A vaccine to prevent cancer?
It is hard to scroll through Facebook, turn on the TV, or open a newspaper without seeing some mention of vaccines. Recently, the news has been full of reports about measles and the MMR (Measles/Mumps/Rubella) vaccine in southwestern Washington’s Clark County. The MMR vaccine, along with vaccines for tetanus and influenza, are well known. However, there is a vaccine that could prevent cancer that fewer than half of children and young adults are receiving.
The human papillomavirus (HPV) is responsible for at least 90 percent of all cervical cancers, a very dangerous and deadly disease, according to statistics from the Center for Disease Control and Prevention. HPV is also responsible for the pre-cancerous lesions that are detected on pap smears and require invasive biopsies and procedures to remove parts of the cervix to prevent cervical cancer. As an OB/GYN, I see the negative impact that HPV has on patients daily. Both males and females are at risk and HPV has been strongly associated with oropharyngeal (head and neck), penile and anal cancers. Fortunately, a huge number of these cancers are preventable.
The Gardisil-9 HPV vaccine protects against the 9 most dangerous strains of the virus. These strains can lead to cancer as well as genital warts. Like cold and flu viruses, many different strains of HPV exist and those most likely to cause cancer are included in the vaccine.
Like most vaccines, the HPV vaccine is most effective when administered before any infection occurs. For this reason, the best time to vaccinate is starting at 11 to 12 years old, for all children. The vaccination schedule suggests a first vaccine between the ages of 9 to 14 years old and a second dose six to 12 months after the first. If vaccination starts after 15 years of age, the recommendation is for a total of three doses.
Because the vaccine protects against many different strains of HPV, it may be beneficial to receive the vaccine even if an HPV infection or the effects of an infection have already occurred. It is partially for this reason that the FDA recently approved the vaccine for men and women from the ages of 26 to 44 years old. This approval has not been incorporated into broad recommendations or guidelines, so it’s important every person reviews their vaccine options with their healthcare provider. Additionally, not all insurers are providing coverage for this vaccine in the newly approved age range.
Vaccine and medication safety are often top-of-mind for parents and patients alike. The HPV vaccine is not known to cause any major side effects. The most common reactions are redness or swelling at the injection site, headache, fatigue and joint pain and resolve on their own. As with any medication or vaccine anyone who has had a serious reaction or may be allergic to a component of the vaccine should speak with their healthcare provider prior to receiving the vaccine.
Only about 43 percent of teenagers in the U.S. are completely up-to-date with the most recent HPV vaccination guidelines based on data from the CDC. The coverage in Washington State is slightly higher than the national average, at 49.5 percent. The vaccine has not been available for long enough to provide long term data on the reduction of cancer cases. We do, however, have preliminary data that suggests a significant reduction in abnormal cells on pap smears and cervical biopsies. This trend suggests that if vaccination rates continue to increase, we may see as much as a 90 percent reduction in HPV related cancers. So, yes, we are lucky enough to live in a time when there is a vaccine available to prevent cancer!
Dennis Goulet, MD, MPH, is an Obstetrics & Gynecology physician with The Everett Clinic at Shoreline. Dr. Goulet feels that every patient is unique and finds great joy in building relationships with patients and partnering with them to achieve wellness throughout their lifespan. He is currently accepting new patients to his practice.