Cervical Cancer Vaccine

About Our Experts

Richard M. Boulay, M.D. is a gynecologic oncologist with Lehigh Valley Health Network.

Kristin S. Friel, M.D. is a gynecologist with Lehigh Valley Health Network.

Sarah L. Stevens, M.D. is an adolescent medicine specialist with Lehigh Valley Health Network.

• I’ve heard news reports about a “breakthrough” cervical cancer vaccine. Will this vaccine really eradicate cervical cancer?
• Who should get this vaccine?
• How much does the vaccine cost? Will my insurance cover it?
• Does the vaccine have side effects?
  
• Should I make an appointment with my daughter’s pediatrician for this vaccination?
• My daughter is already sexually active. Could she still benefit from this vaccine?
• How does HPV cause cervical cancer?
• Will the vaccine eventually eliminate the need for my annual pap smear?
• What if your test is normal?

Q: I’ve heard news reports about a 'breakthrough' cervical cancer vaccine. Will this vaccine really eradicate cervical cancer?

A: The Food and Drug Administration in June 2006 approved Gardasil, a vaccine manufactured by Merck and designed to prevent the viral infection that leads to cervical cancer. The human papilloma virus (HPV), spread predominantly through sexual contact, causes most cervical cancers. The new vaccine will immunize young women against four of the more than 100 types of HPV. Two of these (known as HPV 16 and 18) are thought to cause 70 percent of all cervical cancers. Two others (HPV 6 and 11) cause 90 percent of genital warts cases. When Merck tested this vaccine on adolescent girls, it was 100 percent effective at preventing these specific types of HPV.

The American Cancer Society estimates that 9,710 women in the United States will be diagnosed with cervical cancer in 2006, and 3,700 women will die from it. We hope that this vaccine greatly reduces the incidence of cervical cancer, but it probably will not eradicate the disease. Because the vaccine does not immunize women against all types of HPV, women who get the vaccine can still develop cervical cancer, but their risk of doing so will be greatly reduced.

Q: Who should get this vaccine?

A: The Centers for Disease Control’s Advisory Committee on Immunization Practices (ACIP) has recommended this vaccine for 11 to 12 year old girls. The vaccine would probably be administered during their regular pre-adolescent physical. Girls at this age most benefit from the vaccine because they usually have not been exposed to HPV through sexual contact. Health care professionals may also offer the vaccine to girls and as young as age 9 and young women as old as age 26.

Q: How much does the vaccine cost? Will my insurance cover it?

A: The vaccine will be administered in a series of three shots over six months. Merck is charging $120 per dose, which totals $360 for the total treatment. Actual costs at physician’s offices may vary. Most large group insurance plans will probably cover the vaccine, but coverage will vary from insurer to insurer. Federal health programs such as Vaccines for Children (VFC) will cover this vaccine for the uninsured.

Q: Does the vaccine have side effects?

A: This is an extremely safe vaccine. Common side effects include pain, swelling, itching, and redness at the injection site along with a fever. As with any vaccine, there is a rare chance of an allergic reaction, including hives or trouble with breathing.

Q: Should I make an appointment with my daughter’s pediatrician for this vaccination?

A: At the moment, area physicians do not have the vaccine in stock, so it’s too early to make an appointment for a vaccination. We expect that local pediatricians and gynecologists may begin offering vaccinations by early fall.

Q: My daughter is already sexually active. Could she still benefit from this vaccine?

A: She may benefit, depending on what types of HPV she has been exposed to. If she has not been exposed to HPV 6, 11, 16, or 18, the vaccine could still reduce her risk of developing cervical cancer and genital warts.

Q: How does HPV cause cervical cancer?

A: When a woman comes in contact with certain types of HPV, the virus infiltrates cells in the skin that line the cervix. The immune system easily clears away most types of HPV. Sometimes the immune system can’t effectively fight the virus, and the virus proliferates into an infection that does not go away without treatment. If allowed to persist, the infection can interrupt the cell’s normal growth cycle, causing cells to grow too quickly. If left untreated, these cells may turn into cancer.

HPV can also affect the rectum and vagina, leading to cancers in those locations. However, HPV can lie dormant for many years, even decades. In some women, it may never lead to cancer. In others, it will. Smoking increases the likelihood that cells infected with HPV will become cancerous.

