What if I told you there was a vaccine that prevented cancer, but less than half the people who could benefit from it are receiving it? What would you have to say about that?
It turns out about 70 percent of cases of cervical cancer are now vaccine-preventable. And that’s a big deal, because there were 528,000 new cases of cervical cancer worldwide in 2012.
This isn’t often on our radar here in the states, because only 12,042 of those cases were in the U.S. We can thank George Papanicolaou for that.
In the 1940’s, the U.S. adopted widespread use of his pap smear. This resulted in a dramatic decrease in the number of cases of cervical cancer.
The pap smear provides early detection of cancer when it exists, allowing treatment to commence at early stages when it is more successful. Even better, the pap smear can detect abnormal cells before they turn into cancer. The disease can be prevented. So can the harsh treatments that go with it.
The human papillomavirus (HPV) HPV causes almost all cases of cervical cancer worldwide. It’s a sexually transmitted virus that often causes no symptoms or disease. Even so, various strains of HPV cause cervical cancer and genital warts, as well as cancers of the penis, anus, and mouth. In particular, HPV types 16 and 18 account for about 70 percent of cervical cancers.
Surprisingly, the trouble with HPV is that most people aren’t aware they are infected. In fact, 79 million people in the U.S. are infected with HPV. Since many have no symptoms it continues to spread through the population. Pap smears are a great tool for detecting early changes caused by HPV. But they don’t prevent the initial HPV infection.
Enter the HPV vaccine.
Introduced in 2006, the HPV vaccine received a lot of negative attention. Some people think it encourages young people to engage in sexual activity. It doesn't. In Texas, the former governor issued an executive order mandating the vaccine for 11 and 12 year old girls. This triggered a political firestorm. Plus, the vaccine has been the subject of questionable journalism.
The HPV vaccine comes in two forms – Gardasil and Cervarix. Both protect against multiple HPV types, including 16 and 18. These are the two strains most likely to cause cervical cancer.
This week, the journal Pediatrics shared good news about the HPV vaccine. Since its introduction in 2006, the prevalence of HPV types found in the early vaccine has declined dramatically in immunized women. Specifically, immunized females aged 14-19 experienced a 64 percent decrease, while women aged 20-24 experienced a 34 percent decline.
Mind you, the original vaccine protected against four strains of HPV. The current formulation protects against nine strains. The early vaccine failed to cover about 30 percent of cancer-causing strains, but ongoing research seeks to improve this number.
Let me emphasize this point. We are talking about a vaccine that prevents cancer. We are talking about a vaccine that will save lives from the effects of these viruses. We are talking about an opportunity to preserve fertility in women who will avoid invasive diagnostic procedures and cancer treatments.
Yet only 40 percent of girls and 20 percent of boys ages 13-17 in the U.S. have received the vaccine. It’s a vaccine that prevents cancer and far less than half of those who should receive it actually do. What the heck?
A big piece of this shortfall lands squarely on the shoulders of primary care physicians. Studies show they find the discussion burdensome and the idea not readily received by parents. So they suggest HPV vaccination less often than other vaccines recommended for the same age group.
The CDC currently recommends the three shot immunization series for boys and girls aged 11 to 12 years old. This catches almost all adolescents prior to sexual activity. It’s also an age where their immune system will mount a robust response to the vaccine. Females can receive the series up to age 26, males up to age 21, if they have not previously received them.
Doctors, please start recommending these vaccines appropriately. Parents, please start asking about them. We are lucky in the U.S. that we have widespread screening for cervical cancer. But over 4,000 women will still die of it each year. That’s 4,000 too many when we have a way to prevent the disease.
Amy Rogers MD is not a practicing physician and nothing written here should be taken as medical advice from either Amy or AssetBuilder. Medical decisions should be made with care in consultation with your health care provider.