By Neena Bhandari

Sydney, 26.02.2008 (Women’s Feature Service): After a routine Pap smear test, Susan Tailford was diagnosed with cervical cancer at the age of 41. Each year in Australia, about 1,000 cases of cervical cancer result in the deaths of over 200 women.

“The shock of being diagnosed with any form of cancer is quite devastating. You want to blame someone, especially for a wart virus that was contracted through sexual intercourse. As there had been very few men in my life, my anger went from my ex-husband to my current partner. My ex-husband wasn’t around so my current partner had to cope with my anger and mood swings,” says Susan, a mother of two daughters.

Unlike some other cancers, cervical cancer is not hereditary. Almost all cases of cervical cancer are associated with some strains of the Human Papilloma Virus (HPV), a sexually-transmitted virus.

About 50 per cent to 80 per cent of sexually active women are infected with HPV at some time in their lives. Although 98 per cent of HPV infections clear by themselves, in less than two per cent of the cases this infection can lead to cervical cancer.

Susan underwent a hysterectomy and had her ovaries removed. After recovering from the surgery she was prescribed Hormone Replacement Therapy (HRT). Susan says, “During this treatment, I read some articles about the prolonged use of HRT. I even discussed my concern with a few doctors at the Royal Women’s Hospital in Brisbane. They all agreed that it was better for me to stay on HRT because of my age and the risk of developing Osteoporosis.”

“I accepted their opinions and I coped quite well with this treatment until I was diagnosed with Breast Cancer in 2001. There have been so many articles written about the link between HRT and Breast Cancer, I feel my life would have been very different if I had not contracted Cervical Cancer and consequently been prescribed HRT”, says Susan, who lives with her partner on Bribie Island in Queensland.

Cervical cancer is the second most common cancer in women, after breast cancer, killing more than 250,000 women worldwide each year. In the US, cervical cancer strikes more than 10,000 women each year, killing more than 3,700.

The Cancer Council of Australia has reported that the risk of Australian women developing cervical cancer before the age of 75 years is one in 183.

A Cancer Council spokesperson says, “We continue to promote the importance of cervical cancer screening as there is clear evidence it has contributed to lower incidence and mortality.”

Cervical screening has been available for Australian women since the 1960s, but became a more structured program in 1991. National figures show a 29 per cent decline in incidence of cervical cancer between 1993 and 2003. Similarly, deaths from cervical cancer declined by 25 per cent over the same period.

In 1985, clinical immunologist and developer of the cervical cancer vaccine, Professor Ian Frazer demonstrated clear associations between HPV and cervical cancer. This link justified his belief in the possibility of immunisation, which would be one of the first for any form of cancer.

In collaboration with the late Doctor Jian Zhou, Prof. Frazer developed the technology to produce HPV-like particles at the University of Queensland, which has led to the development of the vaccine for cervical cancer known as Gardasil™ and Cervarix™.

Gardasil has shown to be 100 per cent effective against two HPV sub types (HPV16 and HPV18), which are responsible for 70 per cent cervical cancer cases and 90 per cent of genital warts in women. It is hoped that the vaccine will prevent 70 per cent of cervical cancers worldwide, saving around 200, 000 lives every year.

“This vaccine has the potential to do most good in the developing world, where it could help lift women out of poverty by relieving the burden of disease,” says Prof Frazer, who emigrated from Scotland in 1981 to study viral immunology and auto-immunity at the University of Melbourne.

Women in the developing world, where Pap smears are not widely available, account for most of the worldwide cervical cancer deaths. While the vaccine

is “cheap” for some, it is not necessarily affordable by thousands of women in poorer countries. It costs between $300 and $500 for three doses given over a six month period.

Gardasil has been approved in 93 countries, having been launched in 76. The global roll out of the vaccine is being driven by health company CSL group’s licensee Merck.

The vaccine is provided free in Australia to females aged 12 to 26 years. More than 2.2 million doses of Gardasil have been administered since the programme began in April 2007.

“Anything that can prevent cervical cancer is a miracle. In my case, Gardasil vaccine may have ultimately saved me from undergoing a mastectomy, chemotherapy, losing my hair and having to wear a prosthesis every day of my life,” says Susan, who is now 58 years old and works as a part time Property Manager for a local Real Estate Agency.

The second vaccine, Cervarix, marketed by GlaxoSmithKline (GSK) hit the Australian market last August; specifically targeting women aged 27 to 45 who were not able to get access to Gardasil.

Both vaccines have been the result of decades of research by Professor Frazer, who says they were created using the same technology and have a “very similar profile”.

West Australian and Victorian researchers agree the best time to protect against the cancer-causing HPV is at the start of puberty, but say many women over 26 would benefit from being vaccinated against cervical cancer, despite already being sexually active.

Like with most vaccines, some concerns have been raised about Gardasil’s safety after Australia’s medicines regulator, Therapeutic Goods Administration (TGA), received almost 500 reports of adverse reactions possibly related to Gardasil.

Professor Frazer rejects the suggestion and says, “The vaccine safety data remain good, with 13 million doses delivered worldwide including 2.2 million in Australia, and no evidence that there are any significant side effects other than occasional fainting and temporary pain at the vaccine site.”

But sceptics say young women are not being given enough information about Gardasil to make an informed choice.

Even if one has been vaccinated against cervical cancer, all women aged between 20 and 69 are urged to have a Pap smear every two years. Every year around 15,000 women are treated following an abnormal Pap smear.

While Pap smears are not used to diagnose cervical cancer, they detect abnormal cells or pre-cancerous lesions in the cervix which may have the potential to become cancerous. The rates of pre-cancerous lesions that lead to cervical cancer have been rising. As many as 25,000 more women have said to have had Pap smear tests in 2007 than the previous year.

There are more than 100 HPV types and of 15 of which are linked to cervical cancer. Prof Frazer, who is Director of the Centre for Immunology and Cancer Research at the University of Queensland’s research centre based at the Princess Alexandra Hospital in Brisbane, is continuing his research to translate the success of the cervical cancer vaccine to other cancers and infections.

Professor Frazer also advises the Gates Foundation and the World Health Organisation’s Expanded Vaccine Initiative as a consultant from time to time to help insure that their knowledge is accurate and up to date.

The long drawn physical and mental healing process after contracting cancer can take its toll on survivors. For Susan, her cancer journey has made her a different person. She says, “I don’t take life for granted any more. I wake up each morning and I am thankful that I am here to share another day with my family and friends.”

As research into prevention, treatment and cure for cancers continue, availability of more HPV vaccines, together with the National Cervical Screening Programs, can help protect women against this dreadful disease.

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