Reported August 02, 2007

OTTAWA - Ontario announced Thursday it will begin to offer a vaccine that could help prevent cervical cancer to girls in Grade 8, a day after an article in the Canadian Medical Association Journal argued it is premature to offer the immunizations on a universal basis.

Ontario's free and voluntary program, which is to commence in classrooms this fall, will offer the Gardasil vaccine to about 84,000 young women at a cost of about $39 million a year or $117 million over three years - Ontario's share of the $300 million announced in the last federal budget for the vaccine.

Gardasil is administered in three doses over six months. "By the end of this school year, all of our Grade 8 girls will get it if they choose," said Sandra Pupatello, Ontario's Minister Responsible for Women's Issues.

The support the vaccine has received from organizations such as the Society of Obstetricians and Gynecologists of Canada and Cancer Care Ontario has trumped any misgivings, said Pupatello. "There has never been an issue around women's health that has had this level of unanimity. It wasn't a difficult decision."

Last month, Nova Scotia became the first province to introduce the vaccine in schools. The Ontario vaccinations are to be administered by public health nurses. Consent forms and information will be given to parents ahead of time.

The vaccine will not be offered retroactively for free. Girls and women who want the vaccine, but are older, will have to pay to buy the vaccine from a pharmacy and have the immunizations at a doctor's office, a process that costs about $600.

About 1,400 Canadian women will be diagnosed with cervical cancer this year, and 400 will die. The vaccine prevents two strains of human papillomavirus (HPV) a common sexually-transmitted infection responsible for 70 per cent of cervical cancers.

The Society of Obstetricians and Gynecologists of Canada cheered Ontario's move and the society has urged other provinces to follow suit, as well as to offer the vaccine to all girls and young women between the ages of nine and 26.

"Provincial and territorial governments must address the issue across Canada. We don't want a generation of girls protected in one province and not another," said the statement from said society president Dr. Guylaine Lefebvre.

But the lead author of the CMAJ article still argues there are limitations to the vaccine, and there should be more study. Among other arguments, the paper said it's hard to predict how long the vaccine will be effective and added there has not been enough of a chance to determine the vaccine's "real-world effectiveness."

The paper also suggested the vaccine may create a false sense of security and pointed out that vaccinated women will still need to ensure they practise safe sex and schedule regular Pap tests.

Clinical trials of the vaccine included 40,000 participants.

"But were they 40,000 kids in Grade 8?" asked CMAJ_lead author Abby Lippman, chairwoman of the Canadian Women's health Network and a professor in the department of epidemiology, biostatistics and occupational health at McGill University. Only about 1,200 of the participants in the trials were girls between the ages of nine and 15

"I just don't know why the rush right now," said Lippman, who contends there is no epidemic of cervical cancer.

"I was not aware that you require an epidemic to introduce a vaccine. There are no epidemics of Hepatitis A or B," said Dr. Vyta Senikas, associate vice-president at the Society of Obstetricians and Gynecologists.

Senikas said the 400 yearly cervical cancer deaths are not a small number.

"These are young women. There are 400,000 abnormal Pap smears a year," she said, adding that it takes two years to clear a patient, which usually creates a great deal of anxiety. The vaccine also protects women from genital warts, another anxiety-inducing condition.

The vaccine is already offered through school programs in Australia, some European countries and U.S. states.

"There is an overwhelming body of evidence from five years," she said. "That body can't be ignored for asking for more evidence."

Source : CanWest News Service 2007