JEREMY PEPPAS

The year started with great promise for those engaged in the fight against cervical cancer in Arkansas.

A press conference was held in the capitol rotunda. Lt. Gov. Bill Halter was there, along with members of the Arkansas Cervical Cancer Task Force. All united in their fight against cervical cancer.

One way to beat the disease early is to get vaccinated against the human papillomavirus, more commonly known as HPV, so state Sen. Sue Madison (D-Fayetteville) took the obvious step and filed Senate Bill 954 on March 5. The title?

"An act to require the Division of Health to provide vaccinations against the human papilloma virus to each girl 12 years of age and older."

Much like the Schoolhouse Rock song, it became a bill, just a bill, sitting up on Capitol Hill. Well, more like languished on Capitol Hill until March 27, when it was withdrawn from committee and then, later that day, withdrawn by Madison.

Not acting on Senate Bill 954 was not necessarily a wise move. In Arkansas, cervical cancer has been deadly. The state ranked fourth nationally in mortality and the vaccine has been demonstrated to be effective against some strains of HPV, which causes cervical cancer.

But, there isn't enough vaccine in the state to immunize everyone, said Dr. Richard Nugent, who serves as Chief of the Family Health Branch, Division of Health Services with the Department of Health and Human Services (DHHS). Nugent has been an ob/gyn for 35 years. "It could take years to get enough for everyone who wants it," he said. "In the meantime, it will be voluntary. Those who express an interest will get the shots until the supplies run out."

The most commonly used vaccine for HPV is Gardasil®, manufactured by Merck.

Nugent added that Merck was confident the pharmaceutical giant would be able to produce enough Gardasil to satisfy the demand. But, he added, "It would take a year or two."

In some ways, Gardasil is not a magic bullet.

"It protects against four strains," Nugent said. "You actually have over 100 (strains) and at least 30 cause cervical cancer. The strains 16 and 18 are most prevalent and account for 70 percent of the cancers."

So what's the controversy? Why did a Senate bill that could have obvious health advantages fail?

It has to do with the recommended age of the girls who would get vaccinated.

"We have to pick the target population that would benefit the most," Nugent said. "And that's going to be the girls as recommended by the CDC."

"That's why we will be likely concentrating on girls 12 years of age. As they enter junior high, and in most cases before they have had sexual intercourse or their sexual debut. That way, you catch girls before they are exposed to the virus."

Smart, practical, sensible even. But no one ever said the Arkansas legislature was full of sensible people.

But it looks like the federal government is going to provide another option.

"In the state of Arkansas, about 66 percent of children get their immunizations through the Vaccines for Children Program, which is funded by the federal government," said Dr. James Phillips, who also works for DHHS and is Branch Chief Infectious Diseases. "We are making the vaccine available for the children who are eligible."

Of course for women who are past the age for the vaccine, the annual Pap smear is the best defense against cervical cancer.
"I would say it was pretty standard in the annual physical exam," Nugent said. "Some women just don't get Pap smears and that's the population that gets cervical cancer. About half of the women who had cervical cancer hadn't ever had a Pap smear."

The last year with available numbers was 2004, and Arkansas saw 138 cases of cervical cancer with 56 deaths that year. The incidence rate was 9.9 per 100,000.

Nugent's figures suggest that half of those cases could have been avoided.



May 2007