PARAMUS There’s finally some good news for women about cancer, specifically, cancer of the cervix. That dreaded disease the second most common cause of death from cancer (after breast cancer) worldwide is caused by the HPV virus, and now a new vaccine is available that is virtually 100 percent effective in preventing HPV infection and cervical cancer.
"There are 10,000 cases diagnosed annually [in the U.S], and 10 women die each day of cervical cancer," according to Dr. Gara Sommers, a gynecologic oncologist at Valley Hospital in Paramus and Holy Name Hospital in Teaneck, who spoke on Nov. ‘1 at the JCC here on behalf of the Paramus Bat-Sheva chapter of Hadassah. The topic "HPV, its relationship to cervical cancer, and the new vaccine, Gardisil" was intended to introduce and explain what Sommers described as "a phenomenal breakthrough in my subspecialty."
Dr. Gara Sommers, left, tells members of the Paramus Bat-Sheva chapter of Hadassah that all women should be vaccinated against HPV. With her, from left, are program chair Rhoda Fried and chapter president Laura Menter. photo by Miryam Z. Wahrman
Dr. Sommers strongly recommends that all women, and even girls as young as 9 years old, be vaccinated. "The reason for vaccinating at such a young age is to build up the immunity so that no matter how early or late a child becomes sexually active, they are safe," she said. In June ‘006, the FDA licensed the vaccine for use in females ages 9-‘6, and some pediatricians, as well as obstetrician-gynecologists, have begun offering the vaccine. Sommers confided that when her two young daughters are old enough, she will have them vaccinated against the virus.
"No matter the age, I recommend the vaccine, because the longer you live, the more likely you are to get cancer," continued Sommers. The Merck-produced vaccine, Gardisil, is designed to immunize against the four HPV virus types most commonly associated with cervical cancer. It is given in three doses: an initial immunization, followed by booster shots two months and six months later.
"In my practice, I am urging anyone with a history of HPV to be vaccinated, as it helps prevent recurrent disease," said Sommers. In addition, anyone who has more than one sexual partner should strongly consider vaccination. She estimated the cost of the three vaccines at $350, plus the physician’s fees. Sommers predicted that Merck will soon obtain FDA approval to expand the range of females for whom the vaccine is approved. Another company, Glaxo, is also reportedly developing a similar vaccine.
Sommers also advised the mostly female audience to get pap smears every year. The procedure, performed in a gynecologist’s office, is the most effective screening test available for detection of cervical cancer and pre-invasive diseases of the cervix. When pre-invasive diseases or cervical cancer are detected early, the success rate of treatment is very high.
Sommers pointed out that socioeconomic conditions as well as sexual practices and other factors affect the incidence of cervical cancer in different populations. She explained that the highest incidence of the disease is found in indigent nations where females have multiple pregnancies, the practice of safe sex may be nonexistent, and there is little access to modern health care.
Some groups show a significantly lower incidence of cervical cancer. According to several studies from the 19th and ‘0th centuries, the disease is practically nonexistent among Catholic nuns. Based on that information, it was first understood that sexual transmission was a major route for contracting the cancer. Now it is known that cervical cancer is 100 percent sexually transmitted, and that HPV is the agent of transmission.
To be sure, most women with HPV will not develop cervical cancer, but HPV-positive women should be particularly vigilant about having regular testing through pap smears. On the other hand, women who are not infected with HPV do not develop cervical cancer. Thus, according to Sommers, "there is a zero percent chance of cervical cancer in completely monogamous couples."
Asked if women in completely monogamous couples need to be vaccinated, Dr. Sommers said that all women should be vaccinated, since after five years of testing on over ‘0,000 women, the vaccine has not been associated with any known side effects or complications. Since there is no known risk associated with the vaccine, she said, it is worthwhile for every woman to gain this protection against HPV.
Significantly, Jewish women appear to show a much lower incidence of the disease than non-Jews. Authors of a 1901 study published in the prestigious British journal Lancet observed that cancer of the cervix "was seldom or never met with amongst the numerous Jewesses" seen at two London hospitals. Subsequent research showed the ratio of the incidence of the cancer in Jewish vs. non-Jewish women to range from 1/9 to 1/5. In a later study, Israeli women of Oriental, Sephardic, and Ashkenazi origin were found to exhibit similar low incidences of cervical cancer. However, Jews with North African (mostly Moroccan) origins seemed to be the exception, displaying a higher rate, closer to that of non-Jews.
A study done in the 1950s compared Israeli Jewish women with Jewish and non-Jewish white New York City residents. All the Jewish groups had significantly lower rates of cervical cancer than non-Jewish white women in New York. Since socioeconomic factors were similar among the groups, the question was raised as to what factors could account for the reduced risk in the Jewish population.
Although it was suggested years ago that having a circumcised partner may reduce rates of infection and cervical cancer, that factor was ruled out by several studies comparing Jewish to non-Jewish women with circumcised partners. The non-Jewish women who had circumcised partners still demonstrated higher rates of cervical cancer than the Jewish subjects.
Another factor studied was the practice among some Jewish women to abstain from intercourse during and for several days after menstruation (i.e., observing the religious laws of niddah). A number of recent studies have demonstrated that this practice does not appear to be the protective factor. A ‘003 article by Joseph Menczer notes that "the great majority of Israeli Jewish women no longer practice the laws of niddah, yet the incidence of cervical cancer among them remains persistently low." Increased sexual activity of Israeli women in recent years also appears to have had little effect. Menczer concludes that in spite of changes in sexual habits and decrease in observance of laws of niddah, "the population-based incidence of cervical cancer in Israeli Jewish women has not increased and remains very low."
One study from ’00’ identifies a form of cancer gene, called p53, which may hold a clue to explaining the low incidence of cervical cancer in Jewish populations. Scientists from the Edith Wolfson Medical Center in Holon, Israel, showed that a mutant form of the p53 gene associated with cervical cancer appears to be present at a lower rate in Jewish Israeli women. This genetic factor could account for the lower susceptibility to cervical cancer found in Jewish populations. (This is in stark contrast to the BRCA1 and BRCA’ cancer-causing mutations that appear in higher rates in Ashkenazi Jewish women and increase the incidence of early onset breast and ovarian cancers.)
Whatever is responsible for the reduced incidence of cervical cancer in Jewish women, it is important to emphasize that the risk from HPV and cervical cancer for Jewish women is still significant, and the vaccine holds tremendous promise in terms of reducing or even eliminating the risk of HPV infection, pre-invasive diseases, and cervical cancer. And, according to Richard Roden and T.C. Wu, writing in Nature Reviews (‘006), the protection provided by the vaccine may be even more extensive. HPV can contribute to the development of head and neck, anal, penile, vulvar, and vaginal cancers as well as cervical cancer. They conclude, "Although these cancers are less common than cervical cancer, it will be important to determine whether the benefits of the HPV preventive vaccine extend beyond cervical cancer."
Laura Menter, president of the Paramus Bat-Sheva chapter of Hadassah, announced that the group’s "Hadassah-month" project for November linked to Dr. Sommers’ presentation was the donation of educational materials on cervical cancer prevention and care to the Paramus Library.Dr. Miryam Z. Wahrman is Professor of Biology and Director of General Education at William Paterson University of New Jersey. Author of "Brave New Judaism" (Brandeis University Press/UPNE, ’00’, paperback ‘004), she has recently developed a course at WPUNJ called "Bioethics and Society."