During the last few decades, we’ve continued to learn more about the sexually transmitted human papilloma virus (HPV) family. It has been revealed as a major cause of cervical, vulvar, vaginal, anal and oral cancers, as well as warts. With that knowledge, the medical community has recently evolved screenings and vaccinations.
In December 2014, the FDA approved Gardasil 9, a new vaccine targeted against nine HPV strains that are responsible for most cervical cancers and cases of genital warts.
How is Gardisil 9 different than previous vaccines?
The pre-existing HPV vaccines on the American market, Gardasil and Ceravix, are targeted against fewer strains of HPV. Gardasil targeted four while Ceravix only targeted two strains. While both Gardasil and Gardasil 9 offer coverage of the strains that are most associated with genital warts, Ceravix does not. Gardasil 9 offers coverage against five dditional HPV strains that are responsible for 20 percent of cervical cancers not covered by the original Gardasil vaccine. Thus, Gardasil 9 offers better prevention of cancer than its predecessor.
Who is eligible for the new vaccine?
Gardasil 9 is approved for girls 9-26 and boys 9-15. The safety data is very reassuring and most side effects from the vaccine are negligible, such as injection site pain, headache or feeling woozy from getting an injection. Providing vaccination against HPV is most effective in virgins prior to exposure to the virus with onset of sexual activity and is given in most pediatric and ob/gyn offices. However, already being sexually active does not mean you should not get the vaccine, just that you may already be infected with one or more strains and get less protection than someone who was never infected in the first place. Providing vaccination against HPV does not lead to earlier nor riskier sexual activities in young girls or boys. The series is given in three injections over six months and may not require a doctor’s visit at the time of vaccination. Ask your pediatrician or ob/gyn if you or your child are a candidate for the vaccine.
In February 2015, the FDA approved the first HPV test for primary screening for cervical cancer in women over 25.
I already get a pap smear. Why do I need an HPV test?
Many of us have it ingrained in our heads that we need pap smears (where the provider scrapes the cervix with a brush to collect cells that a pathologist looks at under a microscope) to check for cervical cancer. However, the evidence suggests more and more that this may become an outdated screening test, especially when used alone, for certain people. Knowledge that most cervical cancers are caused by the sexually transmitted HPV family allows us to better target women at increased risk for cervical cancer by utilizing HPV testing.
Approximately 10 percent of women infected with HPV will have persistent infection and be elevated risk for cervical cancer; identifying these women is key. Depending on a woman’s age, the current guidelines recommend either a pap smear alone or a pap smear with co-testing for HPV. Some women can extend their screening intervals up to five years if they have a normal pap and are negative for HPV while others need more frequent screening based on personal history and age.
So should I get the HPV test instead of a pap smear?
Although the FDA has approved the cobas HPV test for primary screening for cervical cancer, this does not necessarily mean that you should not be getting a pap smear! The FDA approves tests, but medical societies define screening recommendation and so far there are not recommended guidelines endorsed by the major medical societies for utilizing HPV testing alone for primary cervical cancer screening. However, that is not to say that they are not on the near horizon. The screening strategies for cervical cancer have become more complex than simply getting a yearly pap test, so be sure to ask your doctor at your well woman appointment if you are due for cervical cancer screening or not, and if so, what screening strategy is being used. It is always good to know what tests are actually being done and not just assume you are getting a ‘pap’ every year. And don’t forget to ask if you are a candidate for the HPV vaccine to further reduce your risk of cervical cancer and other HPV-related diseases.
These are just two recent HPV-related advances in the arena of women’s health, but likely we will see more and more evidence of the role of HPV in anal and oral cancers as well, so keep watching for those HPV headlines and stay on top of your preventive health!
Rosanna Gray-Swain, MD, is a board-certified physician at West End Ob/Gyn. She can be reached by calling 314.286.2620.