Have you ever given money to help find a cure for cancer? You probably have: according to the Canadian Cancer Society, in 2016/17 Canadians donated more than $40-million specifically to cancer research (and much more to education and support programs). But did you know that for some cancers, we have something even better than a cure? We have
prevention. The HPV vaccine prevents the development of an infection that is associated with almost all cases of cervical cancer, as well as a number of other forms of cancer. The problem is, despite that we can now prevent some cancers, many young people are not being vaccinated against HPV, and the reasons are simple: misinformation and discomfort.
Human papillomavirus (HPV) is, as its name suggests, a virus. More significantly, it is an enormously common sexually transmitted infection (STI), currently believed to be the most common STI in the world. Both women and men can be infected by HPV and can transmit it to their partners of either sex. Dozens of strains of HPV have been identified; of these, nine are responsible for the majority of serious health consequences. According to the Canadian Cancer Society, HPV infection causes almost all cervical cancers; it is also associated with 80 to 90 percent of anal cancers, 40 percent of vaginal and vulvar cancers, 40 to 50 percent of penile cancers and 25 to 35 percent of cancers of the mouth and throat.
The large majority of sexually active people will have HPV at some point during their lives. For most people, the infection will be asymptomatic—that is, they won’t know that they are infected or that they could transmit the infection to a partner (Some strains of HPV cause genital warts in men and women; this is the only common sign of infection). Most people’s bodies will fight and clear an HPV infection within two to three years with no long-term concerns. But each year some 3,500 Canadians develop a HPV-related cancer, and a third of these patients are men.
HPV is transmitted through intimate contact—skin-to-skin contact with the genitals—which doesn’t have to be penetrative. Condom use will not necessarily prevent transmission of the virus: oral sex and even mutual sexual touching can lead to infection. And HPV is so common that a person could be infected by her/his first sexual partner—in fact, research suggests that HPV infection most often occurs during the first three years that a person is sexually active.
The HPV vaccine is a proprietary vaccine formula (most commonly Gardasil 9, but there are others) that is effective against the most harmful strains of HPV. In Alberta, patients receive three doses of the vaccine, given as injections, over six months. Immunization provides lasting protection against HPV and reduces the development of infection from the targeted strains.
The vaccination is most effective when it is received before an individual has intimate sexual contact. The vaccine does not treat or cure infection in a person who has already been infected with a strain of HPV (although research suggests vaccination may still offer a benefit for the infected person); rather, the intention is to prevent infection in the first place. And here’s where things get complicated…
In Alberta, as part of public health policy, children in Grade 5—both boys and girls—receive the HPV vaccine at no cost, provided their parents sign a consent form. Students who miss vaccination in Grade 5 can receive it in Grade 9, and those who miss it in Grade 9 can receive it in Grade 12. But some parents are reluctant to give their consent, worried they’re sending the wrong message about sex to their kids.
Medical researcher Mariana de Castro Ribeiro Guedes and her colleagues have found that
“some parents associate the vaccine with a stimulus for sexuality, what they see as precocity”
—that is, that it gives adolescents and teens tacit permission to become sexually active. Research from around the world does not bear out this fear: researchers have shown that vaccinated teens do not become sexually active earlier than their peers. But frankly, talking about—or even thinking about—STIs can be uncomfortable for many people, especially for parents imagining their kids’ future behaviour.
And there’s the added issue that HPV is largely (and wrongly) identified with girls and women, whose sexuality is often more carefully scrutinized and regulated than that of boys and men. The question of HPV vaccination is thus saddled with a moral dimension that most other conversations about well-being and disease prevention lack. In an article published in early 2017, nurse educator Dawn S. Stone reported that even some doctors are reluctant to discuss the vaccination with their pre-teen patients, preferring to wait until patients are in their mid-teens. Unfortunately, for some teens, by that point they’re already infected.
Alberta Health Services’ messaging is pretty direct:
“HPV is easily spread by even a brief moment of skin-to skin contact in the genital area. In other words, you don’t have to have intercourse to get HPV—you can contract it through oral sex or simply touching.”
That means that common teen experimentation, even when it doesn’t lead to intercourse, can still put young people at risk.
