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With the approval of Merck's vaccine against cervical cancer Thursday, parents will soon be having some important and touchy conversations with their young daughters — about sex.

That's because an overwhelming 70% of cervical cancer cases around the world are caused by strains of the human papillomavirus (HPV), which are transmitted via intercourse. Gardasil, the second cancer-fighting vaccine approved by the agency, is designed to prevent infections of four of the most common strains of HPV. (It will also fight off HPV infections that cause genital warts.)

The FDA approval is the first hurdle for the vaccine, which now faces a committee of the Centers for Disease Control on June 29. It's the CDC's job to decide who should receive the vaccine, and when. They are considering making the vaccine mandatory, like the childhood immunizations against measles and rubella, for all girls aged 11-12. Based on the CDC's recommendation, state officials and private insurers will then determine whether they will pay for the shots — no easy task since the vaccine is given three times over six months and costs $360. In order to be most effective, say doctors, Gardasil should be given to young girls before they become sexually active and are potentially exposed to the virus. The FDA approved the vaccine for girls and women ranging in age from nine to 26.

Because HPV is transmitted sexually, some pro-abstinence conservative groups had opposed Gardasil's approval early on, fearful that giving the shots to young girls would promote promiscuity. But cancer doctors have argued that the benefit of preventing cases of the second-leading cause of cancer in women in the U.S. far outweighed this concern.

And it's not just women in the U.S. and the developed world who will benefit. With HPV infections a major cause of cervical cancer deaths in the developing world, the Bill and Melinda Gates Foundation has provided almost $28 million to create programs that will eventually provide the vaccine to women in India, Uganda, Peru and Vietnam.

• Alice Park
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