Very poor uptake of cervical cancer vaccine
THE uptake of the controversial cervical cancer vaccine for young girls over 12 in Kildare has been very poor since its roll-out last April.
The cost of the vaccine, a hefty E98, has been cited as one contributing factor as well as concerns over its overall safety for young women and its various side-effects.
Local GPs also criticised what they described as the HSE's "blatant U-turn" regarding the cervical cancer vaccine earlier this year - which the HSE said was due to cutbacks - and claim the move has played its part in why the numbers of young girls vaccinated in Kildare remains so low.
The HSE has also been accused of sending "mixed signals to parents and sowing the seeds of uncertainty" in their minds since it reversed the decision to roll out a national programme.
Cervical cancer is the third leading cause of cancer deaths in women worldwide according to statistics from the Irish Cancer Society.
Ireland has one of the highest death rates from cervical cancer in western Europe. The latest figures from the National Cancer Registry of Ireland (NCRI) show that 286 women were diagnosed with malignant cervical cancer in 2007 and nine of these women were living in Kildare.
According to Dr Brendan O'Shea, spokesman for the Kildare faculty of the Irish College of General Practitioners (ICGP), the discounted rate was negotiated with the pharmaceutical company which produces the vaccine, to enable GPs to offer it at a reduced price.
Dr O'Shea has since denied allegations that, as a result, GPs are profiting from the vaccine, which he describes as "exceptionally expensive".
"Kildare GPs may either provide the vaccine at their own practice, or can refer their patients requesting the vaccine to a colleague," he explained. "They have been able to negotiate a discount for volume from the manufacturer. However, even allowing for this, due to the price set by the manufacturer, it remains an exceptionally expensive vaccine. Prices set for administering the vaccine in general practice will vary to a very minor extent from one practice to the next, however no practice is making a significant or substantial profit from administering it."
Meanwhile, as spokesperson for the Kildare faculty of ICGP, Dr O'Shea has expressed its disappointment but not surprise at the very poor take-up of HPV Immunisation in Kildare.
"This is not surprising however," he said. "Given the costs associated with it in difficult times, and the large U-turn performed by the HSE in firstly indicating it was going to 'roll out' a national programme directed at the population at risk, and then subsequently and rather blatantly reverse this decision on the grounds of cost, such decisions sow uncertainty in the minds of parents and provide very mixed signals."
According to Dr O'Shea the evidence for this vaccine is sound and scientifically based; however, the jab has been linked to side-effects and death in some cases of patients who have other serious underlying causes.
"It is clear that it is safer to take on the very negligible risks associated with the vaccine as opposed to taking chances with the death rates associated with cervical cancer, which still currently affects around 200 Irish women each year, and is responsible for about 70-80 deaths per annum," he said.
"Given these very stark and overwhelmingly important facts, we should be following the example set in the NHS in UK, where they have been running a very tight cervical screening campaign (smear test) for over 20 years, but have still nonetheless instituted an immunisation campaign in addition."
Last April local GPs in Kildare expressed their regret that the vaccine would not be covered by the medical card and issued a press release to say they were able to obtain the preferred vaccine on the basis of a discount for volume, of around 29 per cent, at a cost of n98 per shot.
Parents of young girls aged 12 or over were stongly advised at the time to go for the immunisation against the Human Papilloma Virus, HPV, which is a commonly occurring virus responsible for genital warts, and closely associated with cervical cancer in women.
This coincided with the death of reality TV star Jade Goody on Mothers Day, March 22, this year. Her death made headlines throughout Ireland and the stark reality of cervical cancer was played accross the screen as the run-up to her untimely and painful death was televised.
Young girls and women in Kildare connected with the Jade Goody story and the number of requests for information on the cancer rose higher than ever before.
Goody, a former Big Brother contestant and mother of two, had a number of health scares throughout the past decade.
