There were some 6,300 HPV-related malignancies in Arkansas from 2000-2015 and more than 35,000 cases nationally each year. Oropharyngeal malignancies related to HPV recently surpassed those of the cervix and occur mostly in boys. Males are also susceptible to anogenital malignancies, including penile cancer, and women can develop oropharyngeal lesions. 45% of women aged 20-24 are actively infected. 27% of all women are infected at any given time. The numbers for males are not as well documented. There are over 150 strains of papillomavirus, but only a handful (16, 18, 31, 33, 45, 52, 58) cause cancer. The Gardisil 9 vaccine prevents these strains.
Arkansas has the most cases of cervical cancer based on the number of people that live in our state compared to other states, and we rank poorly for HPV vaccines of boys and girls between the critical ages of 13-17 years old. To prevent thousands of future cases of cancer in our state it is extremely important to improve our HPV vaccine numbers. Current Arkansas rankings:
HPV is a difficult topic for parents because it is spread by physical (sexual) contact. While this most commonly involves vaginal intercourse, it does not have to, and contact of any kind, including non-sexual contact, can be a cause of spread. Because the virus lives diffusely in the skin (not just in the anogenital region), local measures such as condoms, which are important against STDs (sexually transmitted diseases) including herpes, chlamydia, and gonorrhea, do not prevent HPV. 80+% of non-vaccinated adults will have an HPV infection during their lifetimes, only they won't know it.
The HPV vaccine prevents HPV types that cause several cancers in both men and women, including cervical cancer, vaginal and vulvar cancers, anal cancer, throat cancer, and penile cancer. There is no effective screening or testing for anal, vulvar, penile, or throat HPV-related infections or cancers, as there is no swab or blood test that can check for all HPV types. Also, the virus is "hibernating" in some people at levels that are not detectable by testing. Therefore vaccination, ideally before ever having sex, is highly recommended and is the most effective way of preventing HPV.
Vaccination is most effective when given prior to HPV infection, meaning before becoming sexually active. Because the age of initiation of sexual activity is variable, and because vaccination in HPV naive (not previously exposed) individuals is much more effective, early vaccination is essential. The HPV vaccine is recommended for routine vaccination at age 11 or 12 years for both boys and girls.
For people who are already sexually active, the vaccine may still be of benefit. This is because there are many strains of HPV. The vaccine can still protect us against those strains (that the vaccine covers) that we haven't yet been exposed to.
No, it's not too late. The CDC's Advisory Committee on Immunization Practices (ACIP) recommends vaccination for everyone through age 26 years if not adequately vaccinated previously. HPV vaccination is given as a series of either two or three doses, depending on age at initial vaccination.
Gardisil 9 (Merck) is the only HPV vaccine currently offered in the US. The 9 refers to the fact that it protects against 9 different strains of the HPV virus. In addition to the cancer-causing virus strains (16, 18, 31, 33, 45, 52, 58), it also protects against types 6 and 11, which cause 90% of anogenital warts. The quadrivalent (4 types) version was introduced into clinical practice having completed trials in 2006. The 9 valent version came later.
Historically, vaccines against viral diseases typically used killed or attenuated (weakened) viruses. The Salk and Sabin polio vaccines are examples of these methods. Gardisil is an example of a recombinant vaccine in which the viral surface proteins which stimulate the immune response are made in a yeast or plant vector, harvested, and given to the recipient. This means that there are no intact viral particles, only non-infective surface components, and the vaccine can be made to target multiple viruses.
The safety profile of Gardisil 9 has been very good. In trials including over 15,000 individuals, injection site reactions similar to other vaccines were the most common side effect. Dizziness, headache, and fever occurred in about 1 per 1000, and it is usually recommended that recipients remain seated for 15 minutes after injection.
It is highly effective. Almost all HPV infections that cause abnormal cells and cancer can be prevented by the HPV vaccine. The HPV Vaccine (Gardasil 9) targets the types of HPV responsible for around 90 percent of cervical and other HPV-related cancers and 90 percent of genital warts. Clinical trials show it is highly effective in preventing these types of HPV in young people who have not previously been exposed to them.
Two doses of the HPV vaccine are recommended for most persons starting the series before their 15th birthday. The second dose of the HPV vaccine should be given 6 to 12 months after the first dose. Adolescents who receive two doses less than 5 months apart will require a third dose of the HPV vaccine. Three doses of the HPV vaccine are recommended for teens and young adults who start the series at ages 15 through 26 years and for immunocompromised persons.
Current data suggests vaccine protection lasts many years. Completing the primary vaccination course (2 or 3 doses depending on age) is expected to offer lifelong protection.
HPV vaccination does not preclude the need for cervical cancer screening later in life since it is possible that one was infected before being vaccinated. Screening for the presence of HPV DNA in cervical tissues is gradually supplanting the PAP smear, which looks for morphologic evidence of early cancerous changes. Several groups feel that the absence of HPV DNA means that screenings can be less frequent (every five years rather than three). A history of abnormal PAP or anogenital warts is not a reason to skip vaccination, as a person could subsequently be exposed to one of the other strains of the HPV virus family.
Anogenital warts are growths on the anogenital areas in both boys and girls that are a direct result of HPV infection. While not malignant, they can be embarrassing and a cause of shame and guilt. They are hard to treat and can persist for long periods. HPV vaccination can prevent them but does not contribute to their healing once established.
While the burden of HPV incidence (the number of infections at any given time) is greater in girls than boys, it is important to vaccinate boys as a way to gain herd immunity and decrease the reservoir of virus in the community.
There is no evidence that HPV vaccination promotes sexual behavior. In fact, research has found that teens living in the states that proactively promoted the HPV vaccine were not having more sex than teens in the other states.
Not all physician offices keep the vaccine on hand, although many do, particularly if they see many children. It is readily available in Benton, Carroll, Madison, and Washington counties. The most significant barrier is "Don't Ask, Don't Tell." Patients don't ask, and providers don't tell, for a variety of not very good reasons. Don't be shy. Ask about HPV and request to get your children protected. The vaccine is free for children without insurance through Vaccines for Kids, a state program available at many physician offices. The cost is about $230/dose for those with insurance, and that cost is typically covered based on your plan.
The HPV vaccine is FREE to any child under the age of 18 with or without insurance through the Vaccines for Kids program. After age 18, you pay for all 3 doses without insurance, so it benefits you to schedule the vaccine for your children between the ages of 13 - 17 years old.
The Cancer Challenge is the sponsor for this site. Founded in 1993, the Cancer Challenge has supported cancer care and cancer patients in our area with over $13,800,000 given to various local organizations dedicated to the diagnosis and treatment of cancer. If you'd like to help fight cancer in Northwest Arkansas, you can donate here. All donations stay local and support cancer programs and services in our community.
Dr. Malcolm Hayward, a board member since 1998, is responsible for assembling the information for these pages. Dr. Hayward has practiced Oncology in Northwest Arkansas since 1980 and was a founding member of Highlands Oncology in 1996. He is a Fellow of the American College of Physicians and Board Certified in Medical Oncology.