Cervical cancer: Give the HPV vaccine a chance Note: HPV is the abbreviation for human papillomavirus, which is a common name in the industry, so let’s follow it as well. We have received a large number of questions about the HPV vaccine recently, so here is a unified answer to 30 questions for reference. I have read through a lot of literature and there is a lot of content, so in order to make it easier to read, I have only given the main points conclusively without going into detailed discussion.1. Cervical cancer is the second most malignant tumor of female reproductive tract after ovarian cancer, with nearly 600,000 new cases and 300,000 deaths worldwide every year. Almost all (99.7%) cervical cancers are caused by HPV infection. 2008 Nobel Prize in Medicine was awarded to Harald zur Hausen, a German scientist who discovered the relationship between HPV and cervical cancer, who first discovered that HPV causes cervical cancer and conducted an in-depth study of its mechanism. This major discovery was the basis for the development of the HPV vaccine. 3. HPV infection does not only cause cervical cancer, 90% of anal cancers, 40% of vulvar/vaginal cancers and 12% of head and neck cancers are closely related to HPV infection. 4. Sexual intercourse is the main way of HPV infection, but not the only way. HPV infection is very common and the probability of being infected by HPV is very high once you start to have sex, and the rate of HPV infection in sexually active women is about 50% to 80%. There are more than 100 subtypes of HPV, divided into low-risk and high-risk types. 50% to 90% of HPV infections can be cleared by the immune system within a few months to 2 years after infection and will not lead to long-term harm.7. Only persistent infection with high-risk HPV types will progress to malignant lesions. definition of persistent HPV infection: two consecutive detections of the same high-risk HPV type at intervals of more than one year are considered to be persistent infections.8. HPV l6 and 18 are the most dominant high-risk HPV types, and 70% of cervical cancers are caused by these two HPV types, so the current HPV vaccine mainly targets these two HPV types, in other words, the current vaccine may only prevent 70% of cervical cancers.9. The HPV vaccine is the first human attempt to eradicate a type of cancer through a vaccine, which has epochal significance.10. Strictly speaking, it is not yet possible to conclude that “HPV vaccine can prevent cervical cancer” because the evolution of persistent HPV infection to cervical cancer can take up to 15-20 years, so the first clinical trial data with the incidence of cervical cancer as the study endpoint will not be available until 2020.11. The 15-year wait could mean 2 to 3 years of lost opportunities for young women to prevent cervical cancer, which is the main reason that led to the approval of HPV vaccines in Europe and the United States as soon as possible. The “do no harm and benefit” principle is the ethical basis for the approval of HPV vaccines.12 The two HPV vaccines currently available worldwide are Merck’s Gardasil and GlaxoSmithKline’s Cervarix, which have been marketed in more than 100 countries and regions and used in tens of millions of cases worldwide.13 Both vaccines have shown high long-term effectiveness (>95%) in preventing cervical cancer, precancerous lesions, and other genital diseases in women who are not yet infected with HPV, and both vaccines are currently considered to be equally effective, with Gardasil providing additional protection against genital warts such as condyloma acuminata.14 The age at which HPV vaccination is appropriate varies from country to country, or from institution to institution in the same country. The FDA-approved age is 9 to 26 years, and some agencies recommend 11 to 12 years as the best age for vaccination. Because, in the United States, sex seems to be possible at any time after high school.15 The age limit is not absolute, but depends on whether or not one has a sexual life. The HPV vaccine is most effective for women who have no sexual history, and if they are not sexually active by the age of 35, then it is cost-effective to get the vaccine at this time. No, basically, you can get vaccinated at any time, but once you start having sex, the chance of getting HPV infection increases greatly, and the official agencies feel that it is not cost-effective from the point of view of pharmacoeconomics.17. As a public policy, the official agencies will definitely consider the input benefits of immunization, which is why most countries and WHO do not recommend HPV vaccination for men from the official documents, because 1. the benefit for men is mainly the prevention of genital warts, and such diseases are not fatal; 2. it is not possible to see the effect of male vaccination on the prevention of cervical cancer in women. 18. so, regardless of whether one has had sex or not, or whether one has been infected with HPV, the vaccine is the possibility of spending money on a kind of prevention. given that HPV vaccine is not cheap, official agencies will consider the overall input-output, and individuals should also choose according to Most HPV is cleared by the body’s immune system and there is no specific drug to treat HPV, so generally HPV infection does not require treatment.20 Cervical cancer is a long process, and the cervical cancer screening technology (which includes HPV testing) is now quite mature, so regular cervical cancer screening after the age of 30 is more important for women who have already had sex or HPV infection is even more important for women who have already had sex or are infected with HPV. Unfortunately, the coverage rate of cervical cancer screening in China is less than 14% of women of appropriate age.21. Is the HPV vaccine safe? Judging from the tens of millions of uses over the past 8 years, it has stood the test. As for the more long-term safety, it will take time to answer.22.HPV vaccine is not recommended for pregnant women at present because there is not enough data to support it.23.Merck (Mercer) and GlaxoSmithKline started to apply for listing in China in 2006, and it has not been approved as of the current period. The main reason for the delay in approval of HPV vaccine in China is that China’s drug review center insists on using different criteria for judging efficacy than those of Europe, America and WHO. The view is this: since it is a cervical cancer vaccine, it is necessary to see the exact preventive effect on the occurrence of cervical cancer, or at least on precancerous lesions (cervical intraepithelial neoplasia). The average time between HPV infection and the appearance of precancerous lesions is 5 or even 10 years, so the pre-marketing clinical trials of the vaccine should take at least 5 years.25 In an article published in the Chinese Journal of Oncology in July 2013, the Center for Drug Evaluation was called upon to revise the current criteria for evaluating the effectiveness of HPV vaccines to align with Europe, the United States and WHO, and to accelerate the progress of HPV vaccine marketing in mainland China. Assuming we believe that the HPV vaccine is indeed effective, tens of millions of women of the right age in China have been deprived of the opportunity to choose preventive vaccination during the years of delayed launch. It is hard to say what is wrong with China’s new drug review system, where the rules are placed, and it is not easy to change them, requiring extraordinary competence and courage.26 Some women from the mainland choose to go to Hong Kong for HPV vaccination, and they ask if they can get the vaccination if they happen to be on their period, and the answer is yes: yes.27 The HPV vaccine is usually administered in three injections, taking a total of about six months to complete, namely The first injection at the beginning, the second injection in the second month, and the last injection after 6 months. Therefore, if you go to Hong Kong for vaccination, you have to make at least 3 round trips, and the cost of the vaccine itself is about 2,000~3,000. 28.There are some medical checkup agencies that have opened the business of HPV vaccination in Hong Kong, but whether it is worth it, please consider it by yourself according to the situation with reference to the above, in order to avoid conflict of interest, no recommendation will be made here. 29.There are also ethical arguments about HPV vaccine, for example. Some people believe that vaccinating teenagers is a disguised encouragement to start their sex lives early. If pornography cannot be banned, then we should promote sex with condoms. These people do not even understand the basic logic, but also look like they have compassion for the next generation.30. HPV vaccine is still not available in many developing countries even though it has been approved for marketing, but the vaccination rate is still not high, mainly because the vaccine is not cheap, and we have seen many articles criticizing the companies producing the vaccine for not having a conscience, but the non-monopoly free market, we should respect Companies are free to set prices. Profiteering is what gives rise to more milestone new drugs.