Cervical cancer vaccine has its limitations

29 Dec 2006, The Straits Times

Question

Name of the Person: Peter Loo Poi

Cervical cancer vaccine has its limitations

Have Medisave pay for anti-cancer vaccine 

IT WAS reported recently in The Straits Times and other newspapers that the application of Gardasil vaccine offers great protection against most cervical cancers for girls and women between the ages of nine and 26. 

The announcement is welcome news. However, a course of treatment of Gardasil costs between $600 and $700. This is quite a substantial sum of money, especially for low-income families. It amounts to almost a month's salary in some cases. 

I wish to suggest that those who would like to be vaccinated be allowed to make use of the money in their Medisave account. 

I understand that the Gardasil vaccine can be given to an individual only once in her lifetime. So, why not relax the strict rules regarding the use of Medisave? After all, Medisave funds are the hard-earned money of the workers. 

There should always be a little flexibility in the use of Medisave, to cater for those who need some monetary assistance. 

Reply

Reply from MOH 

In "Have Medisave pay for anti-cancer vaccine"(ST, 29 Dec), Mr Peter Loo asked that Medisave be used to pay for Gardasil, a new vaccine against cervical cancer. 

In Singapore, the incidence of cervical cancer has been consistently declining over the past 30 years. The incidence for the period 1993-1997 was 14.2 per 100,000 population per year and this improved to 10.6 from 1998-2002. However, there is room for further improvement. Studies have shown lower incidences in countries like Sweden (7.71) and Finland (4.0) (data is from the period 1993-1997) that have well-established Pap smear screening programmes, which detect precancerous cells and allow treatment before cervical cancer is established. 

Cervical cancer is caused by infection with human papillomavirus (HPV), which is transmitted sexually There are various types of HPV that may cause cervical cancer and HPV types 16 and 18 cause about 70% of cervical cancers. The new vaccine, Gardasil, protects against infection by HPV types 16 and 18 and has been approved by the Health Sciences Authority for use in Singapore by females aged 9 to 26 years. The vaccine will have most effect when it is used in women before they become sexually active and become at risk of HPV infection. However, the long term effectiveness of the vaccine is still not known. For example, we are not sure if the immunity would decrease over time and require re-vaccination. Similarly, the vaccine will not be useful to those who have already become infected. The vaccine also does not protect against other types of HPV that cause the other 30% of cervical cancers. Therefore, Pap smear screening with early detection and treatment would remain the mainstay of management. 

It is important to note that since the vaccine does not protect against all types of HPV infection that might lead to cancer, women, including those who have been vaccinated with Gardasil, should continue with cervical cancer screening with Pap smears. All women who have ever had sexual intercourse are also advised to have their first Pap smear by the age of 25 years. After the first screening, 3-yearly Pap smear screening is recommended. 

As with any new treatment, it is necessary to make a thorough assessment of its cost-effectiveness to ensure that healthcare resources, including Medisave are used appropriately. MOH will monitor the developments and make a decision when sufficient evidence is available.