Cervical cancer kills some 231,000 women worldwide annually. According to the Alliance for Cervical Cancer Prevention, an estimated 466,000 new cases of cervical cancer occur among young women worldwide - despite screening - each year, the vast majority in developing countries, where cervical cancer is the most common cause of cancer deaths among women.
Kevin Harrington, a clinical oncologist at the Royal Marsden Hospital and Institute of Cancer Research in London, told The Guardian in October 2005 it was possible that the vaccines could stamp out cervical cancer in developed countries. Harrington said the disease is a far greater problem in South-East Asia and India, and commented: "It is likely the vaccine will not be affordable where it is most needed."
How cost effective is cervical cancer vaccination in developing countries?
According to an analysis done in Brazil and published in HPV Today (August 2006), "introducing a vaccine at less than $25 per vaccinated woman (inclusive of three doses, wastage, delivery and programme costs) would likely be very cost-effective for low and middle-income countries. When costs increase to $50 per vaccinated woman, vaccination was still more cost-effective than screening alone."
Morgan Stanley have stated that the disease burden is significantly greater in the developing world (the lack of Pap smears and HIV exacerbate the problem). In July 2007, Merck & Co submitted an application to seek WHO certification for Gardasil as part of the commitment to make this vaccine available in the developing world. Merck is committed to making Gardasil available at dramatically lower prices in GAVI (Global Alliance for Vaccines and Immunization) eligible countries
Is the demise of the smear test imminent?
Multiple studies have demonstrated that HPV testing as an adjunct to cytology for primary cervical cancer screening markedly compensates for the relative insensitivity of a single Pap test (International Journal of Cancer, 2006).
According to an editorial in HPV Today (August 2006), as these vaccines are type-specific, protection against cancer is expected to be in the 65-75% range. Therefore, populations currently served by screening practices will have to continue screening for a number of years. Clearly, if pre-adolescent and adolescent vaccination is adopted, screening will continue virtually unchanged until these generations reach the age groups targeted for screening. In populations with limited or no screening, however, HPV vaccines might represent a new opportunity.
Copyright IMS Health, 5 October 2007