Brett A. Miles, DDS, MD
Associate Professor of Otolaryngology Head and Neck Surgery
Co-Chief, Division of Head and Neck Oncology
Mount Sinai Health System
What EVERYONE Needs to Know About HPV (Human Papillomavirus) and Vaccination
Human papillomavirus (HPV) is widely known as the virus that causes cervical cancer in women, but many people don't realize it also leads to other life-threatening cancers that affect both men and women. For instance, it causes most oropharyngeal (throat) cancers, which are far more common in men and are expected to surpass the number of cervical cancers by the year 2020.
In the United States, about 20,600 females and 12,600 males are diagnosed with HPV-associated cancers each year, according to the Centers for Disease Control and Prevention (CDC). Fortunately, there is a vaccine that, when received early enough, can prevent most of these cancers.
What Is Human Papillomavirus (HPV)?
HPV is the most common sexually transmitted infection, affecting nearly all sexually active men and women at some point in their lives. There are many different subtypes of HPV. Some are low-risk, or benign (non-cancerous), though they can cause genital warts. Several others are high-risk, or malignant, having the potential to cause cancer.
HPV infections usually cause no symptoms or health problems, and most people clear the virus naturally through their own immune systems. Unfortunately, about seven percent of people with HPV do not, resulting in chronic infection.
How Is it Transmitted?
HPV is usually transmitted during sexual activity through contact between one moist mucosal surface--whether vaginal, anal, or oral--and another. It can also be spread through intimate skin-to-skin contact and, less likely, bodily secretions, such as through saliva when kissing.
What Kinds of Cancer Does HPV Cause?
Having a chronic infection with or repeated exposure to HPV in the cervix, genitals, anus, tonsil, or base of the tongue can predispose people to cancers in those areas later in life. High-risk HPV causes almost all cervical and anal cancers; a majority of tonsil and tongue-base (oropharyngeal) cancers; and a significant share of rare genital cancers, such as vaginal and penile cancers.
The HPV Vaccine
The HPV vaccine was initially created for preteen girls to prevent cervical cancer when they are older, but is now recommended for boys, as well, because the transmission process is a two-way street, and males can get HPV-related cancers, too. Since 2006, the U.S. Food and Drug Administration has approved three vaccines--Gardasil, Gardasil 9, and Cervarix--to prevent infection with the high-risk HPV subtypes that cause the majority of cancers.
Who should get vaccinated? The vaccine is proven effective only if given before acquiring an HPV infection, which most people do shortly after becoming sexually active. That's why the CDC recommends routine vaccination for all preteen girls and boys at age 11 or 12, before they have engaged in any sexual activity and been exposed to HPV; however, vaccination may begin as early as nine years old.
For teenagers and young adults who have not previously been vaccinated, the CDC recommends vaccination up to age 21 for men, in general; and up to age 26 for women, men who have sex with men, and immunocompromised individuals, such as those with HIV.
The vaccine is not recommended for anyone older than 26 because by that age, those still sexually active have likely already been exposed to most high-risk HPV subtypes. The vaccine has been insufficiently studied in pregnant women, so they shouldn't get vaccinated, either.
How does it work? The HPV vaccine is given in three doses over a period of six months. It exposes your immune system to an inactivated, non-infectious form of HPV lacking viral DNA. Though the virus is inactive, it tricks your body into thinking you have been exposed, driving your immune system to produce antibodies to HPV. In the future, should you be exposed to the real virus, those antibodies will bind to it and prevent it from entering your cells.
It is unknown if the vaccine gives lifetime protection because it has not been around long enough, but research shows people will be protected from the virus for a period of at least eight to 10 years, and there is no evidence to suggest its effect weakens over time.
Is it effective? The HPV vaccine is highly effective at preventing infection with the most common cancer-causing HPV subtypes, but only when given prior to HPV exposure--in other words, before engaging in any sexual activity for the first time.
Is it safe? The HPV vaccine is very safe. It has been tested in tens of thousands of people, and many studies, including an analysis of more than 600,000 doses administered, show it is has a very low side-effect profile.
How much does it cost? The retail price is generally $130 to $140 per dose, but the actual cost may vary depending on your health care provider or insurance company. Most private insurers and Medicaid cover the cost of HPV vaccination in accordance with the CDC recommendations.
Making an Informed Decision for Your Child
Vaccines in general are controversial, with many people concerned about adverse side effects. The HPV vaccine is even more controversial because it is associated with sexual activity, yet recommended for preteen girls and boys. However, when considering HPV vaccination for their children, it is important for parents to make an informed decision after doing research, gathering the facts, and talking to their doctors, rather than basing their decision on fear or personal bias.
I don't think there is a parent who would wish their son or daughter to end up with cancer, but that is what may happen if their children are not vaccinated at the recommended age. Remember, HPV vaccination is effective only if given before an individual is exposed to HPV. Providing the vaccine before a child becomes sexually active insures long-term protection against life-threatening HPV-related cancer later in life.