HPV Vaccines and Cervical Cancer Prevention: A Closer Look

Dr. Nicole W. Karjane

If there’s one word that seems to dominate the conversations and consciousness of people both in and outside the healthcare community these days, it’s a seven-letter word that has come to take on even more weight — and unfortunately, a good degree of controversy as well:

Vaccine

The stunning success rates of the COVID-19 vaccines in the United States (and all around the world) in 2020 and 2021 have brought vaccination administration practices to the forefront in a way not seen since polio ravaged our society in the 1950s. Of course, the scope of science is as vast as the array of viruses and illnesses, and effective vaccines exist to combat much more than polio and SARS-CoV2 viruses.

Alas, stubborn resistance, misinformation, and manufactured “controversies” also accompany these other vaccines and vaccination efforts. Such is the story when it comes to the ongoing fight against cervical cancer in U.S. women — and its strong link to human papillomavirus (HPV) vaccination efforts.

It’s a story we’re proud to tell here, through the expert lens of Nicole W. Karjane, MD, Professor and Residency Program Director, Obstetrics and Gynecology, Virginia Commonwealth University (VCU) School of Medicine, Richmond, VA.

In her approximately 30-minute lecture entitled “Human Papillomavirus (HPV) Vaccine and Prevention of Cervical Cancer,” recorded at the VCU Institute for Women’s Health virtual seminar The Health of Women 2021 in the summer of 2021, Dr. Karjane dives into details surrounding the history, efficacy, and administration of the human papillomavirus vaccine — a true-game changer in the drive to enhance cervical cancer prevention and reduction in overall cervical cancer diagnosis. Dr. Karjane also discusses the “pretty significant” costs of HPV infection and its related disease — calling cervical cancer “the huge, huge burden.”

Dr. Karjane hopes to see ongoing improvements in these HPV vaccine administration practices, and understands the very real challenges that OB/GYN, family medicine, internal medicine, and other healthcare professionals face when dealing with today’s U.S. patient population.

“There’s a lot of hesitancy about HPV vaccines,” says Dr. Karjane. “We know there’s hesitancy now even with the COVID vaccine. The take-home message here? People should be vaccinated as adolescents, before they’re exposed to HPV.”

[NOTE: POSSIBLY EMBED LINK TO LECTURE AUDIO CLIP HERE] ⟶

HPV-Related Infections and Cervical Cancer

Each year in the United States, there are more than 11,000 new cases of cervical cancer diagnosis. In excess of 4,000 such cases typically result in death — or more than one out of every three. While these grim numbers may be somewhat familiar to American women – and certainly to U.S. obstetrics and gynecology physicians and nurses – what may be less readily known and understood is the strong link between a cervical cancer diagnosis and human papillomavirus (HPV)-related infections.

As obstetrics and gynecology (OB/GYN) professionals understand all too well, women are naturally susceptible to human papillomavirus-related infections. In fact, women are around twice as likely as men to contract an HPV-related infection. While most women are able to clear an HPV infection without any escalation or sequelae, some do develop a continuing infection that can escalate into high-grade dysplasia — which over time leads to invasive cervical cancer.

As Dr. Karjane addresses in her lecture, more than 98% of vulvar cancers and cervical cancers in situ have HPV association. HPV types 16 and 18 are particularly deadly, as they’re responsible for more than 70% of all cervical cancer cases. In addition to cervical, vulva, and vaginal cancers, Types 16 and 18 are also implicated in the etiology of penile, head, and neck cancers.

Enter: HPV Vaccines

There is hope, however. And this hope comes in the form of a HPV vaccine. Designed to prevent initial HPV infection, the vaccines block the troubling and potentially fatal cascade from occurring. As Dr. Karjane lays out in her vaccine timeline, initial approval of the quadrivalent HPV vaccine, which contains the viral capsid protein for HPV types 6 and 11 as well as 16 and 18, came in the summer of 2006. By 2009, there was a bivalent vaccine that contains just the protein for 16 and 18. A larger breakthrough came in 2015 with the release of the 9-valent vaccine, which went on to replace all other U.S. vaccines by 2017 — and now operates on a 2-dose schedule, similar to the dominant Moderna and Pfizer vaccines against SARS-CoV2 and COVID-19.

