VACCINE FOR UTERINE CERVIX CANCER: results after two years of work

The human papillomavirus vaccine (Gardasil) has been available in Italy for two years, and is finding increasing use in adolescents given the high risk of contracting HPV 16,18,6 and 11: four very dangerous histotypes, the first two associated with cervical cancer, and the others implicated in the development of genital warts.
The vaccine produces neutralizing antibodies that inhibit the penetration of these viruses in the cells and consequently the infection and the viral replication, preventing the onset of dysplastic and neoplastic processes or genital warts.
The vaccine, is used in the prevention of cervical cancer and warts, but does not protect against an already acquired infection; its effectiveness is represented by a reduction of at least 70-75 percent of cervical cancers and 90 percent of genital warts.
It is probable that the vaccination also causes a reduction of preneoplastic and neoplastic cells in involved areas, such as vagina, vulva, anus, and oro-pharynx.
The vaccine is effective when used in women not yet exposed to papilloma virus: it effects children and adolescents, particularly twelve years old, in Italy: however, it can also benefit young women up to 26 years, and all the ones that have not yet started sexual life, and many women over 26 years of age. In fact, before the woman has come into contact with HPV, the vaccine is effective in 100 percent of the cases: the effectiveness decreases if the woman is already exposed to one of these strains, and it has also be shown that the exposure is related to the number of partners.
In an experimental group of women over 23 years of age, 76.5 per cent had never come in contact with the virus histological type 16 or 18; 21.1% was exposed to 16 or 18; 2.4% to both, and only 0.2% to all four.
The average number of partners for women was two, a value similar to that of Western populations: the study showed that the vaccine is directed to the age group where the cost benefit ratio is greater, but it can also be useful in older age groups; it would also be desirable to study women aged over 26 years.
Screening for uterine cervical cancer, should be continued, however: in fact the vaccine
protects from 70-75 percent of tumors.
The screening logs crossed over with those of the vaccine will provide further information on the goodness of the vaccine.

REFERENCES

Daria Minucci- Direttrice Divisione di Ostetrica e Ginecologia- Azienda Ospedaliera di Padova