HPV: A Vaccine That Prevents Cancer Is Also Greatly Misunderstood

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Just-released clinical trial results reveal that the new HPV vaccine provides even more protection against cancer than before. But, according to a new survey from Planned Parenthood, parents still have not warmed up to it. (Photo: Getty Images) 

HPV, or the human papillomavirus, is the most common sexually transmitted disease (STD) in the world. The virus can resolve itself in the body on its own, but it can eventually result, years later, in anal, cervical, mouth and throat, penile, vaginal and vulvar cancers.

And while a vaccine exists to prevent HPV and its future side effects — one of only two cancer-preventing vaccines currently in existence — only 37.6 percent of girls and 13.9 percent of boys ages 13 to 17 got all three doses of the vaccine in 2013.

In a survey shared exclusively with Yahoo Health, Planned Parenthood Federation of America (PPFA) and NYU’s Center for Latino Adolescent and Family Health polled a national representative sample of 1663 children ages 9 to 21 and their parents, to investigate awareness about HPV, the cancers it causes, and the vaccine’s safety and efficacy.

When It Comes To HPV ‘Parents Don’t Know A Lot’

Of those surveyed by Planned Parenthood, only about a third (30.7 percent) of parents had elected to have their children vaccinated with all three doses needed for complete protection. An additional 4.8 percent had children who had received two out of the three necessary doses, while another 6.7 percent had only one of the three necessary doses. Over 40 percent of parents polled were either undecided about whether their child should receive the vaccine or had decided not to vaccinate their child against HPV.

“What we saw very strongly [in our survey] were two things,” says Leslie Kantor, vice president of education for Planned Parenthood Federation of America, “One, that HPV is also a problem for boys and men and two, that a substantial number of folks are concerned with the safety of vaccines.” Kantor adds that what the survey “showed really clearly is that one problem overall is that parents don’t know a lot” when it comes to HPV, its risks, and the safety and efficacy of the vaccine.

Of the 40.6 percent of those surveyed who have not yet vaccinated their children or are not planning to, about 70 percent of those named “safety concerns” as their reason for their indecision or choice not to vaccinate.

“People don’t understand that HPV causes cancer. This is a vaccine to prevent cancer,” emphasizes Kantor, noting that there has somehow been a major public health failure in educating parents that electing to have their child receive the HPV vaccine “is to help protect their kids from cancer” when they grow up.

The HPV Vaccine Has Been Proven To Be Safe 

“There are many conversations on the Internet and in social media about HPV vaccine safety,” Jill Roark of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control (CDC) tells Yahoo Health. “All vaccines used in the U.S. are required to go through years of extensive safety testing before they are licensed by the FDA. HPV vaccines, like all vaccines, are continually monitored for safety. There have been no serious safety concerns linked to HPV vaccination.”

Recently, the Toronto Star ran a much-discussed article with the alarmist headline — which has since been changed — of A Wonder Drug’s Dark Side. The piece detailed families who believe their children had been harmed after receiving the Gardasil vaccine for HPV. The article said: “Hundreds of thousands of teen girls have safely taken Gardasil … But a Star investigation has found that since 2008 at least 60 Canadians experienced debilitating illness after inoculation. Patients and parents say the incidents point to the full disclosure of risks.” 

The piece featured emotionally gripping details of the suffering, and even death, a few girls had experienced shortly after getting a dose of the vaccine. Their families, understandably, blamed the vaccine, but there was no evidence in any of the cases directly linking the injury to Gardasil. The Toronto Star came under global criticism by the medical and public health communities — and the paper’s public editor said the Star had failed in their reporting by admitting from the article any of the large body of science proving that the vaccine is safe.

"The only — and very rare — serious side effects of HPV vaccines that scientific studies point to are allergic reactions. Continuing studies of databases of adverse effects have not found any evidence of any other serious side effects,” stated an Op-Ed that was submitted to the Toronto Star by 65 Canadian specialists in infectious diseases, public health and related sciences.  

The Centers for Disease Control and Prevention’s (CDC) has a Vaccine Adverse Event Reporting System, where people can self report reactions and injuries they believe have been caused by vaccines. But the agency notes that inclusion in this database “does not constitute admission that healthcare personnel or a vaccine itself caused or contributed to the event.”

The New HPV Vaccine Provides Even Better Cancer Protection

A study being released on Thursday in the latest edition of the New England Journal of Medicine presents strong data in support of a trial of the new HPV vaccine, called Gardasil 9, which protects against even more strains of HPV and, thus, against even more instances of cancer. The clinical trial exhaustively proved that the new version of the vaccine protects against the nine types of HPV it sets out to protect against with 97 percent efficacy.

On February 26 a CDC federal vaccine advisory committee voted to recommend use of Gardasil 9, clearing the way for the broader-coverage vaccine to be used in clinics. 

Related: 10 Things To Know About The New HPV Vaccine

“The current HPV vaccines both protect against HPV types 16 and 18 which cause most HPV cancers. One of those vaccines also protects against types 6 and 11, which cause most genital warts. The 9-valent HPV vaccine [which is reviewed in the New England Journal of Medicine] will still protect against infection with HPV types 6, 11, 16, and 18. It will also protect against an additional five HPV types, which will provide more protection from cancers caused by HPV infection,” explains Roark.

“The biggest surprise is that there was no surprise at all,” Elmar Joura, MD, an associate professor of gynecology and obstetrics at the Medical University of Vienna and lead researcher of the HPV vaccine study, tells Yahoo Health, “The vaccine did perfectly what it was expected to do: It perfectly prevented infection and disease and it was designed to prevent infection and disease.”

