News & Articles For You From Randolph OB/GYN

Gardasil: The HPV Vaccine That Reduces Cervical Cancer Risk

By Dr. Karen J. Horne, MD, Randolph OB/GYN

As a practicing OB/GYN physician, I receive many questions everyday regarding Human Papillomavirus (HPV), abnormal Paps, and Gardasil, the vaccine against HPV. Most patients are interested in ways to reduce their risk of cervical cancer, but a basic understanding of the mechanism by which HPV leads to cancer is the first step to prevention. Also, proactively receiving Gardasil is crucial in further reducing risk. Here are the most important points I stress to patients.

What is HPV?

Human Papillomavirus (HPV) is a very common virus that infects skin and can linger for many years. There are over 100 strains of the virus that can cause anything from benign warts on hands and feet to malignancies of the vulva, vagina, and cervix. HPV strains 16 and 18 are the most common causes of cervical cancer. HPV is acquired through sexual transmission and can reside in the body for years before becoming evident. In fact, most women never know when or from whom they contracted HPV. One reason transmission of HPV is so prevalent is because 90% of infectious carriers show no signs of the virus. Most women are exposed to HPV at some point in their lives. In 2004, more than 26% of all women in the US were estimated to be infected with HPV. More than 44% of women 20-24 years old had HPV. By the age of 50, over 80% of women had been exposed to HPV.
 
What happens if I am exposed to HPV?

Once the virus infects certain tissues, it induces the cells to grow abnormally. In the case of cervical cancer, if the abnormal cells are not recognized with screening Paps, then they can continue to grow until a tumor is formed. It is important to remember that, not only can HPV cause cervical cancer, but it can also lead to cancer of the vagina, vulva, and anus.
That’s the bad news. Here’s the good news. It IS possible to clear the virus from the body.  Younger women (adolescents-early twenties) are especially good at fighting off the virus.  Patients that are older tend to have lingering infections that usually manifest as a series of abnormal Paps. Patients that smoke have an especially difficult time clearing the virus, and in fact, tend to deteriorate even more quickly.

What can I do to reduce my risk of cancer?

Prevention is the key. Steps to minimize exposure to HPV include:
1. Reducing the number of sexual partners
2. Always using a condom with each and every sexual encounter
3. Receiving annual exams by a physician and receiving Paps as often as indicated
4. Following up on all appointments and treatment recommendations
5. Receiving Gardasil, the HPV vaccine, preferably before the first sexual experience.

What is Gardasil?

Gardasil is a vaccine developed to protect against the two most common strains of HPV that cause cancer (16 and 18) and the two most common strains that cause genital warts (6 and 11.) Gardasil not only protects against cancerous changes to the cervix, but also to the vagina and vulva.

Who can receive Gardasil?

Any female between the ages of 9-26 years old can receive Gardasil. The FDA approved its use in 2006. Since then, the American College of Obstetrics and Gynecology has endorsed the use of Gardasil. The American Academy of Pediatrics not only endorsed Gardasil, but also published a statement in favor of vaccinating girls 9-11 years old in order to establish immunity to HPV before their sexual debut. As with any immunization, the best time to be vaccinated is before exposure to the disease.

Are their risks to receiving Gardasil?

The safety of the vaccine was studied in clinical trials years before it was marketed to the general public. In these trials, over 29,000 men and women participated (Yes! Men can receive Gardasil, too!) Both the CDC and the FDA closely monitored these trials for adverse events. Although considerably rare, the vast majority of adverse reactions include fainting, pain, swelling at the injections site, headache, nausea, and fever.

Can I receive Gardasil if I have already had abnormal Paps?

Yes. Remember that the vaccine includes protection against four strains of HPV. If exposure to one particular strain is reason for the abnormal Pap in question, then it is still beneficial to be vaccinated against the remaining three. Also, some of the latest studies are showing Gardasil provides certain cross-protection against other strains of HPV, thereby accounting for a decrease in abnormalities in patients who have already been infected.  This may also explain the reduction in vulvar, vaginal, and anal cancer in patients who have been vaccinated with Gardasil.

Why should my daughter get vaccinated against HPV? Wouldn’t that send mixed signals?

Once the FDA approved Gardasil in 2006, many parents were concerned about the repercussions of giving their children an “STD vaccine.” It is vitally important that parents understand Gardasil in no way prevents the acquisition of sexually transmitted diseases.  It simply helps the body create an immune response against HPV-6, 11, 16, and 18, thus allowing women to fight off the virus before it causes cancerous changes to the body.
Many parents have expressed concerns that Gardasil may promote promiscuity. My response to that is:  Education, Education, Education! When a young girl reaches the age to receive Gardasil, parents should look at this as an opportunity to educate their daughters.
1. Get your daughter involved in the discussion.
2. Encourage your preteen or teen to “own” their bodies and their healthcare.
3. Empower your daughter to take measures to protect herself.
4. Take this opportunity to discuss bodily changes and sexual temptations. Give her the “birds and the bees” talk while emphasizing responsible behaviors.
5. Evaluate what your daughter already knows about sex, cervical cancer, and the link to HPV. Be sure to use this as an opportunity to “fill in the blanks.”
6. Ensure that your daughter has accurate information and is aware Gardasil is NOT an “STD vaccine.”
7. Educate your child on the risks of intercourse (e.g., unintended pregnancy) and promote either abstinence or safe sex.
8. If your daughter expresses interest in engaging in sexual behaviors, use this as an opportunity to discuss birth control and proactive measures to reduce risks associated with early intercourse.
9. Encourage your daughter to examine other areas of wellness including: Avoiding second-hand smoke, wearing seatbelts, refraining from underage alcohol consumption, exercising at least three times a week, eating a balanced diet, and maintaining a healthy self-image.
10. Most importantly, let this conversation open the door for future conversations as your daughter transitions into the teen years.

What else should I know?

• You CANNOT acquire HPV from Gardasil.
• This is NOT a substitute for annual gynecology exams.
• Gardasil does not prevent ALL forms of cervical cancer.
• Gardasil does NOT prevent other forms of STDs.

What should I do if I am interested in learning more?

I recommend scheduling an appointment with your OB/GYN to discuss risk reduction strategies including vaccination with Gardasil.

Contact our office at 704-333-4104 or use our online contact form to discuss your health care needs.