Vaccination to prevent cervical cancer launched in Czech Republic

Fifteen-year old Anna Jicinska, a high school student from the city of Brno, was the first girl in the Czech Republic to be vaccinated against the human papillomavirus - the primary cause of cervical cancer which kills around 500 women every year in this country.

Anna got the first of three shots on Tuesday in Prague, and says it was just like any other vaccination. It was Anna's mother's idea to get her daughter vaccinated and she also paid the costs. The price of the three doses needed for a person to develop a sufficient level of antibodies is around 10,000 crowns (475 US dollars).

"Since I started enquiring about the vaccination, I have been aware it is not going to be cheap. It is quite a lot of money but health prevailed over money. I consulted a number of experts, including paediatricians, and had only positive response from them in the sense that this is the best we can do in the way of prevention," Anna's mother, Katerina Jicinska, says.

Cervical cancer is the second-most common type of cancer suffered by women worldwide. It begins in the lining of the cervix where normal cells can develop pre-cancerous changes that can turn into cancer. This process usually takes several years but in some cases the development can be very rapid. The condition can be successfully treated while still at a pre-cancerous stage. So far, the only method of prevention was regular smear tests, used to detect infectious, premalignant, and malignant processes, usually caused by sexually transmitted human papillomaviruses (HPVs).

Special tests can also detect the presence of the human papillomavirus itself. Around 80 percent of women are believed to come into contact with the virus at some stage of their life but in most women, their immune system can deal with the infection over a few years. Around 3-5 percent of women in whom the virus persists face an increased risk of developing cervical cancer.

The Czech Republic, together with the other countries which joined the EU in 2004, has a very high incidence of cervical cancer compared to the old EU member states. Some 1,100 women are diagnosed with the disease every year, 500 of those die. Czech doctors agree the alarming levels need to be reduced and vaccination could play an important part in the process.

Dr. Lukas Rob is the head of the onco-gynaecological ward at Prague's Motol Hospital and also the vice president of the European Society for Gynaecological Oncology. He is a staunch advocate of blanket vaccination of young girls between the age of 11 and 14: that is, before their first sexual intercourse. It is vital that girls should be vaccinated before they begin their sexual life because if they have already come into contact with the virus, the vaccine would be ineffective.

"In the Czech Republic, we have a relatively long term high incidence of cervical cancer. For example, now the incidence is 20 per 100,000 women and, for example, in Great Britain it is less than 7. Among the white population in the United States, the incidence ranges between 6 and 8 and among the black population it ranges from 13 to 16. In the Czech Republic and other post-communist states in the EU have an incidence higher than 20."

Why is that?

"It is very difficult to explain. For example in all these countries, we have so-called annual preventive gynaecological examinations, annual screening, but it is not really screening. We have no organisation of this process, we have no central evidence of the cytological labs. We have very many small cyto labs. The same situation is in Germany and Germany has an incidence of 15. The European Union average is less than ten. The problem is that we need big new cyto labs with a high quality. Maybe in the future we will need HPV tests together with the cytological smear tests. And that's why it is very important to open a discussion about vaccination in the Czech Republic."

The vaccine is to prevent the development of cervical cancer. How does it actually work?

"Ninety-nine percent of the cases of cervical cancer and pre-cancer lesions are associated with the high-risk HPVs. This vaccine is effective against type 16 and type 18 and approximately 75 percent of women in Central European countries are infected with these two types. But the remaining 25 percent are other types. This vaccine is against these two most prevalent types in Europe."

Is the vaccine going to be covered by insurance?

"I think that it is not a good idea. I think it is necessary to open a discussion about including the vaccine in the vaccination programme in the Czech Republic for the age group between 11 and 13. If older women want to pay for this vaccine, it is OK, but I think that only the vaccination of a whole group of 11-year-old girls is a good idea for the future."

Is it realistic that a whole age group get vaccinated?

Photo: David Vaughan
"I think it is necessary to vaccinate the age group below 15 years of age. We know that before the first intercourse, the effect of this vaccination is greater than if we postpone it until after the first intercourse."

What is the situation with vaccination in the Czech Republic's neighbouring countries?

"Now it is open because the European approval is just one month old and in the US it's been six months. But for example, the guidelines of the US society of onco-gynaecologists say this vaccination should be implemented. But now there is a discussion with the government about the payment. Because if the government did not support it, I think that for the future, the role of the vaccine would be very small, because it is very expensive."

Doctors say the effect of the vaccination will be seen in 20 years time at the earliest, when the girls who get vaccinated today reach an age at which the disease is most often diagnosed. Meanwhile, doctors maintain, regular screening tests remain a vital preventative measure against cervical cancer.