Dr. Susan Wootton was a medical student in the 1990s when she heard something that excited her: “a vaccine against cancer.”
During a class lecture, an obstetrician spoke about the human papillomavirus vaccine, which was still in development. She admits it was hard to believe at the time.
“Not only were we going to prevent routine (HPV) infections, but there was the technology to prevent cancer. That was almost 30 years ago,” said Wootton, who is now a pediatric infectious disease specialist at UTHealth and associate professor at McGovern Medical School.
More than 79 million Americans are infected with HPV, making it the most common sexually transmitted infection in the country, according to the Centers for Disease Control and Prevention. There are 100 different types of virus, including ones that cause cervical cancer. Nearly all cervical cancers are caused by HPV, according to the American Cancer Society.
A vaccine for HPV, marketed as Gardisil, has been on the market since 2006.
Dr. Abby Berenson, a gynecologist and UTMB professor, said parents were reticent when the vaccine was introduced to the market. It was not mandated for school attendance in Texas, therefore many considered it optional, she said. Because HPV is a sexually transmitted infection, Berenson believes parents felt their children were too young to be vaccinated against it. Also, people generally worry about the safety profile of new vaccines, she said.
Wootton’s 11-year-old daughter, Fiona has undergone the first of two HPV vaccine injections. They didn’t hurt much, said Fiona, who ate ice cream and watched funny cat videos after her shot. Wootton imagines the vaccine conversation is different for parents who aren’t doctors, but the fact remains the same: the vaccine prevents the infection and the possibility of those cancers later in life.
“As a family, with any vaccine, we’re the first in line to get it done,” Wootton said. “How it was framed to me was as a cancer prevention vaccine, so that’s really how we talk about it.”
HPV by the numbers
In the 14 years since Gardisil has been on the market, the percentage of precancers — conditions or lesions with abnormal cells, associated with an increased rink of cancer development — caused by HPV types 16 and 18 declined 9 percent, according to a 2019 study published in Cancer Epidemiology, Biomarkers and Prevention.
Among women who had been vaccinated, the percentage of precancers decreased by 22 percent and in unvaccinated women, the percentage dropped by 4 percent.
Gardisil — the only FDA-approved vaccine against HPV — initially prevented four strains of the virus; in 2014, the approval of “Gardisil 9” increased the number of strains prevented to nine. According to the FDA, these strains are associated with the majority of cervical, anal and throat cancers, as well as most genital warts cases. In 2020, the American Cancer Society estimates there will be 14,000 new cervical cancer diagnoses and nearly 5,000 deaths.
While the vaccine is approved for anyone over the age of 9, the federal Advisory Committee on Immunization Practices recommends beginning vaccinations wit a first shot at the age of 11 or 12. Girls should return for a second shot between the ages of 13-26 and boys between 13-21, for the vaccine to be most effective.
‘Game-changer’
Berenson, director for the Center of Interdisciplinary Research and Women’s Health, dedicated her career to the HPV vaccine. A trained pediatrician and adolescent gynecologist, she has taken care of patients with abnormal pap smears for 20 years. She believes the HPV vaccine continues to be a game-changer in cancer prevention.
“As a gynecologist, I had seen a lot of patients suffer from worrying about their pap smears to having to go through procedures like biopsies and (Loop Electrosurgical Excision Procedures),” Berenson said. “It’s not just physical cancer that can be eliminated, but all those procedures that lead up to it.”
For the first three years, the vaccine wasn’t recommended for boys even though they are just as likely to be infected and continue the spread of the virus, Berenson said.
“They wanted to wait until their child was older, but the point is to administer vaccines well before any potential exposure,” she said. “You wouldn’t wait until the first day of kindergarten to get your child the chicken pox vaccine.”
Not just for girls
As a new mother in the mid-2000s, Jen Darrouzet could not believe she lived to see a vaccine to prevent cancer.
While researching online, Darrouzet, who lives in Austin, found pushback from parents who thought giving young people this vaccine would encourage them to have sex, she remembered.
“It didn’t make sense at all,” said Darrouzet, whose younger son was born 13 years ago, just as former Texas Gov. Rick Perry tried to mandate the vaccination for all 11- and 12-year-old girls.
Some of her liberal friends didn't trust Perry, a Republican. And her conservative family members didn't like the idea of being forced to vaccinate their children from a sexually transmitted virus, she said.
But she decided that both her sons — now 16 and 13 — would be vaccinated when they were old enough. And so they were. To the boys, it was only a needle prick. But Darrouzet knew it would make a huge difference later in their lives.
“I don’t want the fact that we are wary of talking about bodily functions preventing us from having healthy families,” she said. “This is a community burden. If a third of the population is not covered, the whole community is at risk.”
‘A no-brainer’
Sixty-six percent of adolescents ages 13-17 received the first dose to start the vaccine series, according to the CDC. But a 2018 report showed that 51 percent of that group has not received the second dose.
Fewer children in rural areas are vaccinated against HPV compared to those in urban areas, the CDC reported.
Irene Vasquez, 22, received the first dose of the HPV vaccine when she was in middle school. She said her mother is cancer-cautious because of a family history of colon cancer.
Vasquez saw it like any other vaccine even after her doctor said it was related to sex in some way. She doesn’t think about it often, she said.
“Because I was so young, I didn’t think about it from a future reproductive health perspective,” Vasquez said. “It’s a no-brainer; get the vaccine and don’t get HPV.”
Vaccines work best when 80 percent of the population is vaccinated, Berenson said. At that point, even those who aren’t vaccinated will benefit because the virus won’t circulate.
“In Australia, they gave it out in school and got to 80 percent quickly,” Berenson said. “They have a different health care system than we do. In the U.S., parents need the ability to make their own choices.”
julie.garcia@chron.com
Twitter.com/reporterjulie
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