Offering new hope
While treatment for cervical cancer has been refined in recent years, researchers still ponder how to suppress human papillomavirus before it gets to a precancerous stage detectable in Pap smears. Last fall, a study led by investigators with the Merck & Co. pharmaceutical firm and the University of Washington found that none of about 2,400 young women vaccinated for the particularly troublesome HPV strain known as Type 16 developed either the virus or cancer. Although the vaccine is not yet ready for public use, the goal is to eventually administer it to girls before they become sexually active. The findings, reported in the New England Journal of Medicine, offer new hope and received immense media attention when they were released, but center researchers stress they should in no way be seen as a "cure."
"The singular goal for all of us should be to emphasize the importance of Pap smears to the widest possible audience."
— Michael Muto, MD
"It represents the future, but we may be looking at two to three decades before we see a real drop in cervical cancer incidence from vaccine because it is preventive; it will not be useful for women already exposed to HPV, or effective in reversing disease that has already developed," explains Christopher Crum, MD, director of women's and perinatal pathology at Brigham and Women's and a member of the Dana-Farber research staff. Crum notes that the vaccine targets just one of nearly 20 types of HPV associated with cervical cancer. Vaccines addressing a broader spectrum of virus types, as well as those designed to counter the course of disease, are in development.
"We have been collaborating with one group that is testing a therapeutic vaccine on women with precancerous disease," Crum says. "Some of our patients took part in the Phase I trial to test the vaccine's safety, and we have been serving as the center for pathology review and virus testing for the Phase II trial, which has just been completed." Crum and other researchers at DFCI and BWH are also collaborating on identifying genetic biomarkers for papillomavirus, "host" genes that are altered in some way by the virus and can signal the presence of cervical cancer.
In addition to these basic investigations, Viswanathan hopes in an upcoming study to ask cervical cancer patients which quality-of-life factors are most important to them during treatment. "I plan to assess patients who receive high-dose versus low-dose brachytherapy and see how accurate we are in explaining how they're going to feel during and after treatment," she relates. "The goal is to create a questionnaire for patients that can help us understand what they are encountering, and how we can better help them."
"[This vaccine] represents the future, but we may be looking at two to three decades before we see a real drop in cervical cancer incidence."
— Christopher Crum, MD
Technology and research are bringing the mysteries of cervical cancer closer to the surface, but Muto suggests that the major focus remain the simple, 50-year-old procedure that can best thwart it. "The singular goal for all of us should be to emphasize the importance of Pap smears to the widest possible audience," he says. "After that, everything else will take care of itself."
More information on cervical cancer is on DFCI's website,
at www.dana-farber.org/cervicalcancer
