The HPV Vaccine: Blocking Cancer With a Shot
Dr. Jason Terk, a pediatrician at Cook Children's Health Care System in Keller, Texas, was pleased when the U.S. Food and Drug Administration approved the use of a new vaccine series in 2006 for children to protect them from the potentially dangerous consequences of the human papillomavirus. HPV is extremely common. About 1 in 4 people in the United States are infected with the sexually transmitted virus. Most infections go away naturally, but in more than 30,000 cases every year, HPV causes various forms of cancer. "We're talking about cancers that can be very difficult to treat," Terk notes. Cervical cancer is the most common HPV-associated disease for women, while cancers of the throat, tongue and tonsils most commonly afflict men.
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Despite its potential benefits, public suspicion toward the HPV vaccine mounted quickly, based on alarming stories alleging serious side effects and parental fears of encouraging early sexual activity. Even today, after 10 years of experience have shown the vaccine to be safe and effective against the strains of HPV it targets, fewer than half of youngsters are fully protected -- and instances of HPV-associated cancers are on the rise. As a result, cancer centers across the country have issued a plea for parents to get their children vaccinated, which should be a bit easier than in the past thanks to a revised recommendation that the Centers for Disease Control and Prevention put out late last year. The new guidance calls for two shots of the vaccine for 11- and 12-year-olds (the second dose coming six to 12 months after the first) instead of three shots in six months.
Fears about side effects, and the belief that tweens who are not sexually active don't need the vaccine, are misguided, experts say. The millions of doses given show that the most serious side effect is fainting, according to the CDC -- a concern for any vaccine or medical procedure. Dr. Jessica Cataldi, a pediatrician at Children's Hospital Colorado, frames the vaccine to parents as a way to prevent cancer rather than sexually transmitted infection, and explains that "this earlier age is actually when you have the strongest and most lasting immune response." Plus, patients need to be armed against HPV long before they are exposed to risk. "If [parents] try to wait until they think it's a relevant issue then most of the time it's too late," Terk says.
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Surprisingly, it may be doctors rather than parents who present the biggest obstacle to wider use. Studies show that a lackluster provider recommendation is often to blame for HPV vaccine refusal: Physicians tend to overestimate how resistant parents will be to the HPV vaccine and either overexplain the details or recommend it less forcefully than the other common tween vaccines -- Tdap, which protects against tetanus, diphtheria and pertussis, and one that protects against meningococcal disease, including meningitis. "[Parents] pick up that it's being talked about differently and sort of pull back," says Dr. Melinda Wharton, director of the Immunization Services Division in CDC's National Center of Immunization and Respiratory Diseases. "There's sort of a feedback loop that's not very good between providers and families." When doctors recommend the three vaccines as a bundle, parents are much more likely to vaccinate against HPV.
Recently, health professionals have seen reason for optimism. HPV vaccination rates are inching upwards as health care organizations put more resources into advocating for the vaccine and providers make more effective recommendations. The new, easier vaccination schedule may help, too. Females who miss the 11- to 12-year-old window can still benefit by getting vaccinated up until age 26; young men, up to age 21. Gay, bisexual and transgender males can benefit up till age 26.
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The medical community has no illusions about the potential cost of slow progress. "My worst nightmare is that one of my former patients will end up with one of these cancers that I could have prevented," Terk says.
