MEDICINE MORALITY NEW VACCINE PREVENTS CERVICAL CANCER BUT RAISES ISSUE OF TEEN SEX.

Byline: Valerie Kuklenski Staff Writer

Most parents willingly roll up their children's sleeves for shots to ward off everything from mumps and chickenpox to tetanus and hepatitis.

Now they will be asked to do the same for an immunization to shield their daughters from a sexually transmitted virus that is the most common cause of cervical cancer.

Gardasil, the new vaccine from Merck & Co. that prevents four strains of the human papillomavirus (HPV), received approvals last month from the Food and Drug Administration and the Centers for Disease Control. It's cleared for girls as young as age 9 and recommended for 11- to 24-year-olds.

``In the perfect-case scenario, with every female in the targeted age group vaccinated, (HPV experts) expect a dramatic decrease in the incidence of this type of cervical cancer,'' said Jerome A. Zack, a professor and researcher in immunology at UCLA's David Geffen School of Medicine.

With an endorsement expected any day from the American Academy of Pediatrics, the vaccine, the first to protect against any kind of cancer, will soon be a routine part of childhood immunizations. Although most parents are embracing the chance to protect their children from a dangerous -- sometimes deadly -- cancer, there remain concerns about its cost and, for some, the moral issue arising from immunizing a child against a disease that is contracted through sexual activity.

Gardasil and Cervarix, a similar product expected to be submitted by GlaxoSmithKline to the FDA later this year, are effective only before exposure to the virus, which is transmitted mainly through intercourse but can be contracted from oral sex.

``That's why we try to get it in the preteen years, because studies show that women do become sexually active before the age of 18,'' said Dr. Chris Tolcher, a pediatrician with Encino-Tarzana Regional Medical Center. ``Not all, but a lot of them. Depending on where you do the study, anywhere from 20 percent to 40 percent by age 18 have had some experience with sexual activity.''

Gardasil targets the HPV strains blamed for 70 percent of cervical cancer cases. Tolcher noted that while cervical cancer in teens is very rare, the vaccine also prevents 90 percent of viruses causing genital warts, ``which is something we do see in teenagers a lot.''

Tolcher and other area pediatricians are just beginning to field parents' queries about the vaccine. To parents concerned about their daughters seeing an HPV vaccine as tacit permission to have sex, he says: ``This is preventing cancer. This should not in any way be looked at as condoning sexual contact.''

Some conservative organizations, such as Focus on the Family and Christian Medical & Dental Associations -- both promoters of sexual abstinence outside of marriage -- have endorsed the vaccine, saying the health benefit outweighs concerns about premarital sex.

``To me, one thing has nothing to do with the other,'' said Stephanie Schwartz of Oak Park, whose 15-year-old daughter, Courtnie, expects to get the Gardasil vaccine. ``To me, that's for parents who are frightened ... and don't communicate their thoughts and opinions with their children about what they want them to do.

``If this is a prevention against cancer, then get the injection.''

Schwartz was surprised, though, to learn the cost of the vaccine -- $120 to $160 per dose for a series of three shots over six months' time, which puts it among the top-priced childhood immunizations.

``I didn't even think about asking the cost. $360? That's outrageous,'' she said as her daughter received a different vaccine in Tolcher's Agoura office.

Local pediatricians have begun ordering the vaccine but are waiting to hear from insurers about coverage. To date, Wellpoint and Aetna have announced plans to cover at least part of the cost for most subscribers, and others are expected to fall in line after an AAP recommendation is released. It is possible that competition from the Glaxo vaccine will lower the price.

The Los Angeles Unified School District has announced its intention to make the HPV vaccine available to students free of charge, soon after county officials approve funding. Students 18 and over will be able to choose for themselves whether to take the shots, but those 17 and under will require parental consent.

According to the CDC, more than half of all sexually active men and women have been infected at some time with HPV. There are 6.2 million new cases of HPV each year in men and women in the United States, most of which go away naturally without any symptoms. But in nearly 10,000 women each year, the viruses lead to abnormal cells in the cervix that grow rapidly into cancer. Some 3,700 women die each year from the disease.

``That's a high incidence of viral infection,'' Tolcher said. ``So (the vaccine) has the potential to be a great benefit for women's health. And if we can get a breast cancer vaccine, that's even more exciting.''

Nancy Schultz of Winnetka is a registered nurse at Wellpoint who approves medical benefits for insured mothers and children. She is also the mother of two daughters -- Liz, 18, and Allison, 15 -- who will be receiving the Gardasil series when it becomes available.

``Two of the biggest killers in history were viruses -- smallpox and polio,'' Schultz said. ``And we've forgotten because it's no longer active. I think people don't understand how remarkable it is that one or two shots can protect you for the rest of your life.''

Valerie Kuklenski, [phone]

valerie.kuklenski(at)dailynews.com

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New vaccine sparks debate

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