Merck, maker of the cervical cancer vaccine Gardasil, is backing off its lobbying campaign following pressure from medical groups and parents who believe the vaccine should not be mandated as a school attendance requirement for adolescent girls.

The public outcry that caused Merck to announce its stop order on Tuesday stems from the fact that the vaccine protects against the sexually transmitted human papilloma virus (HPV), which causes cervical cancer. School-mandated vaccines are typically for diseases spread through casual contact, such as measles and mumps.

Merck's medical director for vaccines, Dr. Richard M. Haupt says, "We're concerned that our role in supporting school requirements is a distraction from that goal, and as such have suspended our lobbying efforts," adding that the company will continue providing information about the vaccine upon request.

Gardasil, launched in June and the first vaccine to prevent cervical cancer, has inspired controversy since day one. There's the cost -- $360 for three required shots -- and all sorts of insurance concerns and conservative groups who worry the vaccine encourages premarital sex and interferes with parental rights. Even those in support of the vaccine -- like the American Academy of Pediatrics and the American Academy of Family Practitioners -- question Merck's quick push to market this drug, especially in light of the company's withdrawn painkiller Vioxx.

"I believe that their timing was a little bit premature so soon after (Gardasil's) release, before we have a picture of whether there are going to be any untoward side effects," says Dr. Anne Francis, who chairs an American Academy of Pediatrics committee.

Legislatures in 20 states have taken steps to mandate the vaccine for young girls. And with the exception of Texas governor Rick Perry's February 2 executive order requiring Texas girls entering the sixth grade in 2008 get vaccinated, nothing has been made official so far.

Cervical cancer was once the most common cancer in women. But between 1955 and 1992, the number of cervical cancer deaths dropped by 74 percent -- thanks to increased use of the Pap test, a screening tool that can find changes in the cervix before cancer develops and can also detect cancer in its most curable stage. The Pap test is still widely used. And the cervical cancer death rate continues to drop four percent every year.

In 2006, about 9,700 new cases of invasive cervical cancer will be diagnosed in the United States. About 3,700 women will die from the disease. Non-invasive cervical cancer is believed to be four times more common than the invasive form of the disease. Nearly all of these cases can be cured.

Cervical cancer typically occurs in women between the ages of 35 and 55 and rarely in women under the age of 20. It affects mostly Hispanic women, and African-American women develop the disease 50 percent more often than non-Hispanic white women. Women most as risk for cervical cancer are smokers, those with HIV or chlamydia infections, those with diets low in fruit and vegetable consumption, those who between 1940 and 1971 took the hormonal drug DES, and those who have taken oral contraceptives for extended periods of time. Women who have had multiple pregnancies, have a family history of the disease, and have a low socio-economic status are also at risk. Those most at risk, however, are women with human papilloma virus.

Human papilloma virus (HPV) is the most common risk factor for cervical cancer, and some experts believe a woman must have HPV to contract cervical cancer. There are 100 different types of HPV, 13 of which are likely to cause cervical cancer through sexual contact. There are usually no symptoms of HPV, but possible signs of cervical cancer can include vaginal bleeding, unusual discharge, pelvic pain, and pain during sexual intercourse.

There are two ways to stop cervical cancer. First, women can protect themselves against HPV. Protection comes in the form of delaying sexual activity, limiting the amount of sexual partners and their partners, using condoms (thought to be 70 percent effective) and receiving the cervical cancer vaccine, recommended for use in females ages 11-26. The vaccine is most effective for women who have never been sexually active. Second, women can receive regular Pap tests in order to catch pre-cancers. Pap tests are recommended for women three years after their first sexual encounter and before the age of 21 -- and then every year after that.

An abnormal Pap test typically prompts a colposcopy -- a technique that uses a scope to examine the cervix. Diagnosis usually stems from a combination of other scoping methods, pelvic exams, imaging tests, and biopsies used to confirm the presence of cancer and to stage the disease. Stages range from 0-4.

