Preventing Cancer with the HPV Vaccine

It’s a scary thought. Too many adolescents are needlessly at risk of cancer when there’s a safe, effective vaccine available to prevent the disease. 
The human papillomavirus (HPV) is the most common sexually transmitted infection and, with the exception of seasonal flu and pneumonia, hurts and kills more people than all other vaccine-preventable diseases combined. It can lead to cervical cancer, head and neck cancer, and vaginal, penile, and anal cancer. It can also cause genital warts.
HPV is widespread. The virus currently infects some 79 million Americans, according to the Centers for Disease Control and Prevention (CDC), with an estimated 14 million people becoming newly infected every year. It’s easily transmitted and can be passed from person to person with skin-to-skin contact.
The danger of HPV is that it’s insidious: the infection often has no symptoms, and it can stay hidden in the body for decades. An infection that someone contracted in their 20s, for example, can result in cancer in their 40s or 50s. While women aged 30 and older are tested for HPV as part of the screening for cervical cancer, there is no recommended screening test for HPV for either men or women under 30. And no treatment exists for HPV infection.
The toll from HPV-related cancers is significant. About 12,000 women in the U.S. get cervical cancer every year, and 4,000 of them die from the disease. Some 11,000 men and women contract head and neck cancers, with 75{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of those caused by HPV. And 5,000 men and women get HPV-related anal cancers.
Many of those cases can be prevented with an HPV vaccine, but immunization rates have been far too low since the vaccine was licensed and introduced in 2006. The CDC reported in August that only 38{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of girls and 14{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of boys have received the entire regimen of three shots that provides the maximum benefit. The vaccine (it’s covered by insurance, as it’s a recommended vaccine) protects against the four most important types of the virus that lead to more than 70{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of cancers and genital warts.
The CDC recommends the vaccine be given to girls and boys beginning at age 11 or 12, with the three shots taken within a six-month period to benefit from the vaccine’s full effectiveness. The recommendation of vaccination beginning at the early age of 11 or 12 is based on the fact that immunization at that age produces a better response from the immune system — and therefore better protection — in adolescents under age 14. Also, vaccines only work if they are given before exposure to the virus, and preteens are less likely than older teens to be sexually active.
Because of the double benefit of higher antibody responses and lower exposure to HPV, the vaccine is twice as effective if given before age 14 compared with after age 15.
Multiple studies have shown the HPV vaccine to be safe, with no serious side effects. More than 30,000 patients were vaccinated during clinical trials, and more than 100 million doses have been distributed worldwide to date. The two largest studies, which include 200,000 girls in the U.S. and 1 million girls in Denmark and Sweden, found no increase in any of 200 categories of illness.
The vaccine has also proven to be highly effective. In Australia, 80{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of girls have received three doses of the vaccine, and genital warts have nearly disappeared among young women, while rates of cervical pre-cancer have declined 75{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} for those vaccinated by age 14.
Concerns about the vaccine promoting increased sexual activity have proven to be unfounded. Additional studies have shown that those who received the vaccine were not more likely to engage in risky behavior.
The CDC also noted in its August report that one reason for the low HPV immunization rate is that physicians aren’t strongly recommending the shots to their patients. We physicians must do a better job in recommending the vaccine, but my plea to parents is this: if your child’s physician doesn’t mention it, ask! Parents must understand how serious HPV infection can be.
Vaccines are some of the greatest achievements in medicine, have an extraordinary record in preventing disease and suffering, and are one of the most potent weapons we have for personal and public health. We have the ability to prevent thousands of cases of cancer with a safe, effective vaccine. Let’s do so. –
Dr. Rebecca Perkins is an assistant professor of Obstetrics and Gynecology at Boston University School of Medicine/Boston Medical Center, and has conducted multiple research studies on HPV. This article is a public service of the Mass. Medical Society.