Like many of you, I traveled to see family during the holidays. Without fail, dinner conversation often turns to health care as my soon-to-be husband (also an oncologist) and I answer a laundry list of medical questions from our loved ones. We welcome this firing squad of questions, as we hope to spread accurate information to those we care about most. After the usual discussions of cholesterol (yes, Dad, you should be watching what you eat), a family friend with an 8-year-old daughter brought up the HPV vaccine. As many parents, she had been scrutinizing all medical decisions that could affect her child. Her daughter is approaching the age for the HPV vaccination and she asked if it was worth it? Is it safe? My (and oncologist husband-to-be’s) enthusiastic answer: YES!
The Human Papillomavirus (HPV) is a common virus among people. It is sexually transmitted, and approximately 80 percent of people will be carriers of HPV at some point in their lives. There are numerous strains of HPV, some of which cause genital warts, others that cause precancerous or cancerous lesions of the cervix, as well as the anus, vulva, vagina, penis, tonsils and tongue.
HPV is required to develop cervical cancer. Although cervical cancer, in particular, has become less common through widespread screening programs with the Pap test beginning in the 1950s, cervical cancer and its precursors remain a problem in the United States and abroad. More than 12,000 women will be diagnosed with cervical cancer each year in the United States, 4,000 will die, and more than 2 million will be diagnosed with cervical dysplasia.
Cervical cancer remains a great concern for the women in Kentucky, who have one of the highest rates of cervical cancer in the nation. Precursors to cervical cancer, called cervical dysplasia, lead to invasive testing, surgical procedures, and time away from work and family. Furthermore, cervical dysplasia and cancer can lead to difficulties with fertility and childbirth for young women.
Researchers recognized this problem and became dedicated to solving it. We were successful in developing the HPV vaccine which first became available in 2006. We are now on our third version of the HPV vaccine, which protects against nine strains of the HPV virus, the most common to cause cervical dysplasia, cancer, and genital warts. The most recent data from the 9-strain vaccine showed broad protection from HPV, and with wide-spread implementation, could prevent 90 percent of cervical cancer cases worldwide. The vaccine was 99 percent effective in reducing cervical dysplasia in the study group. The potential for lives saved and improved is great! The thought of beating a cancer before it even happens is exciting!
To get back to the concerns of my family friend, is it safe? Again, the answer is a resounding YES. The vaccine was tested in a rigorous clinical trial-a randomized controlled trial. More than 14,000 girls age 16-26 were enrolled in the most recent trial to evaluate the 9-strain vaccine. Common reactions included swelling and redness at the injection site. Severe allergies were rare, occurring in <0.1 percent of patients. There were no deaths attributed to the vaccine. Although the internet may spread stories of patients who were harmed by the HPV vaccine, follow up studies of these girls showed no relationship to the HPV vaccine. The bottom-line is that the HPV vaccine is safe and effective.
The final question is, who should be vaccinated? Girls and boys can be vaccinated between the ages of 9-26. Current vaccine protocols are a 3-shot series at 0, 1-2, and 6 months. Girls and boys vaccinated between 9-14 years old may only require two shots, separated by 6-12 months. The 9-strain vaccine or the previous versions of the vaccine are all acceptable. The vaccine can be given before or after first sexual contact. For those who missed the window to get the vaccine, the best way to protect yourself is practicing safe sex with condoms and getting regular pap tests with your doctor.
It is an exciting time for cancer prevention: we have a vaccine that can prevent cancer! I encouraged my friend to talk with her pediatrician further about the vaccine, and I encourage you to do the same. This is an opportunity to protect our children from cancer and provide hope for the future.
Huh, WK et al. Final efficacy, immunogenicity, and safety analysis of a nine-valent human papillomavirus vaccine in women aged 16-26 year: a randomised, double-blind trial. Lancet 2017; 390: 2143-59.
Moreira, ED et al. Safety Profile of the 9-Valent HPV Vaccine: A Combined Analysis of 7 Phase III Trials. Pediatrics 2016; 138(2).
Throughout the month of January, we will have a series of blog posts that examine the different aspects of cervical cancer–from prevention, detection and treatment. Please check back for new posts.