This information is about vaccines to prevent a virus called the human papilloma virus (HPV), which can cause cervical cancer.

About 3000 women are diagnosed with cervical cancer in the UK each year.

A vaccine to help prevent cervical cancer would be a major step forward in womens’ health. It is hoped that the vaccines will prevent at least 70% (seven in ten) of the most common type of cervical cancer (squamous cell).

The vaccines work by preventing infection with the human papilloma virus (HPV).

The human papilloma virus is a common virus. Over 100 different types of HPV have been identified and each is known by a number. HPV affects the skin and the mucosa (the moist membranes that line the body; for example in the mouth, throat, anus and cervix).

Some types of HPV cause harmless skin warts (papillomas) that can appear on the hands and feet. Types 6 and 11 affect the genital area and can cause genital warts but they do not cause cervical cancer. These types are called low-risk HPV.

Other types of HPV are known to increase the risk of developing particular cancers and are referred to as high-risk HPV. Types 16 and 18 are high-risk types that can lead to abnormal changes in the cells of the cervix (known as cervical intraepithelial neoplasia or CIN). CIN is not cancer, but in some women it can develop into cancer over a number of years if it is left untreated. Treatment for CIN works very well and the risk of it coming back is low.

HPV infection of the cervix is mainly diagnosed in women as a result of the cervical screening programme. A woman may be told that she has HPV when she receives her cervical screening result. If HPV infection is present, changes in the appearance of the cells can sometimes be seen when they are looked at under a microscope during the screening process. Some women who have an abnormal smear test result will attend a colposcopy clinic, where their cervix will be examined using an instrument like a microscope (a colposcope). During the examination, the nurse or doctor can apply a solution to the cervix that makes cells infected with HPV turn white.

Most women have HPV at some point in their lives without it causing any harm. There is no treatment for HPV, but our own immune systems can usually get rid of it quickly by themselves.

The most important thing women can do is to have regular cervical smear tests. These will pick up any abnormal cell changes which can be easily treated before they develop into cancer.

Researchers have been testing two vaccines to prevent infection with HPV. These are called Gardasil® and Cervarix®.

Gardasil® protects against four types of HPV:

• 16 and 18 (high-risk for cervical cancer)
• 6 and 11 (low-risk for cervical cancer but causes genital warts).

Cervarix® protects against HPV types 16 and 18.

Both vaccines are licensed (doctors can prescribe them) in the UK. Gardasil® can be prescribed for women between the ages of nine and 26. Cervarix® can be given to women aged between 10 and 25.

The vaccines don’t protect against all types of HPV (and women may be infected with more than one type), so it is not guaranteed that they will prevent cervical cancer. It is, however, expected that vaccination will prevent most of the more serious precancerous changes (CIN 2 and 3). Gardasil® is also expected to prevent most genital warts.

They are given by injection into the muscle, usually the upper arm or thigh. Three separate doses are needed. The second and third doses are given two months and six months after the first dose.

Both vaccines appear to have few side effects.

The main ones include:

• redness at the injection site
• pain and swelling at the injection site
• a raised temperature.

No, there’s no evidence that the vaccine works in anyone who has HPV infection or abnormal cells changes in the cervix (CIN). Women who are over 21 years old are advised to have a cervical smear test before immunisation with the vaccine.

Women will still need to attend their routine cervical smear tests. This is because there are other types of HPV linked with cervical cancer which the vaccines are not active against. The vaccines are not a substitute for cervical screening.

It is very important that women continue to go for regular cervical smears. The national cervical screening programme has been very successful since it started in 1988 and is thought to have halved the number of women diagnosed with cervical cancer in the UK.

• How many cases of cervical cancer will be prevented by vaccines that only protect against some types of HPV.
• How long the vaccine is protective for. We need to know this to find out if and when booster vaccines will be needed.
• Will other types of HPV take over and become more active in causing CIN?
• Should boys eventually be immunised as well as girls? The vaccines will be of more benefit to females and it is presently unknown whether they work for males.

From September 2008, all 12-13 year-old girls in the UK will routinely be offered HPV vaccination. Starting in the autumn of 2009, there will also be a 'catch-up' programme to vaccinate girls under 18. In Scotland, routine vaccination is planned to start in late 2008.

It is also possible to obtain the vaccines privately.

This section has been compiled using information from a number of reliable sources, including:

• Human papillomavirus (HPV) and cervical cancer - the facts. Royal College of Nursing. October 2006
• Cervical cancer, human papillomavirus, and vaccination. BMJ. Vol 331 October 2005
• CancerHelp UK website www.cancerhelp.org.uk accessed January 2007.
• Knowledge of cervical cancer and the HPV vaccine. British Journal of Nursing 2006, Vol 15. No 3
• HPV vaccines and Screening in the Prevention of Cervical Cancer. Vaccine. Volume 24, supplement 3 Pages v–vi 31 August 2006.

For further references, please see general bibliography.