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Young women and parents of girls as young as 9 likely will face a new question at the doctor's office: Should they accept a vaccination to protect against the sexually transmitted virus that causes most cases of cervical cancer?
"I'm going to do the same thing I did when they recommended the chicken pox vaccine. I'm probably going to follow the recommendation of my pediatrician," said Gwen Scales of Detroit, who has two teenage daughters.
The vaccine, Gardasil, was approved this month by the federal Food and Drug Administration. On Thursday, the Centers for Disease Control and Prevention's advisory committee unanimously voted to recommend Gardasil for 11- and 12-year-old girls as a routine vaccination and for girls and women 13- to 26-years-old as a catch-up.
The committee also said girls as young as 9 can be vaccinated, which has sparked debate about whether vaccination would encourage girls to be sexually active.
The vaccine is effective only before a female is exposed to the human papillomavirus, or HPV. In most cases, that means before she first has sex.
Cervical cancer is one of the most preventable cancers if cell changes are caught early. The traditional way to do this is through a Pap smear.
Some parents are opposed. Others say they will take a wait-and-see approach. Medical professionals and parents like Scales say they are optimistic.
"It's like any other vaccine. If it's something that is going to prevent them from acquiring any type of disease, I would want that," said Scales.
"It's a virus, and we have to bring it down to the scientific basis and take the emotion out of it."
Scales added that some parents might be resistant to the idea because the vaccine is to prevent a sexually transmitted disease. "But I don't see how administering a vaccination for chicken pox would make my daughter want to expose herself to chicken pox," Scales said.
Angie Smith, 43, of Farmington Hills, Mich., is the mother of three girls ages 8, 14 and 18. She said she was shocked to learn that the vaccine might be recommended for girls so young.
"We're not talking about measles, mumps, chicken pox or rubella," Smith said.
"At 9 years old, to have your child vaccinated against a sexually transmitted disease? Me personally, I would not take my child. For some parents, if you take your child to get that vaccine," it's like saying sex is OK. She said she might warm up to the idea of the vaccine for girls a few years older.
Dr. Ronald Strickler, chairman of women's health services at Detroit's Henry Ford Hospital, said he expects a challenge from some parents who say pre-teen is premature for this vaccination. He stressed that it's not just about the sexually transmitted disease, but about a proactive approach to cancer prevention.
He added that the idea is to get this vaccination incorporated into a regular immunization regimen, which typically is administered in a child's early years.
The vaccine studies report Gardasil was 100 percent effective in preventing the two strains of HPV that cause 70 percent of cervical cancer cases, and 99 percent effective against two other strains that cause 90 percent of genital warts cases.
Gardasil is the latest development in a decade of medical progress in the fight against cervical cancer. Three years ago, healthcare providers began giving women HPV tests, something that Kathy Toffolo said she wishes she had gotten.
Toffolo says she did everything right. She went for a Pap test every year. But in April 2003, just two months after her last test came back normal, an ultrasound for another condition showed spots on her ovaries. She also discovered she had invasive cervical cancer.
Today, Toffolo, 42, has been in remission for almost three years.
While Nancy Berman, a nurse practitioner, is optimistic about Gardasil, she said she wants to make sure women know that even if they get the vaccine, they still need to get health exams, regardless of their age .
"Women have been so well-taught to expect the Pap every year ¿ and we now have reason to teach women that the Pap is just part of the exam," she said.
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