Jewish World Review Nov. 22, 2002 / 17 Kislev, 5763

New vaccines may eliminate cervical cancer

By Robert A. Wascher, M.D., F.A.C.S. | Cervical cancer is the sixth most common cancer to occur among American women, accounting for 6% of the cancers seen in women. In many countries where Pap smears are not routinely performed, cervical cancer is the most common cause of cancer-related death among women. Approximately 13,000 new cases of cervical cancer are diagnosed in the United States each year, while more than 50,000 new cases of precancerous changes in the cervix (called carcinoma in situ) will also be identified annually. Currently, about 2% of all cancer deaths are due to cervical cancer in the United States.

In the past, I have reported on promising progress in the development of a vaccine against the strains of human papilloma virus (HPV) that are thought to cause more than 90% of cervical cancers. As many as 70% of sexually active adults have been infected with at least one strain of HPV. While not all HPV strains have been associated with an increase in the risk of cervical cancer, as many as 20% of adults are infected with the cancer-causing HPV type-16, which has been linked with cancers of the cervix and anus in as many as 1% of the infected population. Thus, the development of an effective vaccine against HPV type-16 has been an area of intense research.

In this week's New England Journal of Medicine, Harvard Medical School scientists report on their initial evaluation of a new HPV type-16 vaccine. Nearly 2,400 young women (ages 16 to 23) participated in the study. Each volunteer was randomly assigned to receive a total of either three vaccine injections or three placebo (salt water) injections. All study volunteers received frequent Pap smears for a median duration of about 18 months. The HPV type-16 status of each woman before and after the injections was assessed using a test (RT-PCR) that detects and amplifies fragments of DNA from HPV type-16. Among the volunteers who received the placebo injections, persistent HPV type-16 infection was detected in a significant number of the women. Nine cases of precancerous cervical lesions were also identified among the women who received the placebo injections, and who were concomitantly diagnosed with HPV type 16 infections. In contrast, none of women who received the vaccine went on to develop HPV type-16 infections, and none of the women in the vaccine group developed precancerous changes in the cervix, during the course of this study.

This study is a significant breakthrough in cancer prevention, and the potential impact of its findings will be of great importance in the United States. In less developed countries, the potential public health impact will be even greater. In developing countries where Pap smears are not routinely done, as many as 25% of all cancer deaths in women occur secondary to cervical cancer. While the link between most other cancers and viral infection is not as strong as it is for cervical cancer, the development of an apparently effective vaccine against the oncogenic HSV type-16 will continue to fuel research and development of cancer prevention and treatment vaccines.

At my own parent institution, the John Wayne Cancer Institute, a vaccine against melanoma is undergoing international trials and has enrolled thousands of patients with melanoma. The cancer immunologist's dream of a safe, nontoxic and effective vaccine against all cancers is still many years away. However, this report on the striking efficacy of a new anti-HPV type-16 vaccine is very good news, indeed, and offers hope and inspiration for further progress in this field.


Readers of this column are already well-informed about recent research that has deconstructed much of the decades-long mythology regarding postmenopausal hormone replacement therapy (HRT). So, it should come as no surprise that another study has come along debunking previous claims for HRT's manifold therapeutic benefits. In this week's Journal of the American Medical Association is a report on the impact of HRT and antioxidant vitamins on the progression of coronary artery disease in postmenopausal women.

The study evaluated 423 postmenopausal women with at least one narrowed coronary artery, and followed these volunteers for at least three years. One group of women received supplemental estrogen (the women in this group who still had their uterus also received progesterone). A second group received 400 IU of vitamin E and 500 mg of vitamin C twice daily. The third and final group received placebo (sugar) pills. The study volunteers were then followed by regular clinical exams during the study, and by a follow-up coronary angiogram at the end of the study.

The results of this study reinforce those of the pivotal Women's Health Initiative Study findings that were published in July of this year: the women who were randomized to receive HRT in this new study not only failed to experience any coronary artery disease protection from their hormone supplements, but their coronary artery disease actually appeared to progress more rapidly, on the average, when compared to the women who received the placebo pills.

The women receiving antioxidant vitamins also appeared to experience an increase in the rate of coronary artery narrowing when compared to patients receiving only placebo pills. While these differences failed to reach statistical significance in this relatively small study, its results are nonetheless quite intriguing. What is especially compelling about this study is that the progression of coronary artery disease (CAD) in these patients with preexisting CAD was objectively measured using coronary angiograms.

When the researchers looked at the incidence of vascular disease complications among the study volunteers, they noted a statistically significant two-fold increase in the risk of heart attacks, strokes and death among the women receiving HRT. The women receiving the antioxidant vitamins also tended to have a higher number of these serious events, although such findings were not statistically significant.

Although intriguing, this study involved women who had preexisting CAD, enrolled a relatively small number of volunteers, and evaluated them over a rather short duration. This study should, therefore, be repeated, and should also include postmenopausal women without preexisting coronary artery disease, and should encompass larger numbers of volunteers, and a longer duration of follow-up.


