Cervical cancer vaccination

Synonyms in a broader sense

Synonyms in the broader sense: cancer of the uterine entrance, uterine cancer
English: cervical cancer / cervix cancer

definition

The cervical cancer (Cervical cancer) is a malignant degeneration of the cells in the area of ​​the cervix and is one of the second most common cancers in women (around 500,000 women / year worldwide are affected). The prerequisite for the development of this cancer is primarily an existing infection with certain types of the human papillomavirus (especially HPV types 16 and 18), which are usually transmitted through unprotected sexual intercourse. The permanent infection with the human papillomavirus initially causes inflammation of the cervix, which can lead to degenerative reactions in the cervical cells over a longer period of time.

In 70% of cervical cancer cases there is an infection with HPV type 16 or 18. But also other risk factors, like Smoketaking pills for a long time, genital infections other genesis (e.g. Chlamydial infection), a large number of Births as well as diseases of Immune system, can promote the development of cervical cancer. The main age of manifestation of this disease is between 45 and 55 years of age, whereby the infection with the human papillomavirus may be years ago and the first preliminary stages of cancer between 20 and 30 years of age within the framework of gynecological checkups can stand out.

The Cervical cancer vaccination, as a special vaccine against the cancer-causing HPV types, is aimed primarily at young women before the first Sexual intercourse (i.e. from an infection with the virus that may already have taken place) from infection with the HP viruses. It is important, however, that there are other types of human papilloma viruses that can cause cancer of the cervix - albeit much less often - against which the vaccines currently available are ineffective.

Vaccination recommendation of the standing vaccination commission (STIKO)

The Standing Committee on Vaccination of Robert Koch Institute recommends that all girls between the ages of 9 and 14 be vaccinated with the before their first sexual intercourse since 2014 bi- or tetravalent vaccine against the human papillomavirus. If the vaccination has been missed in this age period, it can be done by at the latest completed 18 years of age to be rescheduled.Women from other age groups or women who were already sexually active at the time of vaccination can also benefit from the vaccination if the infection has not yet occurred.

Vaccines

Two common cervical cancer vaccines are currently being tested, although they differ in their spectrum of activity. Both are produced using genetically modified insect or yeast cells and only contain non-infectious virus envelopes (Dead vaccine) and not that virus self.

A distinction is made between the one administered since 2007, bivalent (divalent) vaccine (Cervarix®), which is only effective against the two main risk HPV types 16 and 18 and which has been administered since 2006, tetravalents (tetravalent) vaccine (Gardasil®), which also prevents infection with HPV types 6 and 11 (these two viruses usually cause Genital warts in men and women, less cancer development). The vaccination is usually administered to the upper arm muscles by the family doctor or gynecologist, a second vaccination after approx. 6 months is then mandatory. At an age of> 13 or> 14 years or if the vaccination interval between the two vaccinations is> 6 months, a third catch-up dose must be administered.

effect

According to recent studies, the vaccines currently in use have one almost 100% effectiveness against the respective HPV types that are covered by the vaccination. After the injection of the vaccine, the body's own immune system forms antibodies against the respective virus envelopes, so that in the event of a future infection successful detection and control the virus is coming. The vaccinated women show no virus detection or malignant changes in the cervix within the next 5 years.

According to recent studies, it has even been shown that the vaccines work in some cases from other cancer-causing HPV types (e.g. HPV 45 and 31), although the vaccine does not target them directly. It is assumed that this overarching protective reaction is due to the similar virus structure, which means that the vaccine causes the immune system to recognize other viruses in addition to HPV 6, 11, 16 and 18. Whether the effect of vaccination wears off after 5 years and therefore a further booster vaccination may be necessary after 5 years, can currently not for sure be assessed. Large-scale studies address the question of the duration of protection.

Side effects

Both the bivalent, as well as the tetravalents Cervical cancer vaccination is considered to be well tolerated, so serious side effects are rare. The more common, undesirable side effects include allergic reaction at the injection needle puncture site (redness, swelling, itching) and fever. In patients with a known allergy to the ingredients contained in the vaccine, it should not be administered.

More side effects can occur nausea and Vomit, dizziness and Passed out such as Head-, Muscle- and Joint pain be. Worldwide, only five cases are reported in which inflammatory processes of the cervical vaccination occurred Central nervous system has come. A direct connection could not be proven at the moment, just as little as in the case of the only two deaths of girls who had undergone vaccination.

Preventive vaccination against cervical cancer

Vaccinations against cervical cancer.
Following promising results in animal experiments, scientists have now been able to demonstrate in clinical studies that a newly developed vaccine will survive great effectiveness at minor side effects excels.
The vaccine consists of proteins derived from those from the Envelope of the human papillomavirus (HPV).
Vaccination makes that immune system stimulated, self-protecting proteins (so-called. antibody) against the cancer to produce triggering viruses, comparable to training.
The effect of the vaccination is reinforced by an auxiliary substance that also activates the immune system (a so-called. Adjuvant).
Effective protection over 4.5 years for women between 25 and 55 years has been proven.