Kids Are More Worried About The Sex Aspect Of HPV — As Are Parents

“When you talk to young people, most of them think, ‘I’ll never get cancer’ and most are not aware of this threat,” says Joura, noting that young people, however, have “heard of genital warts and are much more afraid of getting them because they immediately affect their lives.” He also adds that, in his opinion, the biggest misconception about the HPV vaccine is “the connection between sexual transmission and the use of vaccines.” Joura says that while many parents have been hesitating to vaccinate their children because they believe the vaccine yields increased sexual activity, when you look at the data in comparison to the prevention of cancer and other diseases related to the virus in countries with excellent national coverage of the vaccine — such as Australia, where genital warts have been all but eradicated — the results speak for themselves.

And to those parents concerned about their children becoming sexually active at a young age as a result of receiving the vaccine as recommended at the age of 11 or 12, Kantor says, “It is really, really important for parents to understand that this vaccine is recommended at ages 11 or 12 not because anyone thinks kids are having sex at 11 or 12, but because we want to give the body time to mount an immune response that is strong and active before it has any chance of being exposed [to HPV]. … There have now been many, many studies that show there is no link between getting the HPV vaccine and starting to have sex earlier or having more sex. This vaccine gives no message to kids regarding having sex. What it does is prevent cancer from the most common sexually transmitted virus in the world.” The survey Kantor supervised on behalf of Planned Parenthood found that only 14.6 percent of those children polled who had received the vaccine had received it before the age of 13, the age at which it provides the most effective preventative results.

HPV Causes About 27,000 Cases Of Cancer In Americans Every Year 

About 330,000 American women are diagnosed yearly with pre-cancer of the cervix, which requires testing and treatment. Many of these cancers and pre-cancers could be prevented with HPV vaccination at the age of 11 or 12 years. According to Roark, “HPV infections with HPV types 16 and 18 (which the vaccine protects against) decreased by more than half in teen girls aged 14 to 19 years, in the first four years after HPV vaccination was introduced in the United States. Many people are not aware of the number of cancers and precancerous conditions caused by HPV infection.”

The HPV Vaccine Is Widely Available — And Covered Under The Affordable Care Act 

Furthermore, Roark clarifies, “There are clinicians and parents with the misperception that insurance doesn’t cover HPV vaccination. The Affordable Care Act requires that, as of September 2010, vaccines recommended by ACIP be covered by non-grandfathered private health plans without cost-sharing when administered by an in-network provider.  The Vaccines for Children program is available to provide vaccines at no cost to adolescents that do not have health insurance.”

The HPV vaccine is not only available from pediatricians and Planned Parenthood, but also from the minute clinics [within drug stores and pharmacies] that can give flu shots to minors. “It can be hard for parents to manage three doses, which is why it is so good to know that they can go down the street and have their child immunized at their neighborhood pharmacy or minute clinic,” says Kantor.

But Still, Not Enough Children Receive The HPV Vaccine 

In an editorial in the New England Journal of Medicine, Anne Schuchat, MD, the assistant surgeon general of the United States Public Health Service and the director of the National Center for Immunization and Respiratory Diseases at the CDC, writes:

 “By any metric, HPV vaccine coverage in the United States is a problem. At 57 percent, coverage for the first dose of HPV vaccination among girls 13 to 17 years of age lags behind coverage for other vaccines recommended for children 11 to 12 years of age by approximately 20 to 25 percentage points. If teenagers were offered and accepted HPV vaccination every time they received another vaccine, first-dose coverage for HPV would exceed 90 percent. Even though private doctors’ offices stock vaccines, and parents and teens visiting the offices accept other immunizations, 4 of 10 adolescent girls have not even begun HPV vaccination. Formative research suggests that parents hear mixed messages about HPV vaccination; pediatricians communicate less urgency and give weaker recommendations for this vaccine. When clinicians present the HPV vaccine together with tetanus–diphtheria–acellular pertussis and meningococcal vaccines and make strong recommendations, there is greater acceptance.”

The HPV Vaccine Applies To Sons As Well As Daughters

When the first version of the vaccine was released, “it was only recommended for girls” while research was still being done on its efficacy in boys, Kantor recalls. The Planned Parenthood survey showed that a third of those polled did not realize that the vaccine is something recommended for boys as well as girls.

“When the recommendation changed to include boys, there was much less media attention on that. Parents just have not heard that this vaccine is for boys too. It can protect boys themselves and their partners when they are older. To some extent, we still give the message that it’s girls who are supposed to be preventing pregnancy or sexual assault — the HPV vaccine is part of a larger sexual education effort needed to get across that all of our messages are inclusive of boys as well,” Kantor notes.

In her New England Journal of Medicine editorial, Schuchat concludes:

“Even with the availability of another HPV vaccine targeting additional cancer-causing virus types, vaccination of a much higher proportion of preteens is needed. Otherwise, decades from now oncologists will still be talking about HPV-associated cancers with thousands of new patients every year. Instead, I hope that in a few decades we will be able to tell a generation of adults who never had HPV-associated cancers or precancers that when they were teenagers [that] we had them covered.”

Kantor agrees. “Here we have a terrific vaccine that is pretty easy to get, you can get it almost anywhere, and it can keep your kid from getting cancer. We have a responsibility as parents to prevent cancer in our children.”