As Dr. Karjane touches on in her talk, the Advisory Committee on Immunization Practices (ACIP) initially recommended the vaccines for women only — but by 2011 ACIP changed its recommendation to include routine HPV vaccine administration to men as well. As Dr. Karjane notes, current ACIP recommendation is for “routine vaccination for adolescents starting at age 11 or 12 — the target age group.”

While vaccinating against HPV 16 and 18 has been found to prevent more than 70% of all cervical cancers, the 9-valent vaccine performs with around an 85% cervical cancer prevention success rate. Today, the CDC recommends girls ages 11-12 years receive two doses of HPV vaccine, and says they may start receiving the vaccine at age 9. The CDC also says that all young women through age 26 should be vaccinated — but HPV vaccination is not recommended for everyone above age 26. As Dr. Karjane discusses, studies have shown that beginning HPV vaccination early (by 12 years of age) is crucial for reducing the incidence of cervical cancer.

“It’s very, very, very unlikely to have intercourse before the age of 12,” explains Dr. Karjane. “If you wait until 18 or over, it’s about 82% have had intercourse, and therefore likely have been exposed to HPV. That’s really the rationale for vaccinating early.”

In regards to adult women who are also pregnant, no known link has been established between HPV vaccines and adverse pregnancy outcomes or developing fetus side effects among pregnant women — but the vaccines have also not been studied in clinical trials with pregnant women. As a result, the CDC recommends that pregnant women avoid initiation of the HPV vaccination series until after they have given birth.

HPV Vaccine Side Effects and Causal Concerns

More than 15 years of monitoring and research during the Food and Drug Administration (FDA)-approved vaccination program have demonstrated the ongoing and thorough safety of HPV vaccination. According to the CDC, more than 135 million doses of HPV vaccines have been distributed since they were first licensed, and data continues to demonstrate that the vaccines are both effective and safe. Dr. Karjane notes in her lecture that studies have also shown “absolutely no evidence” of any causal relationship between the vaccines and incidence of autoimmune and neurologic disorders — refuting claims made by some members of the general public. She even cites a published, data-driven 2020 statement by the American Autonomic Society declaring zero causal relationship between the HPV vaccine and complex regional pain syndrome, chronic fatigue syndrome, postural tachycardia syndrome, or other forms of dysautonomia.

Of course, as with all vaccines, there can be side effects that result from HPV vaccination. It’s important to stress to patients that these side effects are mild and go away within a day or two. Common side effects include muscle or joint pain, nausea, headache, dizziness, fever, or overall tiredness and weakness.

Much as we’ve seen with the challenges related to COVID-19 vaccination, fears of side effects, spread of disinformation via social media and other channels, and a simple lack of communication and education will continue to force OB/GYN physicians and other healthcare professionals like you to work hard to improve HPV vaccine administration practices — and reduce the overall instance of cervical cancer diagnosis.

“They are not infectious,” Dr. Karjane flatly states. “It’s also impossible for the HPV vaccine to cause cancer in and of itself.”

Dr. Karjane remains optimistic that we will see continued improvement in the administration practices of the human papillomavirus vaccination, while recognizing much work remains to be done.

“We are not doing that great of a job in vaccinating adolescents,” says Dr. Karjane. “National coverage is just under 50%. Some states are definitely lacking, especially in the middle of the country. We really need to focus on this adolescent group.”

Stay Up-to-Date in OG/GYN and Family Medicine…and Beyond

Whether you’re working in the ever-evolving fields of family medicine and obstetrics and gynecology, or you operate within a different realm of the healthcare universe, AudioDigest can serve as a valuable, versatile tool for you and your practice. If you found this article and Dr. Karjane’s insights beneficial, we invite you to explore additional content from the experts and thought leaders at AudioDigest, including these Top 5 CME Lectures in Family Medicine.

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