Pictured above: Cancer starts with the uncontrolled division of cells.From https://commonfund.nih.gov/metabolomics/programhighlights
The developed world is in the midst of a huge nosedive in genital warts and cervical “precancer” — all thanks to the human papillomavirus (HPV) vaccine. This simple shot trains the immune system to defend itself against HPV, a virus that causes genital warts and several types of cancer. Most sexually active people will be exposed to it in their lifetimes — it’s even been nicknamed the “common cold” of sexually transmitted infections.
Gardasil 9 protects against seven strains of HPV that collectively cause 90% of cervical cancers and anal cancers, plus the two HPV strains that are jointly responsible for 90% of genital warts. Vaccination also reduces the frequency of “precancers,” which are cellular abnormalities that can be treated before progressing into full-fledged cancer — meaning less time, money, and anxiety spent dealing with follow-up procedures and treatments.
The HPV vaccine is an anti-cancer vaccine. The vaccine is safe and effective — and when we say “effective,” we mean it could lead to the eradication of HPV, and with it the cancers it causes. A recent analysis of 66 million vaccine recipients published in The Lancet points to plummeting rates of genital warts and precancer. Among teenage girls, there was an 83% drop in HPV-16 and HPV-18 infections (the two strains of HPV that together cause 70% of cervical cancers) — and cervical precancers were cut in half.
The most dramatic gains were made in countries that offered the HPV vaccine to both boys and girls. Additionally, there were even decreases in the HPV strains that aren’t covered by the vaccine — evidence of “cross-protection,” the phenomenon in which the immune system recognizes close relatives of the viruses it has been trained to attack. Even people who did not receive the vaccine were less likely to catch the virus, simply because their risk was reduced if their partners were vaccinated.
Here in the United States, although HPV vaccination isn’t as widespread as it is in many other developed countries, HPV infections are still declining. A study published in June showed a 78% decline in HPV infections among young women in their early 20s over a 10-year period — and only around two-thirds of them had ever been vaccinated.
A Gap in Access
There is a huge gap in access to lifesaving HPV vaccines, however. The Lancet study was conducted in wealthy countries — where most patients also have access to Pap testing, biopsies, and surgeries, all of which can detect and remove cervical precancers before they develop into cancer. (Though anyone who has had an abnormal Pap result can tell you that reducing the risk for precancer is nothing to sneeze at.)
Cervical cancer is still a top killer in developing countries, but the people who would benefit most from an HPV vaccine are less likely to have access to it. Currently, almost 90% of cervical-cancer deaths strike women in developing countries, where it is the second-most common cancer among women. While cervical cancer rates are holding steady in the developed world, in the coming decades they are projected to increase sharply in less developed regions. The antidote to that increase? Widespread deployment of the HPV vaccine.
Beyond Cervical Cancer
HPV doesn’t just cause cervical cancer. Since it’s sexually transmitted, it can land in any part of the body involved in sexual activity, including the head and neck, genital tract, and anal tract. Recently, “Desperate Housewives” star Marcia Cross talked about her and her husband’s respective battles with anal and throat cancer, thought to originate from the same strain of HPV. Cross is hoping to destigmatize HPV-associated cancers and promote awareness of the vaccine.
In the United States, head-and-neck cancer is more common among men than are cervical cancers among women — and head-and-neck cancer rates are increasing in the male population, while they are relatively stagnant among women. These rates are projected to continue climbing, which will skew head-and-neck cancer even more heavily toward the male population.
Anal cancer is not as common in the general population, but each year HPV is thought to cause 4,300 anal cancers in U.S. women and 2,200 in men. Even though a greater number of women are affected, proportionally speaking, gay and bisexual men are at higher risk. People at risk for anal cancer might want to be screened with an anal Pap test, which is similar to Pap tests that screen for cervical cancer.
Who Should Get Vaccinated?
When the HPV vaccine came onto the market in 2006, it was heavily marketed to tween and teen girls. In the years since, evidence has mounted that it’s beneficial for all young people, regardless of gender, and ideas have also changed about the age range in which the vaccine should be offered. Last year, the FDA approved Gardasil 9 for people as old as 45.
Pictured right: Pink Vaccine Cartoon. From http://www.nlm.nih.gov/medlineplus/magazine/issues/winter14/articles/winter14pg18-19.html
Simply receiving FDA approval doesn’t mean a medication is covered by insurance. In the case of vaccines, insurance coverage usually mirrors the recommendations of the Advisory Committee on Immunization Practices (ACIP). Earlier this summer, ACIP recommended that men as old as 26 receive the vaccine — previously, that recommendation stopped at age 21. As soon as the recommendation is approved by the CDC’s director, young men will have five extra years to receive the vaccine and still be covered by health insurance.
Unfortunately, ACIP still hasn’t put the official seal of approval on HPV vaccination for adults between the ages of 27 and 45, meaning that despite FDA approval, we “old folks” might still have to pay out of pocket, even if we have health insurance.
It’s still best to receive the HPV vaccine before becoming sexually active. As a bonus, kids 14 and younger only need two doses of the vaccine — not the three doses that anyone 15 and older needs.
Planned Parenthood Arizona offers this vaccine to patients of all ages. If you’d like more information about Gardasil 9, or would like to make an appointment to get vaccinated, you can call your local Planned Parenthood health center.