Q: Will the vaccine eventually eliminate the need for my annual pap smear?

A: Unfortunately, no. In the best case scenario, the vaccine will only prevent about 70 percent of all cancer cases—and that’s only in women who have not already been exposed to HPV through sexual contact. Because not all cervical cancers are caused by HPV and because the vaccine will only work against certain types of HPV, all sexually active women need regular pap smears.

More than a third of the 9,710 women in the United States diagnosed with cervical cancer each year will die from the disease, often because their cancer was diagnosed too late, after spreading beyond the cervix. A yearly pap smear enables your doctor to diagnose and treat lesions on your cervix before they become cancerous. There are small procedures that can be done to then prevent cervical cancer. Pap smears also diagnose and treat cervical cancer.

Q: What if your test is normal?

A: It doesn’t mean that you have not been exposed to HPV. If your immune system is effectively fighting the virus, the cells that line your cervix may be normal, resulting in a normal pap result. Keep getting your annual pap smear to make sure those cells stay healthy.

For more information on this topic, go to:

• http://www.fda.gov/bbs/topics/NEWS/2006/NEW01385.html
• http://www.gardasil.com/
• http://www.cdc.gov/std/HPV/STDFact-HPV-vaccine.htm#hpvvac1

He Researches Better Care

His Research Helps You - Tim Friel, M.D., is passionate about research because it helps his HIV and AIDS patients live longer. Now, he hopes to help more people by leading the health network's research efforts.

Tim Friel, M.D., doesn’t have to look far to see the power of research. He sees it every day in the faces of his patients at Lehigh Valley Health Network’s AIDS Activities Office, who are living with HIV. In recent years, his patients have been living longer and thriving thanks to new therapies and treatment strategies carefully evaluated through clinical trials offered there.

“My patients’ successes are a living testament to the immense impact research has on our care,” Friel says. “It’s the reason my colleagues and I are passionate about research.”

Friel is expanding on his passion for research – first discovered while working with HIV patients during his residency and fellowship training at Massachusetts General Hospital. His goal: to invigorate the health network’s research efforts by creating an academic-based research organization.

“Our community should know there already is great research being conducted here,” Friel says. “My goal is to help collaborate our various research efforts.”

By developing this academic research organization, the health network can generate more interest from industry, government and private groups seeking to partner with hospitals to study new products and treatment methods. This means our doctors and clinicians have access to the most cutting-edge treatments, equipment and procedures, and in turn, you have access to progressive health care – close to home.

It’s the kind of health care Friel and his wife, Kristin Friel, M.D., of College Heights OBGYN Associates (whom he met on their first day of medical school), knew they could find for their family in the Lehigh Valley, Tim Friel’s hometown.

He isn’t doing this work alone. He is supported by a steering committee with representatives from all groups currently conducting research in the network. They meet regularly to discuss their challenges and develop strategies for improving the network’s research efforts.

Friel most certainly will draw upon his own experiences. For the past nine years he has been involved in clinical trials looking at HIV medications, vaccinations and diagnostic tests for infections like HIV and hepatitis C. For the past two years he has overseen the health network’s department of medicine’s research efforts.

“In research we test a hypothesis and learn from our results,” he says. “These results will help us continue to improve the care of our patients and our community. It’s thrilling to be part of this process.”

Keeping It All in Balance

Strength and flexibility—those qualities keep Kathleen Treat of Breinigsville on her toes as artistic director of Steps in Time Academy in Whitehall, and in her busy life as wife and mother of two young girls. She has the help of a great partner, her husband, Dave, and she knows where her priorities lie.

“I have two passions—my family and the dance studio,” Kathleen says. “The support I get from both keeps me fulfilled and focused.”

Feel as though your life is running you? Determining what’s most important is the first step toward taking control, says psychologist Mary Kaland, Ph.D., of Lehigh Valley Health Network. “Think about short- and long-term priorities,” she says. “Having a perfect house or taking the kids to every possible activity may seem important, but spending meaningful time with them and giving yourself some attention may be more valuable.”

Keep a diary of your activities to see what’s really necessary and what can be eliminated or postponed, Kaland says: “Get rid of ‘shoulds’ unless they fit your priorities. Look for people who can help you with things like carpooling and cleaning, and have your family pitch in. It is possible to care for both yourself and your family; it just might not look as perfect as your fantasy.”