In 2002, shortly before her Big Brother 3 appearance, she had a cervical smear test that revealed abnormal cells, a possible indicator of cancer. She was later tested for ovarian cancer in 2004 and bowel cancer in 2006, but was given the all-clear on each occasion.
On September 1, 2008, it was reported that Goody's cancer was "advanced and life-threatening" and on February 4, 2009, it was confirmed that Goody's cancer had spread to her liver, bowel and groin. Ten days later her cancer was declared terminal and she was dead within six weeks.
When news broke that Goody's cancer was terminal, medical authorities in Ireland and the UK began reporting a surge in requests from women, particularly younger women, for screening for cervical cancer. This reversed a trend that had seen demand for screening decline overall in the past decade, with the highest decline being among women aged 25 to 29.
"CervicalCheck, the national cervical screening programme, was launched in September 2008," said Ann Brown, press and communications officer at the Department of Health and Children. "Over a quarter of a million women have been screened since then. Over time this programme has the potential to reduce the number of deaths from cervical cancer by up to 80 per cent. n43m will be spent on the programme in 2009."
From last September, in line with best international practice, CervicalCheck changed from that of an open access entry system to an organised call, re-call system of invitation. This change will ensure that an effective and efficient population approach to screening that maximises target population coverage is maintained.
"CervicalCheck has a national register of women aged 25 to 60," said Ms Brown. "Over each screening round, all eligible women aged 25 to 60 will be invited for screening and invitation letters will be issued to women evenly across all age ranges. The criteria for eligibility under the programme are clearly set out on the CervicalCheck website. Any woman who has not had a smear test in the past three years can opt into the programme simply by registering online, by completing and returning a form by freepost, or by calling CervicalCheck on Freephone1800 45 45 55 to request an invitation.
Certain women are eligible for a free smear test without a CervicalCheck invitation letter. These include women aged over 60 who have never had a smear test and women of any age post colposcopy."
CervicalCheck, the national cervical screening programme, was relaunched on September 1 and aims to provide free smear tests to the 1.1 million women aged 25-60 years eligible for screening.
A successful national cervical screening programme in Ireland has the potential to cut current mortality rates from cervical cancer by up to 80 per cent and reduce the incidence of cervical cancer by 51 per cent.
Question and answers with Jane Curtin, Communications Manager Irish Cancer Society on the HPV vaccination programme.
1.What is the ICS's view on the abandonment of the HPV vaccination programme?
On Tuesday 4 November, the Irish Cancer issued a statement expressing serious disappointment at the decision of the Health Minister to cancel the HPV vaccination programme for 12 year old girls, due to cuts in spending caused by the economic downturn.
The Society had welcomed the original decision by the Minister for Health and Children to roll out this mass vaccination programme for 12 year old girls as a progressive measure. The Society considered it a safe and effective programme aimed at preventing the virus which is one of the biggest risks in developing cervical cancer.
At the time the Minister had stated that the decision was due to spending cuts caused by the economic downturn and that her priority was the development of the cervical screening programme which had been launched on 1 September 2008 and treatment services at the eight designated centres In our statement on 4 November, we also asked the Minister to make a clear commitment to the restoration of the vaccination programme at the earliest possible opportunity and we continue to lobby for this.
We would also ask that the mass vaccination programme includes a 'catch up' programme for 13-15 year old girls to ensure that they are not put at risk of developing cervical cancer in the future.
2. Is screening is a more effective way to offer protection?
CervicalCheck, the national cervical screening programme was launched on 1September 2009 and aims to provide free smear tests to the 1.1 million women aged 25-60 years eligible for screening.
A successful national cervical screening programme in Ireland has the potential to cut current mortality rates from cervical cancer by up to 80% and reduce the incidence of cervical cancer by 51per cent.
The purpose of screening is to detect cell changes before they become cancerous in women who are or have been sexually active and have already been exposed to HPV (Human Papilloma Virus). Most smear test results will be found to be normal with only a small number of women requiring further investigation or treatment.