Discussion about vaccination

Studies show that the vaccine is a almost 100% effectiveness against the Precursors of cervical cancer shows if vaccinations are given before the first sexual contact.
However, vaccination is controversial in Germany.
This is due to the following points of contention. If a woman becomes infected with an HPV virus, it does not immediately mean that she will develop cervical cancer.
The chance of getting cancer through infection with the HPV virus is less than 0.1%. Usually the body's immune system fights the virus and the infection heals on its own within 12-15 months on average.
Even if it is not successfully fought by the immune system, a so-called occurs first Dysplasia, a change in cells long before cancer arises.
These dysplasias can be divided into different stages. It often takes up to 10 years for cancer to develop from stage one.
In Germany women are encouraged to visit a gynecologist about once a year, who uses a smear to look for these cell changes.
So if a woman is infected with HPV and the cells change slowly, so will it mostly discovered long before cancer develops.
The infection rate of sexually active women in Germany is over 50%, therefore mostly only young patients to a cervical cancer Vaccination advised.

It is often assumed by vaccinated patients that they are no longer used Cancer screening have to go because they have been vaccinated.
However, this is a common misconception. Cancer can develop without HPV and can also be triggered by other non-vaccinable HPV strains. It is therefore advisable for every woman to visit her doctor regularly and have herself examined. In addition, like any other vaccination, the vaccination only has a preventive effect and not if cervical cancer already exists.
This means that the HPV vaccination no longer works if the patient already has cervical cancer or has contracted the HPV virus.

Despite the low chance of developing cancer, it may be advisable to get vaccinated. As mentioned above, it is a long way from infection to cell change to cancer development, but in over 50% of all cell changes of grade two and three HPV viruses were detected.
The HPV viruses can also cause other cancers, such as:

• Oral cancer
• Cancer of the anus
  and
• Cancer of the penis

trigger. Therefore, many studies are currently being carried out to see whether boys / men would also benefit from an HPV vaccination.

HPV 6 and 11

The HPV 6 and HPV 11 are for over 90% all Genital warts responsible, so vaccination could significantly reduce the number of sick people here as well.
Because studies show here too that through a vaccination almost 100% of women can be protected from infection.

Implementation of the vaccination

Overall should be vaccinated with cervical cancer vaccinated three times become.
Vaccination takes place in the muscle, for example on poor. The second vaccination takes place after two months, the third after three months. New study data show that vaccination at least 5 years whether it should be vaccinated again afterwards is not yet certain.

costs

In Germany are statutory health insurance companies are to it obliged to pay for vaccinationsrecommended by STIKO.
Hence the costs from approx. 170 euros accepted.
Private health insurance companies are not obliged to do so, it depends on the respective health insurance company whether the costs for the HPV vaccination be taken over.

Since 2014, the health insurances have been obliged to fully cover the vaccination costs for girls between the ages of 9 and 14. The costs of missed vaccinations that want / should be made up for by the age of 18 are also covered by many health insurance companies. Different age groups should inquire in advance with the respective health insurance company about possible reimbursement of costs, in some cases costs are even reimbursed up to the age of 26.

The cost of each vaccine administered is approx. 160 euros, which leads to a total price of approx. 320 euros for complete vaccination protection through two vaccination doses. The total annual costs for Germany are between 130 and 200 million euros.

Side effects

Side effects: The vaccination itself is well tolerated and shows only minor side effects. There may be redness and slight pain at the injection site. In addition, flu-like symptoms such as headache and body aches, as well as nausea and muscle pain can occur.

Fatigue and a gastrointestinal problem were also reported as undesirable side effects. There were no deaths directly related to the HPV vaccination. A connection with thrombosis and the Guillan-Barre syndrome could not be proven. Cervical cancer cannot be caused by vaccination.

Summary

The Cervical cancer vaccination is a vaccination against Viruses, the Genital warts and cervical cancer can trigger.

It is supported by the STIKO, Germany's vaccination commission girl between the ages Recommended for ages 14 and 17. However, it can also be carried out earlier.
The vaccination will too HPV vaccination called. HPV stands for Humanes Papillomavirus. This virus can be transmitted sexually and should therefore be vaccinated before the first sexual contact.
There are hundreds of different types of HPV, including: HPV Type 16 and 18 but responsible for over 70% of cancers.
There are two types of cervical cancer vaccinations.
Once a two combination fabric who vaccinated against types 16 and 18 and then another four-person station wagon, which also contains types 6 and 11.
HPV types 6 and 11 are said to be primarily involved in genital warts.

Since the Cervical cancer vaccination (HPV vaccination) does not offer 100% protection, it cannot replace preventive smear tests (the vaccine so far only works against the two most dangerous ones, for about 70% of all cancers of the cervix responsible for high-risk types of the virus).
Broad vaccination programs are planned for the population, as the human papillomavirus infection is high: Between 70% and 80% of all women in Germany, Austria and Switzerland will be with in the course of their lives HPV infected.
As a rule, the infection heals itself within 12 to 18 months, so that a positive test for the virus, for example, is in no way linked to an existing or later developing cancer.
However, it is important to note that a vaccination is only of a preventive nature: an infection with the virus cannot be cured by it.
Therefore, it is planned, especially the age group of 12 to 14 year olds (puberty) vaccinate before the first sexual contact.
Not only girls but also boys would benefit from the vaccination.
The HPV vaccine is also said to protect against the viruses that cause benign genital warts (related to the cervical cancer but are harmless and are therefore referred to as low-risk types).
The future goal is to use vaccinations to limit cervical cancer and all preliminary stages to a minimum that can no longer be reduced.