Cancer prevention falls through loopholes

Excluded from coverage, women pay up to 540,000 won for vaccine

By Noh Hyun-gi

Every 10 minutes a woman dies of cervical cancer, according to the World Health Organization. It is the second most common cancer for women after breast cancer. Virtually all cases of cervical cancer are caused by HPV, or human papillomavirus transmitted through sexual intercourse.

Two vaccines are available, but young Korean women are discouraged to have them because of the high cost. Unlike many developed countries, Korea’s national health insurance does not cover the injections. In fact, the system excludes preventive measures altogether.

Three shots of Cervarix (GlaxoSmithKline) or Gardasil (MSD) injected over six to 12 months can protect women from the two most dangerous strains of the common virus. Each injection costs between 120,000 and 180,000 won.

“You can prevent cancer with these shots and that is truly significant,” said Lee Sanghoon, a gynecologist at Korea University Anam Hospital. “I understand the cost is hardly negligible.” Lee mentioned that efforts are being made to persuade the Ministry of Health and Welfare for subsidies.

He was among the clinicians at the Purple Ribbon Campaign’s “Doctors Cafe” event on Wednesday at Cheonggye Plaza, central Seoul. To commemorate Cervical Cancer Prevention Week (third week of May), the Korean Society of Obstetrics and Gynecology invited citizens to ask doctors any questions they might have about cervical cancer. The doctor said many people wanted to learn about differences between the two vaccines and precautions for pregnant women.

The injections prevent HPV type 16 and 18, which are responsible for 70 percent of all cervical cancer. There are over 150 strains of HPV, and those in the high-risk category can cause cells of the cervix to become abnormal and eventually cause cervical cancer. Cervix is the lower end of the uterus. Low-risk HPVs can cause genital or anal warts.

Vaccines are recommended for females between the age of 9 and 26. For maximum benefit, one should get the shots before becoming sexually active. Given that the average age when Korean women first have sexual intercourse is 21, the Korean Food and Drug Administration says vaccines should be administered to 15 through 17 year olds, as six years prior to intercourse allows an ideal period for effective results.

Therefore, women should consider their sexual history and lifestyle to determine appropriate timeframes.

Cervarix also shields the body from a number of high-risk HPVs through inter-immunization. Gardasil protects against two low-risk types (6 and 11) and recognized as preventive of genital warts (condyloma acuminate) in boys and men.

For the majority of people, their immune system will fight off infection. If the infection persists, the abnormal cervical cells can progress to cervical cancer. Symptoms of cervical cancer include vaginal bleeding and vaginal discharge. Advanced cases can cause loss of appetite, weight loss, pelvic pain, and heavy vaginal bleeding.

“I was immunized a couple years ago and I asked whether the shots are effective for people who have already had sex,” said Jang Min-jeong, an employee at a nearby office who participated during her lunch break. “It’s not cheap but in the long run, the three shots can prevent cancer.”

Another visitor asked the doctor mainly about prices. “I am considering getting the shots, but I am looking for ways to get it as cheaply as possible.”

Evidence supporting the benefits for sexually active individuals is mounting because the human body is so susceptible to chronic infection, even though it naturally tries to combat such diseases.

“Our immune system can’t produce adequate antibodies on its own — which is why it was difficult to make the medication in the first place,” Lee said. “Thus the shots can reduce chances of subsequent problems for those who may have been exposed.”

In March, a study found that the HPV vaccines can reduce the probability of re-infection, even among women who have undergone surgery for cervical cancer. The team led by Elmar Joura, an associate professor of gynecology at the Medical University of Vienna, compared 1,350 women aged 15 to 26 with a history of cervical surgery. A random 587 received the HPV vaccine and 763 were given a placebo shot. The vaccinated group was 46 percent less likely to contract HPV-related diseases over the following two years. The results of the study were published in the British Medical Journal.

The widely accepted safety of the two injections as well as the surfacing results are unlikely to affect the insurance policy.

Park Jung-hye, assistant director at the Food and Drug Administration, explained that national healthcare only reimburses treatments not prevention methods. “If we see more solid evidence that immunization against the virus reduces the death rate by cervical cancer, then it may call for a policy change. But regardless of the efficacy, the government does not finance preemptive initiatives for now,” she said.

Already, over 20 countries have endorsed the vaccines. Countries such as Germany, the Netherlands and Greece provide the vaccines for free. Most private medical insurances in the United States also cover the shots and France subsidizes 65 percent of the cost.

Awareness raising initiatives differ across the globe as well. Many Korean colleges conduct campaigns where doctors administer shots on campus at a discount. The Dutch and Luxemburg government sends letters to families with teenage girls inviting them to clinics.