To continue to lower the incidence of cervical cancer and ultimately eradicate deaths from cervical cancer, Ireland must introduce a mass HPV vaccination along side the national cervical screening programme.
Overall the evidence suggests that a combination of a vaccination programme which vaccinates all 12 year olds associated with an effective screening programme will reduce 90 per cent of cervical cancers
3.Is the vaccine safe? What do you say to people who might have concerns about it after reading media reports on the death of Natalie Morton in the UK?
On Thursday 1 October, it was confirmed that the death of Natalie Morton was not connected with the cervical vaccine that had been administered to her on Tuesday 29 September. Natalie had a serious underlying health condition which was as far as we understand a cancerous tumour in her thoracic cavity. This was purely a very unfortunate co-incidence.
With regard to the safety profile of Gardasil (one of the HPV vaccines) a recent study in the US showed that over 2.5 years experience of administering 23 million doses of the vaccine 32 deaths were reported of which only 20 could be verified. The cause of death was unexplained in four cases while four needed referral to the allergist
Overall death following administration of the HPV vaccine was one in a million.
4.What are the most common misconceptions about HPV and/or cervical cancer?
Regarding misconceptions on cervical cancer, one key finding was that it is hereditary and/or caused by multiple sexual partners and/or a 'bad' lifestyle.
People do not understand the difference between cervical pre-cancer (where there are abnormalites in the cervix that can develop in to cervical cancer) and cervical cancer
People do not understand or accept that cervical screening is the most effective method of preventing cervical cancer because it picks up the pre-cancer cells which can be treated before they go on to develop into cervical cancer.
People also seem to think that the HPV vaccination will guard against the development of cervical cancer in all women, even those who are or have been sexually active and who have been exposed to HPV – which is the biggest risk factor for developing cervical cancer
Discussion on cervical cancer and transmission of HPV is a sensitive area for women, as it is associated with sexual activity.
Cervical cancer – facts and figures
• When cancer occurs, the cells in the cervix form a tumour. These cells may then break away and spread to other areas. They can involve tissues outside the pelvis, including organs in the pelvis such as the bladder and bowel, and lymph nodes around the hips.
• What causes cancer of the cervix? There is strong evidence that cancer of the cervix is caused by a virus called the human papilloma virus (HPV). Also, it is known that smoking increases your chance of developing it. Cancer of the cervix, however, is not infectious and so cannot be passed on to others. Your risk of cervical cancer is not increased if someone else in your family has had this cancer. Cervical cancer can happen at any age but is more common in women in their 40s and 50s.
• Human papilloma virus (HPV)
The human papilloma virus is passed on by direct skin contact during sex. Most women who have sex will have HPV at some point in their lives. In fact, this virus is so common that even if you have only one sexual partner in your lifetime, you could still be infected. Condoms do not give full protection against it. It is important to remember that having HPV is not a problem in itself and most women have had it. Most of them get rid of the virus within a short time. Because it has no symptoms, they are unaware they have had it. But a small number of women have trouble getting rid of it, especially if they smoke. These women are at a higher risk of cervical cancer.
There are many different types of HPV, over 100 in fact, and most do not cause any problems. Some are of low risk and can cause genital warts. Others are of high risk and can cause cervical cancer.
• Being vaccinated against HPV
Two vaccines to prevent HPV infection have been licensed for use in the EU. These vaccines are called Gardasil and Cervarix. They target most of the strains of HPV that are likely to cause cervical cancer. This includes types 16 and 18. The vaccine is most suitable for women who have not had sex and is licensed for females aged 9 to 26 years. It involves a course of three doses given over 6 months and is injected into a deep muscle. If you are vaccinated, it does not mean that you no longer need smear tests.
You must continue with regular cervical smear tests because the vaccine does not cover all the HPV types that cause cervical cancer and it is not known for how long the vaccine gives protection.
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Thursday 17 May 2012
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