The HPV Vaccine and Pap Results

An abnormal Pap means added testing and fear, which many women can now avoid.

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A dear friend of mine, Sarah Stern, recently had an abnormal Pap test result showing precancerous cells. She submitted to all the requisite follow-up: a colposcopy, or microscopic examination of the cervix; a biopsy of the suspicious-looking area; and treatment with cryosurgery to freeze and destroy the abnormal cells. Plus, she endured plenty of fear and anxiety. Very few women in this country now die of the cancer that killed Eva Perón in the 1950s, but 1 in 3 will, like Sarah, have an abnormal Pap at some point in her life. It appears that you can reduce the odds of being the one, however, by getting vaccinated against the cervical cancer-causing virus known as HPV. The Gardasil vaccine cuts the rate of Pap abnormalities by 43 percent, researchers announced today at the meeting of the Society of Gynecologic Oncologists.

Let's qualify this a bit: The women in the vaccine study were ages 16 to 26, not infected with HPV, and followed for just three to four years—not the two or three decades it can take for precancerous lesions to develop. Still, this certainly adds to the reasons for getting vaccinated. Gardasil, the only vaccine currently available in the United States, protects against four HPV types, two of which cause genital warts and two of which are responsible for 70 percent of cervical cancers. A new vaccine called Cervarix could be approved by the Food and Drug Administration later this year.

"We saw significant reductions in the most severely abnormal Pap smears," says study leader Warner Huh, associate professor of gynecologic oncology at the University of Alabama-Birmingham. The vaccine protection translated into about a 20 percent reduction in colposcopies and a 22 percent drop in cervical biopsies. Considering that $3.6 billion is spent every year on the treatment and evaluation of abnormal Pap smears, Huh adds, vaccination could yield a big cost savings. (The current study was funded by Merck, manufacturer of Gardasil, and Huh also serves as a paid consultant for both Merck and GlaxoSmithKline, manufacturer of Cervarix.)

One reality that gets lost in all the enthusiasm over the HPV vaccine is that it can't completely guarantee a woman won't get cervical cancer. So women still need to go in for regular Pap smears. Moreover, older women like my friend Sarah, 55, usually aren't vaccinated, since Gardasil is currently approved only for women up to age 27; most who wind up with Pap abnormalities were infected with HPV decades ago, well before Gardasil was invented. As the founder of a Mideast think tank called Emet, she's used to getting her message out, and this time she has two. The vaccination might save young women from both cervical cancer and unnecessary torment. And "surgery and early detection saved my life," she tells me. "I want to remind every woman to go for that regular Pap smear."