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A new era in cervical cancer prevention

New vaccines will ultimately help to prevent the infections that cause most cervical cancer in women -- saving thousands of lives around the world in the future

Worldwide, cervical cancer affects more women under 45 than any other malignancy apart from breast cancer.  So it’s surprising that the disease, known also as cancer of the cervix, is in most cases unknown by women.  

On the whole, most women do not know that cervical cancer is caused by a virus but there is a definite eagerness to know more about this preventable disease within the female community. 

Despite the positive impact cervical cancer screening has had in managing this disease, cervical cancer continues to have a high prevalence.  However, a feeling of optimism is emerging as for the first time, revolutionary vaccines will make it possible to prevent most cases of this disease.

Cervical cancer today
Cervical cancer is a major cause of death in women around the world.  In the UK there are around 2,800 new cases and 1,100 cervical cancer deaths a year.  While in the US there are 10,000 new cases and 3,700 deaths per year.  Around the world, every two minutes a woman is dying of cervical cancer.

Looking at cervical cancer across the globe, over 80 per cent of the deaths from cervical cancer occur in the developing world.  Sub-Saharan Africa is the worst-affected region. In Zambia, for example, cervical cancer strikes 63 women in 100,000, which is almost ten times Australia's rate of 7 per 100,000 women.  

Relatively high rates are also seen in some of the former Eastern block states – notably Romania and Bulgaria.  It has been found that increased cases of cervical cancer are apparent in countries where either no or poorly maintained screening programs exist.

Cervical cancer commonly strikes women early, often in their mid-thirties, at an age when they are in the prime of their lives.  Many affected women will be caring for young children and extended families, so one death from cervical cancer can devastate the lives of many people.

Symptoms and prognosis of cervical cancer
The pre-cancerous stages and earlier stages of cervical cancer are usually symptom-less, which is why it is important for women to have regular pap smear tests, also known as cervical screening.  In the absence of screening, the most common sign of invasive cervical cancer is bleeding from the vagina at times other than during menstruation.  

Between 1975 and1995, average five-year survival rates for women diagnosed with cervical cancer in the UK rose from around 50 per cent to 65 per cent – but for those diagnosed with more advanced stages of the disease in which the cancer has spread, the outlook is even worse.

Screening for cervical cancer
In the developed world, potentially dangerous changes in the cervix are usually spotted before cancer emerges which is predominantly attributed to national screening programs.  The British system is a good example of a successful screening program.  It prevents around 4,500 deaths each year in the UK, by detecting cervical disease when it is still at the easily treatable, pre-cancerous stage.  

Similar programs in North America, Western Europe and Australasia have also seen the number of cervical cancer cases fall dramatically.  

In the UK, women are supposed to be called by their General Practitioner to be screened every three years from the age of 25 onwards for pap smear tests.  Cervical cancer experts warn, however, that in recent years attendance for cervical smears has fallen. Between 2000 and 2005, the coverage of the screening program among the women aged 25-29, fell from 77 per cent to 71.6 per cent.  

Smear tests may seem straightforward to health professionals but there is evidence that some women do not know the importance of a smear test, find them embarrassing or even traumatic, and in part this may explain why screening fails to reach everyone who is at risk.  

However, in many poorer countries screening is less consistent and in most developing countries, screening is virtually non-existent.  This is why the death rates from cervical cancer may be ten times higher in East Africa than in some countries in Western Europe.  This lack of screening makes the need for a vaccine against cervical cancer even more pressing.

Human papilloma virus -- the infectious cause of cervical cancer
Unlike the vast majority of other cancers, the cause of cervical cancer has been narrowed down to a single agent; the human papilloma virus (HPV).  This common, highly infectious virus, spread via sexual activity where penetrative intercourse is not necessary, will infect the majority of women at some point in their lives and 80 per cent of women will acquire a genital HPV infection by the age of 50.  

Nearly half of these infections will be by a strain of HPV which has the potential to cause cervical cancer – although experts stress that only a small percentage of women infected will go on to develop the disease as, in most instances, infections of this nature tend to clear naturally.

Over 100 different strains of HPV are known but only 15 strains are considered oncogenic or cancer-causing.  Some other factors, including smoking and long-term use of oral contraceptives, may also make an HPV infection more likely to persist – and therefore increase the risk of cancerous changes in the cervical tissue.  But these lifestyle factors do not cause cervical cancer.  

The evidence points firmly to cancer causing HPV types that are found in over 99 per cent (virtually all) of cervical cancers.

The cervical cancer vaccine: a breakthrough for both science and women around the world
With HPV identified as the root cause, scientists have set out to develop vaccines that prevent against the majority of cervical cancer cases and therefore prevent the majority of cases from infecting women in the first place.  The vaccines produced so far offer protection against HPV 16 and 18, the most-common cancer-causing strains of the virus.

GSK is committed to research in this area and to producing the best possible vaccine to help to prevent infection with cancer causing HPV types and therefore the onset of cervical cancer.  The company is currently developing a cervical cancer candidate vaccine, soon to be available, to prevent cervical cancer in women across the world. 

GSK has already successfully marketed about 30 vaccines against other infectious diseases and expects to launch more new vaccines in the coming years.  So far its vaccines have been used to protect people of all ages, in most parts of the world.

What's happening now and what the future holds…
Experts are keen to keep the profile of cervical cancer high so women are continually reminded that they can already protect themselves through screening – figures suggest that more than a third of European women have never had a smear test.

The European Cervical Cancer Prevention Week in January this year, which was organised by the European Cervical Cancer Association (ECCA) and supported by GSK and other pharmaceutical companies, was intended to do just this with the primary aim being to promote better awareness of cervical cancer amongst women and the importance of having regular smear tests.  

Overall, the outlook for prevention of cervical pre-cancer or cancer has never been brighter.  The arrival of effective cervical cancer vaccines together with refinements to existing screening programs should see a massive decrease in the rate of cervical cancer deaths in the years to come.  

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