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Experts: HPV Vaccine a Preteen Priority

Study Shows Vaccine Is Cost-Effective When 12-Year-Olds Are Vaccinated

HPV Vaccine: Second Opinion

In an editorial accompanying the study, Charlotte J. Haug, MD, PhD, editor-in-chief of the Journal of theNorwegian Medical Association, has a cautionary note. "The bad news is that the overall effect of the vaccines on cervical cancer remains unknown," she writes.

She points out that although two strains of HPV -- 16 and 18 -- are thought to account for the majority of all cervical cancers and are targets of the HPV vaccine, other strains may emerge as cancer-causing, too.

"We do not know enough about this vaccine yet," she tells WebMD.

In July 2008, the CDC and FDA reported that they had received 7,802 reports of adverse effects in those vaccinated with Gardasil, although the vaccine was not proven responsible for any of those events.

"But it's a very interesting concept and we should definitely go on doing controlled research and see if this is going to work," Haug says. "We are vaccinating young girls, and we are going to see the effect in a couple of decades."

"Vaccine duration is the critical parameter to determine if HPV vaccination is cost-effective," says Diane Harper, MD, professor and director of the Gynecologic Cancer Prevention Research Group at Dartmouth Hitchcock Medical Center and Dartmouth College in Hanover, N.H.

That will take time, she and others acknowledge. Meanwhile, "we have to educate girls and women that the vaccine must be used with the current screening system and is not a substitute for lifetime continued Pap screening," Harper says.

HPV Vaccine: Industry View

The new analysis underscores what the CDC has already recommended in terms of widespread vaccination of preteen girls, says Rick Haupt, MD, MPH, executive director of clinical research at Merck Research Laboratories in West Point, Pa. Merck makes Gardasil.

While the Harvard model didn't find it cost-effective to vaccinate up to age 26, the Merck model does show value in vaccinating up to age 26, says Haupt, who explains that models used in the analyses are complex and can differ.

As to fears expressed by Haug in her editorial that the effectiveness of the vaccine is not known, he says Gardasil was tested during clinical trials on precancers of the cervix and localized cancer and was "virtually 100% effective."

Haug's concern that some other HPV types besides HPV 16 and 18 will turn out to play a major role in causing cervical cancer is unfounded, Haupt says. "The idea of type replacement is theoretical at best."

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