Who should get HPV vaccines?

By Lee Hye-jun

In the United Kingdom, the parents of girls aged 12 are offered HPV (human papilloma virus) vaccination for their daughters at school. In the United States, the Center for Disease Control and Prevention (CDC) included the HPV vaccine in the official immunization schedule for the 11 and 12 year olds. These widespread changes have been made over the last decade since the revolutionary discovery of the HPV vaccine.

Cervical cancer was once a major cause of women’s death. Currently in developed countries, it is on a rapid decline mainly due to the increased Pap smear tests in which a sample of cervical cells is examined for any abnormalities. Earlier detection of lesions by Pap tests helps cure them before they develop into cancer. Still every minute a new case of cervical cancer is diagnosed and every two minutes a woman dies from it.

The human papilloma virus (HPV) infection is the most important risk factor for cervical cancer. It is mainly transmitted by direct sexual contact and occurs mostly within five to 10 years from the first sexual experience. Although it often disappears on its own, there is no cure for HPV infection yet. That is why prevention holds such value.

Two types of HPV vaccines are available at this time, Gardasil and Cervarix. They prevent the HPV-16 and HPV-18, which cause 70 percent of cervical cancers, from developing. HPV vaccination is most beneficial when received before exposure to the HPV virus. Therefore, it is usually recommended from age 11 to 12 in Western countries because most girls at this age have not become sexually active. In Korea the median age of the first sexual experience is 20, a few years later than in Western countries, so the recommended age for vaccination is 15 to 17.

The vaccines benefit sexually active women age 26 or younger, as they protect them from specific types of HPV to which they have not been exposed. Of course, if they are already infected with multiple types of HPV from multiple partners, the vaccine is less likely to be protective.

Now the question is whether sexually active women older than 26 will benefit from the HPV vaccines. A study reported that the vaccine was efficacious in women between 24 and 45 years of age regardless of the type of HPV infection and sexual experience. They say that middle aged women these days are more likely to meet new partners and get infected with new types of HPV than in the old days. But in terms of cost-effectiveness, it cannot be recommended for all women older than 26 because the chances of new HPV infection are relatively low.

What about women who had had abnormal Pap tests or HPV infection before vaccination? Theoretically they still get protection from the type of HPV that they are not already infected with, but this is currently being investigated. One thing that is certain is that vaccines will not cure their current HPV infections or abnormal results of their Pap tests.

Last but not least, remember that you should not skip Pap tests because you got vaccinated. The HPV vaccines protect you from specific types of HPV that cause 70 percent of cervical cancer, but the other 30 percent can occur from other types of viruses. Moreover, not all cervical cancer is associated with HPV.

There is no doubt young girls should get the HPV vaccination. For mothers, at this moment, there is no clear answer. But here is one clear answer for all women’s health — both mothers and daughters need regular Pap tests with or without vaccination. HPV vaccines do not replace regular Pap tests.

The writer is a doctor at Maria Fertility Hospital in Seoul. For further questions, send an email to the writer at hyejunlee@mariababy.com, or call the hospital’s English-speaking coordinator at 82 (Korea country code) 2 (Seoul area code) 2250-5577, or visit the hospital’s website, https://eng.mariababy.com/.