Previous studies have shown a slight increase in the risk of developing breast cancer among women who consume more than two or three alcoholic drinks per day. HRT has also been shown to significantly increase the risk of developing breast cancer with prolonged use. In the current issue of the Annals of Internal Medicine, more than 44,000 women are being followed over an extended period of time to study the incidence of index diseases, including breast cancer.

The women participating in this study were followed between 1980 and 1994, and reported their use of HRT and their intake of alcohol on a regular basis. During the study period, 1,722 of the women developed breast cancer. When the researchers analyzed the impact of alcohol intake and HRT use, they found that the women who took HRT for five or more years and did not drink alcohol had a 32% increase in the risk of developing breast cancer when compared to the women who did not take HRT or alcohol.

Among the women who never used HRT but who consumed at least 1.5 to 2 alcoholic drinks per day, the risk of breast cancer was increased by 28% when compared to teetotalers who had never used HRT. Women who used HRT for five or more years and consumed at least 1.5 to 2 alcoholic drinks per day experienced a 99% increase in the risk of developing breast cancer, or a nearly two-fold increase above the level experienced by women who did not drink alcohol and did not use HRT!

This study adds persuasive evidence to support previous findings of a link between breast cancer risk and HRT, and between increased alcohol consumption and the risk of breast cancer. This study also suggests that the combination of HRT and two or more alcoholic drinks per day are additive in terms of their effects on breast cancer risk.


Annals of Internal Medicine: Many women are using non-prescription non-HRT herbal remedies to try and combat the side effects of menopause. However, research into the efficacy and safety of these alternative treatments has been sporadic at best.

An extensive review of published research on this subject was undertaken in an effort to draw some meaningful conclusions. Dong quai, evening primrose oil, Chinese herb mixtures, vitamin E and acupuncture did not appear to provide any objective improvement in hot flashes and other menopausal symptoms.

Soy appeared to be modestly effective, while isoflavone preparations did not appear to be as beneficial as soy. Black cohosh appeared to offer substantial relief of hot flashes, but long-term safety information was lacking in previously published reports.

Both soy (and its derivative isoflavones) and black cohosh may exert their therapeutic effects by stimulating estrogen receptors in the breast and uterus, and the increased risk of developing cancer of these organs with chronic use of these supplements is unclear in studies published to date. These concerns can only be answered through additional well-designed randomized research trials.

JWR contributor Dr. Robert A. Wascher is a senior research fellow in molecular & surgical oncology at the John Wayne Cancer Institute in Santa Monica, CA. Comment by clicking here.


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11/08/02: More Good News About Statin Drugs; Hormone replacement Therapy (HRT) & Alzheimer's Disease; A Role for Antibiotics in the Treatment of Vascular Disease?; more

11/01/02: Digoxin & gender; driving & degenerative disc disease; Coenzyme Q10 & Parkinson's Disease; Ginseng & erections; Viagra & stroke

10/25/02: Aspirin & coronary artery bypass surgery; glucosamine sulfate & progression of knee arthritis; hospital nurse staffing & patient mortality

10/18/02: Motor Vehicle Exhaust Pollution & Mortality; CT Scans, C-Reactive Protein & Heart Disease; Antiperspirant Use & the Risk of Breast Cancer; Atomic Bomb Radiation Exposure Update; more

10/04/02: Antioxidants & the Risk of Stomach Cancer; Best Way to Diagnose Appendicitis?; Coronary Artery Disease: Stent or Surgery?

09/27/02: Breast Feeding & the Risk of Asthma; HMOs & Quality of Care Scores; Red Wine & Vascular Disease

09/20/02: Dietary Folate & the Risk of Colorectal Cancer; Risks Associated with Smoking after Heart Attacks; BRCA1 Gene Mutation & the Risk of Breast & Non-breast Cancers; Breast Tissue Density & Inheritance

09/13/02: Dairy Products, Calcium, Vitamin D & the Risk of Breast Cancer; Efficacy of Nonprescription Smoking Cessation Aids; A Nutty Approach to Heart Disease Prevention; Update on Prostate Cancer

09/06/02: C-Reactive Protein & Estrogen Replacement Therapy; Walking Women & Cardiovascular Disease; Physical Activity Among Teenaged Girls

08/30/02: Babbling babies & brain function; homocysteine levels, vitamins & coronary artery disease; St. John's Wort & chemotherapy

08/16/02: A New Weapon Against Anthrax?; cataracts & motor vehicle accidents; gingko biloba takes a hit; air pollution & heart function during exercise; breast cancer genes & the estimated risk of breast cancer

08/09/02: Botulinum Toxin & Post-Stroke Spasticity; Intestinal Hormone Kills Appetite; Bone Marrow Cells Improve Blood Flow in Vascular Disease; Effectiveness of Restraining Orders on Domestic Violence

08/02/02: Mammography Saves Lives!; Obesity & the Risk of Heart Failure; High Sugar Diets & the Risk of Colon Cancer; Abuse During Childhood & Possible Effects of Genes on Antisocial Behaviors

