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Vaccine development sparks debate on changes to cervical cancer screening guidelines

Durham, N.C. -- While vaccines for cervical cancer that appear to be clinically useful remain in clinical trials, an analysis by Duke University Medical Center researchers concludes that while such a vaccine could delay the need for an initial Pap test it would not eliminate the need for screening.

The researchers published their assessment of cost-effectiveness of different strategies in an article in the August 13, 2003, issue of the Journal of the American Medical Association (JAMA).

"We do not have a vaccine on the market yet, and there are many unknowns about the vaccines' efficacy and duration, but the questions about how these vaccines might change a woman's screening program are topics we can explore and debate now," said Shalini Kulasingam, Ph.D., lead author and research associate in the department of obstetrics and gynecology, Duke University Medical Center. Kulasingam is also a senior fellow at Duke's Center for Clinical Health Policy Research.

In the November 21, 2002, issue of the New England Journal of Medicine, researchers announced that a vaccine for a cancer-causing type of human papillomavirus (HPV) showed promising results. "High-risk" HPV types, which are sexually transmitted, are associated with the development of cervical cancer. In the United States this year, the American Cancer Society estimates there will be about 12,200 cases of invasive cervical cancer diagnosed and approximately 4,100 women will die from the disease.

"There are many high-risk types of HPV," said Kulasingam. "The vaccines in development target the most common types that cause cervical cancer, but they do not protect against all high-risk types. Screening will still be needed even after an effective vaccine is commercially available, but then will it be cost-effective to leave our current screening policy recommendations unchanged?"

The Pap smear currently is the screening method used to monitor for cervical cancer. Recommendations
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Contact: Amy Austell
amy.austell@duke.edu
919-684-4148
Duke University Medical Center
12-Aug-2003


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