HPV vaccine policy

HIV vaccines are receiving ongoing high profile. Their potential is huge but the implementation of vaccination programmes the source of rich debate (BMJ 2007;335 Lo 357-8, Raffle 375-7 & Franco 378-9).

The first argument is that existing cervical cancer screening programmes in developed countries reduce deaths by 80% and it is difficult to argue with these success rates. The costs may even come down with HPV triaged follow up, and the expenditure on a vaccine initiative is formidable. There is no doubt the conventional screening policies will be required on an ongoing basis, but with the opportunity for protecting future generations from primary HPV infection and preventing precancerous and cancerous lesions is too inviting to reject.

The second point is those who would benefit most are the at-risk populations, all in developing countries. Again implementation would be the most challenging but the rewards the greatest.

Finally, the attention to the benefits of screening and prophylaxis will probably be the greatest spin-off. The debate, the rhetoric, the policies, the arguments for and against, the money, the political stances, the religious views and the medical science all contribute to the opening of discussions about women's health.
Should we not all engage as vociferously as we dare on promoting interaction on sexual and adolescent health questions and provide the medical science to inform opinion?

This is an entrée not to be missed.

Soy phytoestrogens

Natural estrogens have great appeal to women as an alternate to conventional hormones at and beyond the menopause. Concerns about the negative effects of standard drugs persuade some women to try phytoestrogens as a “softer option”.

It is difficult for clinicians to advise on such preparations as evidence of benefit - and more importantly harm - is lacking, and it has taken massive trials to uncover the small absolute detrimental effects of estrogens. Until equally stringent trials show the safety of phytoestrogens we will have to rely on smaller studies to show the way.

Marini et al (Ann Int Med 2007;146:839-47) have demonstrated in a RCT of 400 women that genistein, which is found in soy products, increases bone mineral density in osteopenic postmenopausal women. 54 mg of genistein daily for 2 years had positive effects on bone density and turnover compared with placebo, opening the way for long-term trials on fracture effects as well as uterine and breast safety.