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