Alberta’s school-based HPV immunization program was introduced in 2008. At that point, the vaccine was available only to girls. In 2014 the program expanded to include boys because HPV has consequences for men as well as for women, and research showed that the vaccine was safe for boys as well as girls. Although HPV is most commonly associated with cervical cancer, which develops only in women, men can also develop HPV-related cancers—including men in same-sex
The Canadian Cancer Society recommends that females between 9 and 45 and males between 9 and 26 be vaccinated to reduce their risk of cancer later in life. People who missed vaccination as children can arrange to be vaccinated as adults. Endorsing a strategy of prevention rather than treatment, the Canadian Cancer Society urges that HPV vaccination be easily affordable and widely accessible, although these conditions do not prevail in all parts of Canada.
Vaccination against HPV does not replace ongoing health care, of course. Even if women have had the vaccination, they still need regular Pap smears once they become sexually active. The vaccine is effective against the strains of HPV that cause greatest concern, but it doesn’t prevent all HPV infections, and an abnormal Pap smear may have another cause. And because there is currently no test for HPV infection in men, many men discover they are infected with HPV when their female partner has an abnormal Pap smear.
The HPV vaccine is a cost-effective, forward-looking public health strategy. It’s easily administered through schools, it’s relatively low cost (especially compared to the cost of treating precancerous cells or an HPV-related cancer) and it’s highly efficacious, preventing up to 99 percent of cancers associated with the strains of HPV it targets. The health policy and medical research communities resoundingly endorse the HPV vaccine as a cost-effective way to reduce disease and suffering. Researchers have found no evidence that shows teens become sexually active earlier or have more sexual partners as a result of the vaccination—and, yes, researchers have asked these questions, because parents have reported that fear of teens’ potential behaviour is a reason for kids not to be vaccinated.
In the United States, suspicion of vaccination, and particularly a vaccine associated with sexual behaviour, has led to lower than expected demand for the HPV vaccine (In the US, there is also the issue of health insurance, which means that vaccination can be expensive). Canada has taken a different, pro-active approach. October 1 to 7, 2017 marked the first-ever HPV Prevention Week in Canada, sponsored by the Federation of Medical Women in conjunction with many other organizations. This event was intended to raise awareness of HPV infection and its consequences and to make talking about prevention more comfortable.
Research has found that teens and young adults—particularly young men who have sex with other men—far under-estimate their likelihood of being infected with HPV. This is not only a matter of young people imagining themselves to be invincible or having confidence in their early sex partners. It’s simply that HPV is not a high-profile disease like HIV/AIDS or even chlamydia. Most young people aren’t talking about it or even thinking about it—but then again, neither are many of their parents, relatives or community leaders.
Several studies have shown that parents tend to be naïve when it comes to their own children’s sexuality, underestimating the likelihood of a child encountering an STI. It may be difficult to think about your child being sexually active, but when you give consent for your child to receive the HPV vaccine, you protect him or her from a future that might include several now-preventable cancers. The vaccine is most effective if it is received before a person has sexual contact, and parents cannot know when this will occur. So, prevention today is far better than treatment tomorrow.
The best health outcomes occur when our actions are supported by talk. Conversation about the HPV vaccination with your son or daughter—a talk you may have as early as your child’s ninth birthday—may be uncomfortable, but it’s important. Yes, it involves thinking about your child one day being sexually active—and, even more uncomfortably, it involves thinking about your child potentially engaging in sexual behaviours you don’t agree with morally. But not receiving the vaccination means your daughter or son will almost inevitably be exposed to HPV and its consequences.
And if you yourself weren’t vaccinated against HPV in your youth, it’s a good idea to talk with your health practitioner about whether HPV vaccination makes sense for you now. Every year we’re learning more about the vaccine’s efficacy, and we now know that women in their thirties, forties and fifties—even those with a history of HPV-related infection—can benefit from HPV immunization.
So why does everyone need the HPV vaccination? Because receiving that vaccination will have positive consequences for our lives—and our children’s lives—decades from now. And when we give money to cure cancer, isn’t that the future we’re really wishing for? t8n