January is Cervical Health Awareness Month, and with good reason. Each year, almost 13,000 women in the United States are diagnosed with cervical cancer.[1] But with Pap smears and preventive vaccination, over nine in ten cervical cancers could be stopped in their tracks.[2] In October of 2018, Gardasil-9—the vaccine that prevents cervical cancer—was approved for more patients than ever before.
For twelve years, Gardasil-9 was only approved for patients up to age 26. But this changed in October of 2018, when Gardasil-9 was approved by the Food and Drug Administration (FDA) for use in men and women up to age 45.[3]
Gardasil-9 is a vaccination for human papillomavirus (HPV), a sexually transmitted infection that causes genital warts and cancer. [4] Every year, over 30,000 Americans are diagnosed with an HPV-associated cancer. Over 90% of cervical cancers, as well as significant numbers of cancers of the anus, vagina, vulva, penis, and even the throat, are caused by HPV.[5]
Because it protects patients from HPV, Gardasil-9 also protects against huge numbers of HPV-associated cancers. Since 2006, when Gardasil-9—at the time, just known as Gardasil—was first recommended for young adults, the number of vaccine-type HPV infections in teenage girls has dropped by two-thirds.[6]
Initially, researchers believed that by age 26, essentially all sexually active adults would have caught HPV, rendering the vaccine useless. After all, HPV is the most common STI in the United States, and the vaccine only works prior to infection.[7] But recent research revealed that Gardasil-9 can indeed protect older adults against dangerous HPV strains, because few adults encounter every strain Gardasil-9 protects against. In a study of over 3000 participants between ages 27 and 45, lasting over 3 years, the FDA found Gardasil-9 is 88 percent effective at preventing cervical cancer related to the HPV strains it covers.[8]
The note about strains is important. HPV is a group of over 150 related viruses, with a dramatic range of effects on the body. HPV is often harmless, and nine out of ten times, the immune system will clear an infection on its own.[9] But some infections linger and cause genital warts. And some infections are carcinogenic.[10]
Gardasil-9 gets its name from the 9 HPV strains it protects against. Although this is less than a tenth of the total number of strains, seven of these strains are collectively responsible for 90% of HPV-related cancers, and the remaining two cause genital warts.[11]
Ideally, all young people would receive the HPV vaccine before becoming sexually active.[12] This is why Gardasil-9 is currently recommended for children as young as nine. But the data shows that older adults still benefit.
For Cervical Health Awareness Month, talk to your patients about Gardasil-9 and sexual health.
Bring up the Gardasil-9 vaccine with patients up to age 45. Gardasil-9 is a first line of defense against cervical cancer.
Ask your female patients when their last Pap smear was. The United States Preventative Task Force recommends women aged 21-65 receive Pap smears every 3 years. Pap smears are essential to preventing cervical cancer.[13]
Gardasil-9 isn’t just for women. Men should get the Gardasil-9 vaccine as well. In men, HPV can cause cancers of the throat, anus, and penis.[14]
Gardasil-9 is just one part of safer sex. Gardasil-9 does not prevent pregnancy or other sexually transmitted infections. For pregnancy prevention, talk to patients about their birth control options. For STIs, discuss condoms, STI testing, if necessary, pre-exposure prophylaxis for HIV. [15]
References:
[1] http://www.ashasexualhealth.org/january-cervical-health-awareness-month/
[2] https://www.cdc.gov/vitalsigns/cervical-cancer/index.html
[3] https://www.statnews.com/2018/10/06/fda-expands-hpv-vaccine-use-to-age-45/
[4] https://www.cdc.gov/hpv/parents/whatishpv.html
[5] https://www.cdc.gov/cancer/hpv/statistics/index.htmpatients
[6] https://www.cdc.gov/hpv/parents/questions-answers.html
[7] https://www.cdc.gov/std/hpv/stdfact-hpv.htm
[8]https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/UCM622715.htm?utm_campaign=10052018
[9] https://www.cdc.gov/hpv/parents/questions-answers.html
[10] https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-fact-sheet
[11] https://www.cancer.gov/types/cervical/research/gardasil9-prevents-more-HPV-types
[12] https://www.cancer.org/latest-news/who-should-get-the-hpv-vaccination-and-why.html
[13]https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/cervical-cancer-screening2
[14] https://www.cdc.gov/features/hpvvaccineboys/index.html
[15] https://blog.skyscape.com/hiv-no-longer-a-death-sentence-but-not-cured