The War on HPV

So is Sarina Araujo, 40, of the National Cervical Cancer Coalition. After a DNA test came back positive for HPV in 2001, doctors removed several precancerous lesions from Araujo's cervix and she's being closely monitored today. "This is a very strong, persistent virus and my body can't seem to fight it off," she says. The CDC's vaccine advisory committee will make a recommendation on Merck's vaccine after the FDA decision in June. Glaxo filed for approval in Europe in March, and says they'll file for approval in the United States by the end of the year. The precise guidelines in terms of age--the vaccine has been tested in 9- to 26-year-old females--haven't been finalized, says the CDC's Lauri Markowitz. (Tests are still ongoing in males and in females older than 26.) But the committee is considering recommending it for 11- to 12-year-old girls so they can be protected before they become sexually active. Abstinence groups like the Family Research Council will be watching closely. While not opposed to the vaccine, the council believes it should be voluntary and include a warning about the risks of sexual activity. Araujo just wants her three teenage daughters safe: "If you can prevent cancer, how could you not want your children vaccinated?"

Vaccination cannot, however, save the lives of women who have already developed cervical cancer, which strikes particularly hard in South Asia, Latin America and sub-Saharan Africa. At Groote Schuur Hospital in Cape Town, Dr. Lyn Denny treats 200 women a year with the disease, most of them in advanced stages. Pap smears are available, says Denny, but the test is not widely used, especially in poorer populations where the HIV epidemic diverts attention and resources. Because the cancer is slow-growing--it can take more than a decade to develop--women are hit in the prime of life, says Jackie Sherris, of PATH, a nonprofit global health organization. They're leaders in their communities, raising children, caring for family members. "There are countries where Ob-Gyn wards are filled with women with cervical cancer and they're dying," says Sherris. "It's very important to protect them."

To improve the odds, PATH has been testing one-stop screening and treatment programs overseas. Clinicians look for precancerous lesions, then freeze and obliterate the abnormal cells on the spot. PATH is working with partners to produce a cheaper version of the existing DNA test for HPV, which is used in combination with Pap smears in the United States. And they are assessing the logistical and economic challenges of vaccination in developing countries.

And then there's the effort led by Dr. Robert Garcea at the University of Colorado. Last summer Garcea and his team won a $3.5 million Grand Challenges in Global Health award from the Bill & Melinda Gates Foundation. The challenge: to develop an inexpensive vaccine that would protect against HPV and eradicate the virus in women who are already infected. And they hope to make the vaccine out of powder so that it doesn't need refrigeration and can be easily transported to remote villages. "It's never been done before," says Garcea. "If it works, it'll be great."

It is tempting to imagine a world without cervical cancer. "I think we should always be asking the question, Can we get rid of a scourge for future generations?" says Dr. Bill Foege, the global health pioneer who helped stamp out smallpox and is now a senior fellow at the Gates Foundation. "If we can, then it's worth all the heartache and the difficulties." With tens of thousands of women still dying, it's too early to talk about eradication, says Foege. But it's not too soon to dream.

© 2006