Today, we’re going to talk about something really important: the HPV vaccine. To help us understand the vaccine, what it does, and why it’s so important, I was lucky to speak with Julian Schink, MD, Chief of the Gynecologic Oncology program at Cancer Treatment Centers of America (CTCA). Dr. Schink, who is based at the CTCA at Midwestern Regional Medical Center hospital in Zion, Illinois, is board certified in gynecologic oncology as well as obstetrics and gynecology, and works to advance the treatment of gynecologic malignancies. He provides surgery and chemotherapy treatments for patients with gynecologic cancers, including ovarian cancer, cervical cancer, uterine cancer and gestational trophoblastic neoplasia.
Thank you for speaking with me, Dr. Schink. Before we start talking about the HPV vaccine, I want to ask you what HPV is and whether or not it is common.
Dr. Schink: HPV is a sexually transmitted virus that is extremely common. It’s been around for thousands of years. They’ve actually identified HPV in Egyptian mummies, so we know it's been around for a long, long time. The most widely-accepted numbers estimate that at least 50% of people in the US are infected at some point in their lives, though some numbers indicate that it may be as high as 80%. HPV is very, very common. It also causes cervical cancer, and that is why the HPV vaccine is so important.
I had no idea it’s been identified in Egyptian mummies! How interesting. What kinds of risks are associated with HPV infection?
Dr. Schink: The highest and deadliest risk of HPV infection is that of cervical cancer. Cervical cancer kills. Genital warts are also associated with HPV and constitute a significant, though not fatal, risk. Other cancers associated with HPV infection, but are less common than cervical cancer, are anal cancers, some vulvar cancers, and a significant percentage of head and neck cancers.
Head and neck cancers? I didn’t know that.
Dr. Schink: HPV is a co-factor for tobacco-related cancers. For example, if you have HPV in your upper airway, and you smoke, the risk for head and neck cancers is increased.
Why should people get the HPV vaccine?
Dr. Schink: It prevents cancer. Oncologists will tell you that they would much rather prevent cancer than treat it. The HPV vaccine is remarkably effective at preventing cervical cancer, precancerous abnormalities, and genital warts. It prevents 90% of cervical cancers, anal carcinoma and genital warts. It’s very effective.
Is there only one type of HPV vaccine?
Dr. Schink: There are multiple choices which have evolved over the last decade. The first vaccine covered four types of HPV (types 6, 11, 16, and 18). The most recent vaccine covers nine subtypes and oncogenic subtypes. In other words, the newest vaccines expand coverage to include less common high risk types of HPV. The vaccines have been tested in very large clinical trials and shown to be, as I previously mentioned, extremely effective.
What is the recommended age for young people to get vaccinated and why?
Dr. Schink: There are two answers to this question. First, the manufacturers of the vaccine recommend the ideal age range as 9-14 years of age. If it is given in that age group, then the patient only needs two doses, which are spaced 6-12 months apart. If the patient is 15 or over, then it is recommended that patients have three doses, which isn’t a reflection of the vaccine, necessarily, but rather a reflection of how our immune system evolves as we age. The AAP recommends 11-12 as the ideal age for vaccination. The vaccine is for everyone, too, since everyone is at risk for HPV exposure.
How does the vaccine work?
Dr. Schink: It creates an immune response against capsid proteins in the virus, so like a lot of antiviral vaccines, it trains the immune system to respond to infection. There is some controversy about its effectiveness in clearing HPV infection from a body that already has it.
Are there any side effects?
Dr. Schink: Yes. The most common side effect is pain. As many as 90% of patients will experience some discomfort. About 10% of people will have some injection site swelling or localized redness, fever, headache or feelings of tiredness, nausea, and muscle or joint pain. A very small fraction of young people, when they experience pain associated with a needle, faint. Injuries associated with the vaccines have almost all been related not to the vaccine, itself, but falling injuries due to fainting. I haven’t seen anyone study fainting incidence in adults compared with fainting incidence in young people, that would be an interesting question to study.
It would! What are the most important things for skeptical parents to understand about the HPV vaccine?
Dr. Schink: The most important thing to understand is that this vaccine prevents cancer. It prevents lethal cancers! While we see less cervical cancer in US than we used to, it is still the second most fatal cancer for women around the world. As a gynecologic oncologist, it is far better to prevent cancer than treat it, and this vaccine is one of the most effective tools we have today. Cervical cancer is lethal and the median age of women who die from it is 44 years of age. Not only are women dying of it, but they’re dying of it at a young age, which is devastating for families. Even though we have good PAP smear screening here in the US, some people still develop cervical cancer in spite of it. PAP smears are not enough to prevent cancer. HPV is so common, it’s so out there, there is no way to protect anyone from exposure, other than a single, monogamous relationship between two uninfected partners, and that just doesn’t reflect the majority of people’s experience over entire lifetimes. When I was at the UCLA, we did a study of female students at UCLA, looking at HPV infection. 50% of the participants had it. That’s how common it is. We have a lot of data to show that the infection rates for people ages 18-24 are anywhere between 30% and 50%.
How important is it for parents to follow the whole dose courses?
Dr. Schink: Some people will be protected from just one dose, but we have no way of figuring out who that is. Only getting half of any given treatment also doesn’t give people much peace of mind. They have to ask themselves, “Well, am I protected?” It’s important to get the recommended number of doses so the vaccine can be as effective as it is. That being said, it will still be important for women to get regular PAP screening for many years to come until the incidence has dropped to such levels that they no longer justify routine screening. Therefore, the HPV vaccine is important for everyone! Here in the US, people can get vaccinated through age 26. Even if a person has been infected with HPV, the vaccine still covers nine strands, so it is still beneficial. Interestingly, I believe Australia is much more progressive and has approved the vaccine for up to age 45.
Thank you so much for this information and for your time. Is there anything else you’d like to add?
Dr. Schink: It’s critical for people to understand that this prevents cancer. It’s so effective and so important
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