A leading expert in cancer immunology predicts that cervical cancer can be eliminated over a 20-year period if a comprehensive vaccination programme is implemented.
Currently some 250,000 women die every year from cervical cancer globally, about 90 of them in Ireland. Minister for Health Simon Harris has pledged to introduce a new HPV test later this year following the cervical cancer screening crisis and concerns about the lab analysis of testing.
In Australia, where the vaccine Gardasil was developed and where a HPV vaccination programme has been in place since 2007, scientists predict there will be no new cervical cancers by 2028 in women who have been immunised.
Prof Ian Frazer, a co-creator of the HPV vaccine, says, “We reckon the vaccine will have effectively eradicated the virus from all but those who have recently immigrated into Australia.
“That’s basically 20 years after the vaccine programme started.”
Strains of virus
Prof Frazer says that 100 per cent of cervical cancers are caused by the papillomavirus (HPV). The vaccine, he says, protects against nine strains of virus which are together responsible for more than 95 per cent of cervical cancers.
The head of the cancer immunology programme at the University of Queensland Diamantina Institute, Prof Frazer, will visit Dublin in July to receive an honorary fellowship from the Royal College of Physicians in Ireland for his work.
He will also be the keynote speaker when the college marks eight years of the vaccine’s use in Ireland at a conference on the practical aspects of Gardasil and the implications of the cervical cancer screening controversy.
Speaking from Brisbane, Prof Frazer says of the cervical cancer screening crisis in Ireland: "I don't think anybody knows what exactly happened, except that certainly some people have slipped through the net and have gone on to get cervical cancer that shouldn't [have]."
In Australia they worked on the basis that “we know that a certain percentage of pap smears should be positive and if a lab started showing less than that percentage positive there would be a direct inquiry into why that might be”.
Now they are testing for the HPV virus because since the advent of the vaccine there are so few abnormal smear tests.
And “if you can get an immunisation programme going across the country that’s reliable, then 20 years later you won’t have to worry about cervical cancer any more”.
There are about 200 different HPV or papillomaviruses, including those that cause warts on hands. But “the ones that cause cancer are a different breed if you like and they are pretty much exclusively passed from person to person through sexual intercourse, not necessarily penetrative sexual intercourse but at least genital touching. And they are very common,” says Prof Frazer.
“And it’s only about 1 per cent of the population that goes on to get the virus that gives you a very high risk of cervical or genital cancers later in life,” the immunologist says.
“Cervical cancer is the commonest cancer these viruses cause. Penile and anal cancers are also caused by these viral infections, but in men it will most commonly be cancers of the mouth and throat,” cancers women are also now contracting in increasing numbers.
The aim is to give the vaccine to children before they become sexually active. In Ireland it is given to girls. Hiqa is evaluating whether it should also be given to boys and a decision will be made later this year.
Immunising 70 per cent of the girls was sufficient to get the virus to disappear in the age group that was vaccinated in Australia.
But Prof Frazer points out that they started to immunise boys because “if the rate of uptake of the vaccine in girls starts to fall then the best way to mitigate the risk is to also vaccinate the boys”.
He hopes the current cervical cancer screening crisis would make people more disposed to getting the vaccine.
“There’s nothing like a bit of publicity about a disease to encourage people to realise that they are in fact at risk and their children are at risk.
“And I think that one of the drivers for rapid uptake of the vaccine in Australia was that the prime minister’s wife admitted that she had had cervical cancer.”
“Once people realise that the vaccine is not about sexually transmitted infections but about preventing a cancer that is a common one then that can be entirely prevented by vaccination then I think that people will change their mind and decide it’s worthwhile.”
Vaccination rates in Ireland dropped alarmingly to 50 per cent after concerns about damaging side-effects. A recent awareness campaign improved the rate to more than 60 per cent.
Prof Frazer points to a number of independent reviews which found no evidence of any serious or chronic or long-term complications relating to the vaccine.
There is a one in a million incidence of a significant allergic reaction to the vaccine and in Australia “that amounted to two cases in the whole of the last 10 years and worldwide there’s been about 17 or 18 reported. And that’s an unpredictable allergic reaction, about the same you get with almost every vaccine.”
He believes it is unreasonable for parents to decide for their children against the vaccine.
“I think 12-year-old girls can usually make a reasonable decision, especially if the facts are given to them” – that this is a vaccine designed to prevent them getting one of the most common cancers in women “and kills something like quarter of a million women worldwide every year”.