News & Notes

Europe issues HPV vaccine guidance

The European Centre for Disease Prevention and Control ( http://ecdc.europa.eu) has published guidance on the use of HPV vaccine to help policy makers in EU member states.

The ECDC says vaccination will be most effective if targeted at 12to 15‐year‐old girls; screening programmes will need to continue.

Follow‐up data are currently available for only five years, the Centre adds, so ‘systems to monitor long‐term efficacy, vaccine coverage and compliance, integration with other prevention strategies and vaccine safety are therefore considered to be critical in order to evaluate the overall impact of HPV vaccination programmes’.

HRT increases breast cancer and obscures diagnosis

Taking hormone replacement therapy (HRT) for five years increases the incidence of breast cancer and makes mammograms less reliable, a new analysis of the Women's Health Study (WHI) has shown (Arch Intern Med 2008; 168: 370‐7).

The WHI is a prospective study involving a total of 16 608 postmenopausal women randomised to treatment with HRT (conjugated oestrogens plus medroxyprogesterone acetate) or placebo. After 5.6 years, mammography had been more frequent among women receiving HRT (35 vs 23 per cent) but was less sensitive for detecting cancer. The difference diminished when HRT was withdrawn but remained elevated for 12 months. HRT use was also associated with more biopsies (10 vs 6 per cent) but these diagnosed cancer less frequently (15 vs 20 per cent).

Androgen suppression after radiotherapy for prostate cancer

The NICE guideline on prostate cancer includes adjunctive hormonal therapy plus radical radiotherapy as an option for men with localised prostate cancer. A new US study has assessed the long‐term mortality associated with this strategy (J Am Med Assoc 2008; 299: 289‐95).

The original trial randomised 206 men with localised but unfavourable‐risk disease to radiotherapy alone or in combination with androgen suppression for six months. After 7.6 years' follow‐up, radiotherapy alone was associated with higher all‐cause mortality (44 vs 30 deaths; hazard ratio 1.8, 95% CI 1.1–2.9). The difference was largely due to more deaths among men with little or no comorbidity, suggesting that the benefit of adjunctive androgen suppression was confined to this group.

NICE guideline on prostate cancer

NICE has published its clinical guideline on the diagnosis and treatment of prostate cancer. The guideline summarises strategies for diagnosis and staging the disease. Its recommendations for treatment are stratified by risk and categorised for localised, locally advanced and metastatic disease.

NICE calls for further research into prognostic indicators to differentiate potentially fatal disease and further assessment of interventions aimed at eliminating disease.

HPV vaccination impact

At £80 per dose (ex VAT), the HPV three‐dose vaccination programme will have a ‘huge impact’ on the vaccine budget, the Department of Health warns in Vaccine Update (Issue 143, January 2008).

Rigorous procedures for ordering, storage and distribution are ‘paramount’ for reducing wastage. Particularly important measures include suitable fridges, refrigerated transport, stock rotation and avoiding over‐ordering.

Cervical cancer resource

A website for health professionals devoted to raising awareness about cervical cancer has been launched by the Cervical Cancer Initiative. www.cervicalcancerinitiative.co.uk offers news, reviews, case histories and a meetings diary. Copyright © 2008 Wiley Interface Ltd