Vaccine Can Protect Girls, Young Women from Cervical Cancer

Most parents don't hesitate to vaccinate their children against some of the most common childhood illnesses. This year, a vaccine was introduced to protect girls against acquiring a virus that could cause cancer. Although leading medical organizations recommend that all girls 11 and 12 years old be vaccinated, some parents are resisting. Why?

The virus is the human papillomavirus, or HPV. It's now recognized as the major cause of cervical cancer, a disease that kills approximately 3,700 American women each year. The American Cancer Society estimates almost 10,000 US women are diagnosed with cervical cancer annually. The vaccine, recently approved by the Food and Drug Administration, will protect girls and young women against 70% of all cervical cancers. The HPV virus is spread primarily by sexual contact.

Yet some parents may not understand why it's important to vaccinate their preteen girls, says LuAnn Moraski, DO, Assistant Professor of Internal Medicine and Pediatrics, and Program Director of the Med/Peds Residency Program at the Medical College of Wisconsin. Dr. Moraski provides care at the Froedtert & The Medical College of Wisconsin Plank Road Clinic.

"Many parents are asking about the vaccine," she says. "For those who are reluctant to vaccinate their preteen girls, I tell them they need to think of the vaccine as targeted toward preventing cancer and not think of it as a license to encourage sexual activity. The reason it's recommended for girls as young as 11 and 12 is that the vaccine is most effective if it's given before they are exposed to the virus. If you're going to prevent a disease, you want your defenses up before you need them." In fact, she adds, many physicians believe the vaccine should be given to girls as young as 9 years old.

Recognizing Youthful Sexual Behavior
The vaccine has been recommended for preteen girls by the American Academy of Pediatrics, the American Academy of Family Physicians and the Centers for Disease Control and Prevention (CDC).

Research has shown that one in four American youngsters have had sex by the time they enter high school, and three in five have had sex by the 12th grade. Dr. Moraski says, "Kids know a lot more than some parents give them credit for. It's important for parents not to be naïve. Kids deserve accurate information, and parents should talk to their kids about sex at least by the time they're age 10. Kids are exposed to so much sexual imagery on TV, music and on the Internet - those are not always good messages, and not likely the sources parents want their kids to go to for information."

And to parents who say they trust their children when they assure them they are chaste, she notes: "Unfortunately, not all sexual contact is consensual. Also, many children and teens believe 'sex' strictly means vaginal intercourse. They might not regard oral sex or any other variation as 'having sex.' But they can still be exposed to HPV through all types of sexual contact."

"It's important to realize that early sexual activity crosses all demographics - urban and rural, rich and poor, boys and girls. It's not about someone else's kids - it's about our kids."

Medical Breakthrough
When the vaccine was announced earlier this year, the CDC described it as a medical breakthrough, calling it "the first vaccine developed to prevent cervical cancer, precancerous genital lesions and genital warts due to HPV." The vaccine is highly effective against four types of the HPV virus, including two that cause about 70% of cervical cancer.

In A Primer on HPV, the National Cancer Institute describes the human papillomavirus as "very common," noting that "of the more than 100 types of HPV, fewer than 20 are considered 'high-risk' for the development of cancer." In addition to causing cervical cancer, HPV can also cause other forms of female and male genital cancers.

According to the National Women's Health Information Center, genital HPV is the most common sexually transmitted disease in the United States. The center estimates at least 50% of sexually active men and women get genital HPV at some time in their lives. HPV rarely causes symptoms, however, so most infections go unnoticed and clear up. Certain types of HPV may cause warts, or papillomas, which are benign (noncancerous) tumors.

"We know the vaccine is effective," Dr. Moraski says. "It has been extensively tested over five years, it does not contain mercury or thimerosal, and it's without major side effects. The biggest health risk is tenderness at the injection site - a sore arm for a day."

Three-Shot Regimen Provides Protection
To be effective, the vaccine needs to be administered in three doses, she says. The second injection should be given two months after the first injection, and then a third shot six months after the first. Eventually, a booster shot might also be recommended after the three-shot regimen, she says.

The CDC recommends that the vaccine also be given to girls and women from 13 to 26 years of age because they, too, will benefit from getting the vaccine. Although the vaccine is most effective if it is administered before the onset of sexual activity (and thus exposure to the viruses), the CDC recommends that all girls and women 13 to 26 who are sexually active should still be vaccinated.

Boys and men can also be infected with HPV, and can spread it to girls and women. Currently, however, there is no indication for vaccination for boys and men, but testing is under way, Dr. Moraski says. Studies are also being done to assess the benefits of vaccination for women over 26 years of age.

In the meantime, Dr. Moraski emphasizes, the vaccine does not replace an annual pelvic exam and Pap test, which can indicate the presence of other diseases and disorders, including the 30% of cervical cancers that are not specifically caused by the papillomavirus. Sexually active individuals can further help prevent cancer and other conditions by having their male partners use condoms with every contact. "Condoms are the best protection from HPV and other diseases, but they are not 100% effective," Dr. Moraski notes.

"The number one thing for parents to remember about the HPV vaccine for young girls is that it prevents cancer - and cervical cancer is the number two cancer for this age group. Having a cancer vaccine is a very good thing. Second, it's safe. Third, it needs to be given in a series of 3 shots, on schedule, for maximum protection.

"Finally, it provides another reason for parents to talk to their kids about sex, and a number of studies have shown that talking helps. One study observed that when children and their mothers have close relationships and can discuss matters freely and openly, it helps discourage youngsters from sexual activity, especially through junior high school."

Barbara Abel
HealthLink Contributing Writer

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.