Cancer Care Ontario's Statement on the Ontario HPV Vaccination Program

    TORONTO, Oct. 5 /CNW/ -

    Cancer Care Ontario's Position

    Cancer Care Ontario supports Ontario's voluntary school-based
immunization program to deliver the Human Papillomavirus (HPV) vaccine to
grade 8 females.
    Cervical cancer is preventable. Yet year after year, about 500 women are
diagnosed with cervical cancer and about 150 women die from this disease in
Ontario. Some 5,600 women in Ontario are living today with a diagnosis of
cervical cancer (prevalence). Even if abnormal Pap tests or cervical cancer
are successfully treated, the follow-up testing and treatment of cervical
cancer have consequences to individuals and the health system. The disease and
its treatment can result in significant psychological, economic and social
costs, including infertility in some cases.
    The school-based HPV vaccination program is a ground-breaking step in
women's health. For the first time we have a vaccine that can block HPV
infections before they occur. This is important because persistent HPV
infection can lead to cervical cancer if early cell changes are not found and
treated. The currently approved vaccine, Gardasil(R), prevents two HPV types
that cause up to 70 per cent of cervical cancers.
    Cases of and deaths from cervical cancer have gone down by over 60 per
cent in the last 30 years, mostly due to screening using regular Pap tests.
However, about 20 to 30 per cent of women are seldom or never screened for
cervical cancer. Also, no screening method is 100 per cent effective.
    With regular Pap tests and the HPV vaccine, it is possible to eradicate
cervical cancer.
    Gardasil(R) has been extensively tested for over 5 years in international
studies involving over 20,000 women. The vaccine has passed the same rigorous
evaluation process required of all new drugs in Canada.
    The HPV vaccine does not replace Pap tests. The HPV vaccine program is
just one part of cancer prevention. It is critical that HPV vaccination be
accompanied by efforts to increase awareness of the need for regular
screening, particularly among under-screened populations.
    The program must also be part of an overall disease management effort for
cervical cancer, including a comprehensive information system that fully
evaluates the impact of the program on cervical cancer in Ontario. The
Ministry of Health and Long-Term Care will work with Cancer Care Ontario to
develop an evaluation plan for the program.
    HPV vaccination can help save lives that are currently lost to cervical
cancer. That is why Cancer Care Ontario believes it should be considered for
all females between 9 and 26 years of age.

    Evidence Regarding the HPV Vaccination

    HPV vaccine is almost 100 per cent effective in preventing infection with
four HPV types, which are responsible for 70 per cent of cervical cancer cases
and 90 per cent of genital warts.
    In the international studies for the currently available vaccine, reports
of adverse events were similar among those who received the vaccine and those
who were given a placebo.
    National immunization advisory bodies in the U.S. and Canada's National
Advisory Committee on Immunization support HPV vaccination in females aged 9
to 26. In addition to Cancer Care Ontario, the Canadian Cancer Society and
professional organizations including the Council of Medical Officers of Health
(Ontario), Gynecological Oncologists of Canada and the Society of
Obstetricians and Gynaecologists of Canada strongly endorse the use of this
vaccine in females in this age group.
    Since most women and men will be sexually active at some point in their
lives and HPV infections are very common, it is essential that girls are
vaccinated before they become sexually active. HPV infection can occur with
only one exposure from a partner with HPV. This is true whether sexual
activity occurs before or after marriage.
    Grade 8 was chosen for the program because the HPV vaccine is most
effective if received before sexual activity. There is no evidence that
education efforts accompanying the program will encourage earlier sex or
    It will be crucial to monitor and evaluate screening participation rates
among vaccinated females, any adverse events as well as the program's impact
on future incidence of HPV infections and cervical cancer.
    HPV is associated with other cancers, including cancer of the penis,
anus, vagina, vulva and some oral cancers. Therefore, it will be important to
assess the vaccine's potential role in the prevention of these other cancers.

    Regular Cervical Screening is Essential

    The HPV vaccine does not replace cervical cancer screening. Even if
vaccinated, women still need regular Pap tests because the vaccine does not
protect against all cancer-causing HPV types.
    Most women have already been exposed to HPV and need to be screened.
About 3 out of every 4 people - males and females - who have had sex have been
exposed to HPV. While most women with HPV do not develop cervical cancer, some
persistent HPV infections lead to cancer.
    A significant number of newcomers to Canada are from regions with very
high rates of HPV infection and cervical cancer, including Africa, the
Caribbean, Central and South America and Asia. Thus women arriving from these
countries with pre-existing HPV infection may not benefit from the vaccine and
will need to have access to regular cervical screening.
    Regular cervical screening is an essential defense against cancer. Since
HPV infections seldom cause any symptoms, screening is the only way to detect
changes that might lead to cancer.
    Cervical screening can detect early cell changes on the cervix that could
progress to cancer. These pre-cancerous cells can then be treated to try to
prevent cancer. The Pap test also finds cancer early when it can be treated
and cured.
    At least 20 per cent of women are seldom or never screened. These women
tend to be over 50, Aboriginal, of low income or of low literacy. They may
also be newcomers to Canada, especially if they arrive from countries without
cervical screening programs. Cervical screening rates have been at a
stand-still in Ontario for the last five years.
    Ontario needs to intensify efforts to ensure that all women participate
in regular cervical screening, even if they have been vaccinated. In
particular, we need more effective strategies to reach vulnerable populations.
Implementing a comprehensive cervical screening information system will
increase access to screening for all women and allow for enhanced health
promotion and social marketing efforts that are targeted, community-based and
culturally sensitive.
    In conclusion, Cancer Care Ontario believes that the resources invested
in a screening and HPV vaccine program are justified because of the potential
to spare hundreds of Ontario women every year from suffering, long-term
consequences and death from this preventable disease.

    "Terrence Sullivan"        "Carol Sawka"            "Verna Mai"
    (signed)                   (signed)                 (signed)

    Terrence Sullivan, PhD     Dr. Carol Sawka          Dr. Verna Mai
    President and CEO          Vice President,          Director, Screening
    Cancer Care Ontario        Clinical Programs        Cancer CareOntario
                               Cancer Care Ontario

For further information:

For further information: Cancer Care Ontario, Action Cancer Ontario, 620
University Avenue, Toronto, ON, M5G 2L7, T (416) 971-9800, F (416) 971-6888,

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