Healthy Living: October 9, 2018

BANGOR, Maine (WAB) – On October 3rd the FDA approved the use of the Human Papilloma Virus (HPV) vaccine for both men and women up to age 45. Previously, the Gardasil 9 vaccine made by Merck Pharmaceuticals, had been approved for ages 11 to 26 and has been shown to be effective for this important family of sexually transmitted diseases. HPV viruses can cause genital warts, but more seriously they are implicated in cancers of the vulva, cervix, penis, anus and throat. Side effects of this shot are relatively minor, and include soreness and mild swelling at the injection site, or brief headaches. Coverage by insurance is not assured yet. The federal agency entitled the Advisory Committee on Immunization Practices, a division of the CDC, is expected to issue their support soon. When this happens, 3rd party insurances and Medicare are likely to signal their support.

MGN

So why has there been so little fanfare for this important announcement? Well, many Americans can be excused if they have been distracted last week by other news out of Washington DC. But many physicians have long been disappointed that many patients are not compliant with the current advice that all young adults between the ages of 11 and 25 get this vaccine. Overwhelmingly, pediatricians and family docs advise that their patients get the series before they become sexually active, yet estimates of compliance with this vaccine vary between 13 for young men and 37% for young women. This difference between the sexes is particularly concerning for the future health of men. While many parents support their pre-teen daughter receiving this vaccine to prevent cervical cancer, the lack of support for their sons ignores their risk for cancers of the penis, mouth and throat.

What many outside of medicine may not realize is that we are not talking about a minor problem: currently, about half of Americans between age 18 and 55 are already infected with genital HPV. Every year 4000 women in the US die from HPV-related cervical cancer. If you add in the anal, oropharygeal, vulvar, and penile cancers, over 28,000 American deaths are attributed to these viruses every year. And all of them are avoidable.

It is particularly urgent for all potentially sexually active individuals to get the vaccine before they become exposed, because the vaccine does not protect people from going on to get cancer if they already have an HPV infection. In other words, the vaccine is a purely preventive strategy in the fight against these common and deadly diseases. The best medical advice is to receive the 2 shot series early in preadolescence from age 11 to age 14. After this point it will take 3 shots over a 6 month period to show immunity to the HPV subtypes 6, 11, 16, and18 that are often associated with cancer. However, if a person is between 26 and 45 with the potential for having a new sexual partner at any point in their lifetime, the smart choice is to ask about this vaccine at the first opportunity that you might have with your physician.

From the medical perspective, this news is a real win for all adults who want to stay healthy and avoid serious cancer later in life. There aren’t many black and white calls in medicine, but this really is one of them. To paraphrase an old saying, ‘A stick in time could save you 9 (HPV infections)!

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