Clinical Excellence
February 15, 2007
Kaiser Permanente Takes Lead in Fighting Cervical Cancer
New vaccine offered to all pre-teen female members
Kaiser Permanente is taking the lead in the fight against cervical cancer, which strikes nearly 10,000 American women and kills 3,700 each year. Beginning in October, the organization began offering the new cervical cancer vaccine, Gardasil, to female members. The vaccine is designed to target girls and young women before they become sexually active. The Food and Drug Administration has approved Gardasil for girls and women age 9 to 26.
Ruth Shaber, MD, an OB/GYN and director of Women's Health Services for Kaiser Permanente's Northern California region, said the vaccine represents a powerful new weapon in KP's comprehensive, long-term fight to defeat cervical cancer, the third most common cancer in women and one of the few that can be prevented with early detection.
Gardasil was approved by the Food and Drug Administration last June to protect against the human papilloma virus (HPV), the sexually transmitted virus that can cause cervical cancer. The vaccine prevents infection by four HPV strains. Two of the four are associated with about 70 percent of all cervical cancers. According to the Centers for Disease Control and Prevention, about 80 percent of women have been exposed to HPV by age 50, although in most cases, the immune system defeats the virus.
Because the vaccine does not protect against every HPV strain known to cause cancer, Shaber stressed that testing will remain a vital element in KP's overall preventative regime.
"It is not clear how long the immunity from the vaccines will last, so it will be very important for health care providers and women to continue with their cervical cancer screening tests," Shaber said.
Kaiser Permanente continues to push the breakthrough HPV DNA test as well as the traditional Pap smear for early cervical cancer detection. Shaber said using both tests provides a "double safety net" of protection. Recently, in the KP's Northern California region, for example, all female KP members age 30 and above who had not received a Pap smear in three years or more were contacted and encouraged to come in for the dual Pap-DNA screening.
Importantly, KP has boosted the efficacy of the Pap smear, which was developed in the 1950s to detect cell abnormalities that may indicate cancer, through a relatively new, computer-based technology that helps pathologists and laboratory technicians more effectively evaluate test results. Called FocalPoint, the application can identify rare abnormal cells that might otherwise have been missed.
The HPV DNA test was approved by the FDA in 1999, in part on the strength of a cooperative research program involving KP and the National Cancer Institute. A pilot screening of the HPV DNA test was led by Walter Kinney, MD, a gynecologic oncologist based in KP's Sacramento region.
According to Kinney, the DNA test is able to identify women who can safely avoid unnecessary, invasive procedures traditionally required with abnormal Pap smear results.
"Our goal is to improve early detection of the virus and prevent women from developing cervical cancer, the treatment of which is very difficult, both physically and psychologically," Kinney said, noting that treatment can entail a radical hysterectomy, chemotherapy and radiation therapy, and result in a loss of fertility.