Here’s how Kathleen and Dave Treat do it: During the week, Kathleen brings the girls (Skyler, 8, and Addison, 3) to the studio after school for homework, play and dance classes. Dave picks them up on his way home from work and handles the evening activities while Kathleen teaches. Weekends are devoted to family activities.

“We are a true team,” Kathleen says. “We’ve always had this schedule, so we were able to plan for a family with this in mind. My family understands that Mommy may not be available every moment, but they also know they come first.”

You also have to make caring for yourself a priority, says Kaland’s colleague, obstetrician/gynecologist Kristin Friel, M.D. “Women often skip exercise and time with friends or their partner, but you need those things to stay physically and emotionally healthy—and be a good role model for your children.”

Kathleen makes time to relax with the newspaper, and dancing, daily walks and family bike rides keep her in shape. “Taking time for myself helps me clear my mind and stay focused,” she says. “Everyone benefits.”

Want to Know More? For help on saying no and a woman’s bill of rights, call 610-402-CARE.

Saving Ashlynn’s Life

She kept in touch by texting —During Ashlynn Rice’s emergency hospitalization, she maintained a sense of normalcy by exchanging text messages with her friends. Critically ill patients typically aren’t allowed to use cell phones, but in this case doctors recognized it was a way to help their young patient stay calm. Read her full story.

With her parents—Jeff and Penny Rice own a horse farm in Quakertown where Ashlynn keeps her beloved “Junior Mr. Huggs.”

Ashlynn Rice was young and fit—a straight-A student, cheerleader and passionate horseback rider. Then one day at school, the Quakertown 16-year-old began to have severe chest pain and shortness of breath. Her family doctor first suspected an upper respiratory infection, but a chest scan and electrocardiogram revealed something more alarming: a pulmonary embolism. A blood clot had completely blocked Ashlynn’s right lung.

At least 100,000 Americans suffer a pulmonary embolism (PE) each year. The condition occurs when an artery in the lung is blocked, usually by one or more clots that travel there from another part of the body. Most patients are not teens. Risk factors include age, obesity, pregnancy, smoking, long confinement in bed and a family history of PE.

Clearly, Ashlynn needed urgent medical care. “An ambulance was called immediately, and we were told to keep her as calm as possible so the clot would not move,” says her mother, Penny Rice. Doctors at Lehigh Valley Hospital– Cedar Crest gave Ashlynn anticoagulant medicines in hopes the clot would begin to dissolve. She was monitored throughout the night, but by morning her condition had worsened.

“We knew, given the clot’s size and location, that normal anticoagulation with intravenous heparin would not be enough,” says pulmonologist and critical care specialist Matthew McCambridge, M.D. He and his colleagues explored the possibility of administering a “clot-buster” drug, but a bedside echocardiogram revealed that a clot was also present in the right atrium of Ashlynn’s heart. That eliminated the clot buster. “We were concerned that the clot could go to her left lung, and then her breathing and blood pressure would be more compromised,” says cardiologist Melvin Schwartz, M.D. “The best option was open-heart surgery.”

It’s not a common treatment for blood clots, but “it was Ashlynn’s best chance for survival,” says cardiothoracic surgeon James Wu, M.D. Wu performed the lengthy surgery and successfully removed a 4-inch clot from Ashlynn’s lung. Against the odds, she had survived.

Since her ordeal, she’s been diagnosed with anti-phospholipid syndrome, an autoimmune disorder that can cause clotting in the legs and organs. (Most cases of PE arise from clots in the leg, called deep vein thrombosis.) Another possible factor is the oral contraceptives Ashlynn had just begun taking for medical reasons. “Birth control pills contain estrogen, which is known to increase some of the clotting factors in blood,” says Kristin Friel, M.D., an obstetrician/gynecologist with the health network.

Today, Ashlynn is on her way to recovery. She has to keep a close eye on her health, and she’s not yet allowed to ride her horse or do cheerleading lifts or gymnastics. Meanwhile, she’s discovered a new passion. She is so grateful to everyone who helped save her life that she’s decided to pursue a medical career. “This experience has made me realize how precious life really is,” she says.

Published from Healthy You Magazine, September October 2009