07/26/02: Cancer: Nature vs. Nurture; Cardiorespiratory Fitness & Inflammation; Kidney Transplants from Cadaver Donors; Aircraft Cabin Air Recirculation & the Common Cold

07/19/02: PCBs & the Gender of Babies; Breastfeeding & the Risk of Breast Cancer; More Bad News About Hormone replacement Therapy

07/12/02: A cancer surgeon's perspective on hormone replacement therapy

07/08/02: Hormone replacement therapy & the risk of disease; more good news about statins; antioxidant vitamins & disease prevention; more

06/28/02: Antioxidants & the Risk of Alzheimer's Disease; Effects of Exercise on the Hearts of Patients with Mild Hypertension; Statins reduce cardiac events following angioplasty; more

06/21/02: Sex & violence and Advertising: Do Advertisers Get What they Pay For?; Don't Drink the Water (or the Salsa Either!); Vasectomy & Prostate Cancer Risk; Update on Smoking & Disease

06/14/02: Young Men, Obesity & Heart Disease; Breastfeeding & Obesity; Irritable Bowel Syndrome & rectal pain threshold; more data on cox-2 inhibitors & cancer; more

06/07/02: New coronary artery stent reduces risk of restenosis; possible cause of Parkinson's Disease identified; more

05/31/02: New biological insights into obesity & weight loss; broccoli kills cancer-causing stomach bug; anti-inflammatory drugs and the risk of heart attack

05/24/02: Molecular detection of tumor cells in the blood & prognosis; Cox-2 & breast/lung cancers; BRCA2 gene mutations & the risk of breast cancer; breast density & the risk of breast cancer

05/19/02: Moderate alcohol intake and blood sugar levels; more good news for tea drinkers; blood potassium levels & the risk of cardiovascular disease; ethnic differences in diabetic complications

05/10/02: Tea drinkers and the risk of death following heart attack; duration of breastfeeding & adult intelligence; abdominal aortic aneurysms: surgery or observation?

05/03/02: Risk of adverse drug reactions from newly released medications; preoperative beta-blockers may reduce heart bypass deaths; shape-shifting plastics may alter surgical practice; weight loss supplement may cause liver damage
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04/19/02: Change your sex by drinking water?; Anti-inflammatory RXs may reduce growth of breast cancer cells; radiation treatment reduces repeat narrowing of bypass grafts
04/05/02: Fish & Omega-3 fatty acid consumption and cardiac health; news briefs
04/05/02: Can coffee reduce your risk of tooth decay?; exercise & blood pressure; a single high-fat meal reduces coronary artery function
04/01/02: Pre-diabetes: a newly defined category of health risk; teen television viewing and subsequent aggressive behavior; the benefits of strength training in the elderly; more ...
03/22/02: Bacteria, antibiotics & heart disease; mammograms: the debate continues; calcium & the risk of colon cancer ... and more
03/15/02: Mammography debate continues; statins & fracture risk; physical fitness & the risk of death; other intriguing findings
03/08/02: Blows to the chest & sudden cardiac death; air quality & the risk of lung cancer; tomatoes and your prostate
03/01/02: Diet & the risk of ovarian cancer; lifetime risk of developing high blood pressure; Osteoporosis prevention with a once-a-year injection?
02/26/02: The continuing controversy regarding screening mammography
02/22/02: Lowering body temperature after heart attack improves outcome; A silver lining for the chronically sleep-deprived?
02/15/02: Hormone replacement therapy & the risk of breast cancer; use it or lose it: Alzheimer's disease & cognitive stimulation; stress, divorce & death; child daycare, infections & parental guilt
02/08/02: Possible breakthrough in early cancer diagnosis; mammography: the controversy continues; CPR techniques revisited
02/01/02: Antibiotics in livestock feed & human disease; genetic detection of early colon cancer in the stool; genetic analysis of breast cancers may help decide treatment
01/25/02: Drug increases lifespan (if you're a fly...); workplace attitudes and smoking cessation; effects of inadequate sleep on surgeons
01/18/02: Lifelong effects of premature birth; smokers under the knife; aspirin and cardiovascular health
01/11/02: Estrogen levels in the blood & breast cancer risk; Heart attack: sex and survival; dangerous lettuce invaders
01/09/02: Cancer & aging: Two sides of the same coin?
01/04/02: Vitamin a & the risk of hip fracture in postmenopausal women; ovarian cancer risk and oral contraceptives
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12/07/01: Update on school shootings; new implantable heart-assist device approved for further evaluation; prevention of fungal infections in pre-term babies
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10/19/01: New insights into autism; the wiley appendix
10/12/01: More bad news about obesity links to other diseases…Hey dad, can I borrow the car keys?
10/05/01: California leads nation in reduction of tobacco-related disease; exercise as an antidepressant?
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09/17/01: In perspective
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© 2002, Dr. Robert A. Wascher