The HPV Vaccine—Making the Decision to Immunize Your Daughter
The HPV vaccine—perhaps no advance in contemporary medicine is meeting with as much concern as the vaccine that promises to eliminate more than 70 percent of cervical cancer. The reasons are several-fold, say Dalton pediatricians and gynecologists: a lack of awareness about cervical cancer and how it is contracted; parents' unease over immunizing their pre-teen and teen daughters against a disease contracted through sexual activity; as well as the cost and inconvenience of three required shots. The result is that many local parents are struggling to decide if the vaccine is right for their daughters.
The U.S. Food and Drug Administration approved Merck & Company's human papillomavirus (or HPV) vaccine, Gardasil, in June 2006 for girls and women between the ages of 9 and 26. The U.S. Centers for Disease Control and Prevention, the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists all recommend the vaccine. Yet, nationwide, estimates are that only two out of every 10 in the approved age group are getting the vaccine, while more than one-quarter of American women between the ages of 14 and 59 are estimated to have HPV, according to a study published last year in the Journal of the American Medical Association. These numbers are comparable to what they are seeing in the Dalton area, say physicians on Hamilton Medical Center’s staff.
Many people are not aware that, unlike other cancers, cervical cancer is caused by viruses that are transmitted through sexual contact. The key, pediatricians and gynecologists stress, is giving the vaccine prior to any sexual activity, which explains the reason that it must be given at a young age. This is, however, often the difficult aspect for parents, who fear that having the protection will encourage early or frequent sexual activity. However, a young woman could be abstinent, for example, until she marries in her early twenties. Even if she is in a monogamous relationship with her husband, he could pass along the virus to her from a previous sexual partner he has had and infect her with the HPV virus and cervical cancer.
The vaccine, according to physicians, should not be seen as an encouragement to sexual activity and should be viewed, rather, as a long-term health precaution that offers the potential to avoid a life-threatening illness. Some physicians liken it to using a seat belt, which does not promote fast or reckless driving, while other physicians point to the fact that newborns are immunized against hepatitis B to prevent liver cancer later in life. Immunizations exist to protect us against future illness and disease.
Due to the nature of the disease process, teens are often the most susceptible to the HPV virus, although it may not manifest until women are in their 30s or 40s. Even if cervical cancer does not develop, there are other health issues that can arise from exposure to the HPV viruses, including dysplasia (a pre-cancerous condition) that can damage the cervix and lead to problems with future pregnancies or infertility.
Pediatricians now make the vaccine a part of conversations during exams and office visits for girls in the 9-13 age range, and they routinely provide families with written information about the vaccine. Both pediatricians and gynecologists believe that the existence of the vaccine is beneficial because it is bringing mothers and daughters in to their offices earlier than ever before to discuss issues of health and sexuality, including abstinence, and to open the door to a more general discussion about sexually transmitted diseases with mothers and daughters, which, in turn, provides an opportunity for parents to talk with their daughters at home about how they want them to handle the sexual situations that they will inevitably encounter as their teen years progress.
While it is true that the HPV vaccine does not guarantee that a woman will not get cervical cancer or genital warts, it does protect against the two viral types that cause 70 percent of cervical cancer and against two additional viral strains, which cause 90-95 percent of genital warts. It is still unknown when—or if—immunity will decrease and whether women will need to get booster shots later in life. Even if a booster vaccination is needed, physicians feel that another dose of the vaccine is safe. It has been scientifically established that it is not possible to get HPV from the vaccine, which contains no live or killed virus. Side effects are mild with the most common being pain and/or tenderness at the injection site. Three separate shots are required over a six-month period. Insurance coverage varies, and parents should check with their insurance carriers. Without insurance, the vaccine ranges from $150 - $200 for each of the shots.
Sorting through this information can be a difficult process and all vaccines carry some risks. Perhaps the best advice for parents is to call their daughters’ pediatrician or gynecologist to determine if the vaccine is right for them.
Additional information under 'Prevention' can be found: Cervical Cancer and Human Papilloma Virus (HPV)
[Interviewed for the article-Hh Summer08:
Dr. Tim Dindoffer/Timothy C. Dindoffer, M.D., P.C.
Dr. Christine Sager/Associates in Obstetrics and Gynecology
Dr. Harvey Wages/Associates in Obstetrics and Gynecology
Dr. William Edwards/Pediatrics of Dalton
Dr. Ricardo Riesco/PedsCare, Inc.]