For non-invasive cervical cancer, surgery -- ranging from removal of the cancerous tissue to hysterectomy -- may be the only treatment necessary. For invasive forms of the cancer, surgery is often followed by radiation and chemotherapy. Women interested in preserving their fertility should discuss options with their physicians.

The state of cervical cancer has come a long way over the years. And this year, two critical developments emerged. In June 2006, the FDA approved the first drug for late-stage cervical cancer. The drug, Hycamtin, is recommended for use in combination with chemotherapy. Also is June, the cervical cancer vaccine, Gardasil, was released. Both developments are monumental -- and both will undoubtedly help decrease the already-dropping cervical cancer death rate.

For more information about cervical cancer, visit the following sites:

American Cancer Society
Mayo Clinic
Medline Plus
National Women's Health Information Center

My breast cancer friend Adriene -- who I wrote about on May 19 -- e-mailed me today about a friend of a friend who was just diagnosed with breast cancer. This friend -- Jen -- is 31 years old and just yesterday had a lumpectomy. Adriene asked if I could be in touch with Jen since, like her, I am young and I am a breast cancer survivor and I had a lumpectomy. So far, we are somewhat alike. And depending on the results of Jen's pathology report, we may be even more alike -- if she follows a path anything like mine that included chemotherapy and radiation therapy and Herceptin therapy -- or our paths might diverge from one another. Regardless, I feel a connection to this woman, much like I do with anyone with cancer whose path I cross, anyone who is sent my way, anyone who finds me for the sole purpose of support.

So I told Adriene in my return e-mail, "Yes, I will contact Jen." And I have already sent her an e-mail. And I hope when she reads it that she finds a trace of comfort, a hint of encouragement, a glimpse of hope that can somehow transform scared souls into confident spirits. I hope that she emerges from under the rock of breast cancer. Like I did. Like Adriene did.

There is no doubt that the new cervical cancer vaccine -- Gardasil -- is revolutionary. But writer Peter Sprigg, vice president for policy at the Family Research Council, shared yesterday on the washingtonpost.com that the public should consider two cautions when digesting the news of this breakthrough medical advance. He urges us, first, to understand that the vaccine is not 100 percent effective. It is 100 percent effective for the strains of human papillomavirus (HPV) it targets -- but it leaves 30 percent of HPV strains that cause cervical cancer untouched. And it does not prevent all cases of genital warts either. So it is largely effective. But it does not completely eradicate the disease.

Sprigg also believes that parents should determine whether or not their young girls get the vaccine -- that it should not be mandatory. Mandating the vaccine might be in order if HPV was spread through blood or casual contact. But it is not -- it is spread by sexual contact. And families of young girls might best address this issue through education on behavioral issues alone, without interference from the government.

The wonder of the cervical cancer vaccine is not in question by this writer and the council he represents. But there is often a full picture that lingers behind good news and sensational headlines. And Peter Sprigg offers his take on what he believes lingers behind.

Our sister blogs, Autoblog and Blogging Baby have posted stories that illustrate the benefits of internet connection in lives touched by cancer. In a you-can-run-but-you-can't-hide karmic twist of justice, Matt Frame found his stolen 1967 Camaro SS online at an eBay auction. Frame and his father had rebuilt the car before his father died of cancer. Of course, the seller denied that it was the same car, but Frame was able to identify the car as the one stolen from him.

On the cosmic scales of fairness, balance was achieved when Anthony McCoy found the 1969 Chevrolet Camaro that he had spent twenty years helping his father restore before the death of his father to cancer. Although it was not stolen from him by a thief, it was lost due to financial circumstances when his mother was forced to sell the car after the loss of his father. Found at eBay, McCoy made the successful bid. To McCoy, it is priceless.

As today's final example of the power of the internet to break down any barriers of time and space that can separate us from justice, the scales of fairness, or the ability to nurture relationships beyond the immediate, Jason Levine is a pediatric oncologist who stays in touch by email with his young cancer patients and their families by visiting their personal websites. Blogging Baby found a sweet and humorous story told of how a young patient role plays his email contact with her.