Kingsport Times News Sunday, December 21, 2014

Community Health

Get the shot: HPV vaccination can prevent several cancers

March 20th, 2014 11:15 am by Leigh Ann Laube

Get the shot: HPV vaccination can prevent several cancers

Carly Hutchins, RN, recently gave one dose of the HPV vaccination to a patient. The vaccine is given in a series of three shots over six months and protects against HPV-associated cancers, such as cancers of the cervix, throat, tongue and tonsils. (David

In 2006, the Advisory Committee on Immunization Practices (ACIP) added the HPV vaccine to its long list of recommended vaccinations for children. Since then, health educators have worked to help parents understand that the vaccine — usually given to pre-teens before they are likely to be exposed to the human papillomavirus — is the best way to prevent infection and cancers caused by the virus.

"We have had parents who have a lot of questions," said Michelle McPheron, nurse manager with the Lenowisco Health District, which covers Lee, Scott and Wise counties and the city of Norton, Va. "They have questions about any vaccine that's newer, especially one that prevents against a sexually transmitted disease, but the key is getting the parents to understand to get their children vaccinated before the child is at risk."

The vaccine, she said, is no different than the DTaP vaccine, which protects against diphtheria, tetanus and pertussis, or the hepatitis B vaccine.

"We're trying to get them to understand its the same as any other vaccine, and get them protected before they become at risk," she said.

Each year in the U.S. approximately 17,000 women are diagnosed with cancer caused by the human papillomavirus, of which cervical cancer is the most common. Additionally, some 9,000 men each year are diagnosed with HPV-associated cancer, most commonly in the throat, tongue and tonsils. HPV also causes other cancers in both men and women. An effective vaccine against HPV has been available since 2006.

HPV infection is very common; approximately 79 million people in the U.S., most in their teens and early 20s, are infected. Almost all sexually active people get HPV infection at some time, but most never know they are infected. 

HPV infection can occur with a person's very first sexual encounter. Many types of sexual activity can cause exposure to HPV and it's important to become vaccinated before becoming sexually active. Many HPV infections are eventually cleared by the body's immune system but sometimes HPV causes genital warts and cervical cancer.

"So many parents think it's condoning sexual activity in youth, which, with education, they will learn that the reason we would like for the younger ones, the 11- and 12-year olds, to get the vaccine is because we want them protected before they become sexually active," said Becca Wright, family health and wellness director at the Sullivan County Regional Health Department. "When you mention sexually active, that's a turnoff for parents. This is a vaccine that's going to prevent cancer, and it's like other vaccines. The reason we're giving them MMR and others is to prevent disease. The HPV vaccine will prevent disease, cancers in their children. That's the bottom line. This is a cancer we can prevent."

The HPV vaccine was first recommended for girls, then for boys in the past few years as more studies were done, 

McPheron said. "The recommended age is up to 26 if they haven't been vaccinated. The CDC [Centers for Disease Control] tells us that more than 90 percent of cervical cancers and possibly anal cancer can be caused by HPV, and more than 50 percent of vaginal, vulvar and penile cancer are caused by HPV," she said.

HPV vaccines are given in a series of three shots over six months. For the best protection, it is very important to get all three shots long before being first exposed to the virus. Both boys and girls should get all three doses of HPV vaccine when they are 11 or 12 years old. If a teen or young adult (through age 26) has not started or finished the series of three HPV vaccine shots, it's not too late. If your child received the first or second dose of HPV vaccine some time ago, you don't have to start over — just get the remaining shot(s) as soon as possible.

"If you can prevent more than 90 percent of cervical cancer by getting this vaccine, that I hope would be enough proof to encourage them to get it," Wright said. "We do want youth and young adults to get the vaccine, even if they have been sexually active. Hopefully they haven't been exposed to one of the high-risk strains."

Two HPV vaccines are currently available. Cervarix protects against two HPV strains and Gardasil protects against four HPV strains. A new vaccine that protects against nine HPV strains is expected to be released later this year. 

More than 57 million doses of HPV vaccine have been distributed in the U.S. since 2006, and studies continue to show that HPV vaccines are very safe.

Because the cost for the HPV series is expensive for patients aged 19 to 26 who are not insured, Wright said the Sullivan County Health Department has been working with Merck, the pharmaceutical company that manufactures the vaccine, to create a patient assistance program for patients in that age group who meet income guidelines.

According to the American Cancer Society's "Cancer Facts & Figures 2014," there will be an estimated 290 new cases of cervical cancer in both Virginia and Tennessee this year. Nationwide, there will be an estimated 12,360 new cases of cervical cancer, 4,850 new cases of vulva cancer, and 1,640 new cases of penis and other genital cancers.

The report notes that mortality rates from cervical cancer have declined rapidly in past decades due to prevention and early detection as a result of screening with the Pap test.

"Cervical cancer that's diagnosed in early stages is very treatable," McPheron said. "Cervical cancer is not one of the top 10 cancers diagnosed. The incidence and mortality rates have fallen substantially due to Pap screening and hopefully the HPV vaccine. They think most cervical cancers are caused by HPV. The HPV vaccine partnered with Pap screening for females are the two key factors in preventing cervical cancer. In the health district that I live in, which covers Wise, Lee and Scott, our cervical cancer incidence rate is between 7.4 and 8.3 per 100,000. That puts us not at the highest incident rate, but it does put us up toward the top in Virginia."

With the HPV vaccine and the use of HPV testing, cervical cancer screening guidelines have changed. Here's what women need to know:

* Women who are sexually active should begin cervical cancer screening at age 21.

* Women between the ages of 21 and 29 should have a Pap test every three years.

* Women between the ages of 30 and 65 may have a Pap test and an HPV test (called a co-test) every five years if the test results are normal. Alternatively, these women may have a Pap test (without an HPV test) every three years.

* Women older than 65 who have had regular screenings with normal results need not be screened for cervical cancer. Women who have been diagnosed with cervical pre-cancer should continue to be monitored and screened.

* The HPV vaccine is most effective when administered to children before they are sexually active (9 to 12 years old).

For more information about the HPV vaccine, call the Lenowisco Health District at (276) 328-8000 or visit http://www.cdc.gov/hpv/whatishpv.html

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