Adults up to age 45 can now get vaccinated against human papillomavirus (HPV), a common sexually transmitted infection. But the question has become… if you’re over 35, do you really need to get this vaccine? Maybe. But maybe not. “Not everyone is going to need it,” says Sandra Fryhofer, MD, an internal medicine physician in Atlanta, Georgia, and past president of the American College of Physicians (ACP). “But there are some people who could benefit from it.” The people over 35 most likely to benefit from an HPV vaccine are people who could be exposed to HPV infection via a sexual partner. But even then, the benefits could be small, so some experts caution. “We certainly know it’s highly effective in the younger age group,” says Christopher M. Zahn, MD, vice president of practice activities for the American College of Obstetricians and Gynecologists (ACOG). “It may not be as effective in the older range, due to risk factors, due to whether or not they’ve already been exposed or have a history of dysplasia.” (Dysplasia is the medical term for the early changes that happen in cells before cervical cancer develops.)
HPV can cause cancer
Here’s why experts want you to know about HPV: human papillomavirus can cause six types of cancer, according to the Centers for Disease Control and Prevention (CDC). The six types of cancer are cancer of the penis; cancer of the cervix, vagina and vulva; cancer of the anus; and cancer of the back of the throat (also called oropharyngeal cancer). But, as the CDC notes, vaccination can prevent over 90 percent of HPV cancers. It’s a cancer prevention tool, not a treatment. About 79 million people—mostly in their late teens and early 20s—in the U.S. have an HPV infection. But far more people have already experienced HPV at some point in their lives. Most sexually active adults—experts estimate about 80 percent—contract HPV at some point in their lives. Not everyone develops cancer as a result. In fact, many people never even know they were infected. But 34,800 new cases of cancer each year can be traced back to HPV, per the CDC’s statistics. And yet, lots of adults don’t even realize the virus can cause cancer, according to a study recently published in the journal Pediatrics. Researchers from The University of Texas Health Sciences Center at Houston (UTHealth) School of Public Health, found that more than 70% of adults in the U.S. don’t know that HPV can cause cancer. “Knowing that this vaccine prevents cancer is very important,” says researcher Ashish Deshmukh, PhD, MPH, assistant professor at UTHealth School of Public Health.
Expansion of the HPV vaccine to include older adults
The first-generation HPV vaccine hit the market in 2006. But it was only intended for young people, to protect them against some of the strains that could lead to cancer. Last year, the U.S. Food and Drug Administration (FDA) cleared the way for more adult to receive Gardasil 9, an expanded version of a vaccine designed to protect people against nine strains of HPV. So, as of October 2018, adults between the ages of 27 and 45 could receive the vaccine with the FDA’s approval. (The vaccine isn’t licensed for people over 45.) But then the CDC’s panel of medical and public health experts who focus on guidance for vaccine-preventable diseases weighed in. In July, the Advisory Committee on Immunization Practices (ACIP) recommended a catch-up vaccination for anyone up through age 26 if they hadn’t already been vaccinated for HPV. But ACIP did not issue a blanket recommendation in favor of HPV vaccination for the 27-45 age group. Instead, the committee recommended HPV vaccination based on “shared clinical decision making for individuals aged 27 through 45 years who are not adequately vaccinated.” What that means: you’re supposed to weigh the pros and cons and chat with your doctor. The committee recommended that people talk to their doctors about their own risk factors and history to figure out if they would need or benefit from an HPV vaccination. Therein lies the rub. You, along with your physician, must assess whether you’re at risk for being exposed to a new HPV infection. And that can be a delicate process. “It shouldn’t be an automatic (choice) either way,” says Zahn. Said Fryhofer, “You have to think about your potential for a new partner. If you’re divorced or newly widowed, and you’re back in the dating world, you might want to think about getting vaccinated before you could be exposed to a new HPV strain.” “But for people who are in a monogamous relationship,” she continued. “You’re not likely to be exposed to a new strain.” But Debbie Saslow, managing director for Cancer Control Interventions-HPV/GYN Cancers for the American Cancer Society, cautioned that many of these older adults have already been exposed to HPV infections. And at this point, doctors don’t have a surefire tool to help them determine if a person has already been exposed to a strain that could cause cancer. So, while the HPV vaccine is perfectly safe for them to get, it might not really help them, she says. “Just because something doesn’t hurt, if it doesn’t help, that’s not a reason to give it,” explained Saslow.
Confusion about the HPV vaccine
Some experts worry that the expansion of HPV vaccination to people between the ages of 27 and 45 could be confusing to the public—and they worry that it could undermine the efforts to get adolescents vaccinated. They worry that adults might blow off the chance to get their children vaccinated when it’s most effective. “It’s absolutely amazing when given to young people,” says Saslow. Kids under age 15 only need two doses of the vaccine to achieve maximum benefit, and the second dose should be given six to 12 months after the first, according to current recommendations. Three doses would be required for youth who receive their vaccinations between age 15 and 26. The older adults would also need three doses. “Everyone through age 26 needs it, and the earlier you get it, the better,” says Fryhofer. As for women over 35 who are concerned about developing cervical cancer? You might want to call your doctor and schedule a pap test if you haven’t had one recently. “Regardless of their HPV vaccination status,” says Zahn. “It’s still really important that they adhere to the current cervical cancer screening recommendations.” His association endorses the current recommendations from the U.S. Preventive Services Task Force (USPSTF). Under those guidelines, women between the ages of 30 and 65 should undergo a pap test screening every three years or an HPV test every five years. Or you could opt for a dual test every five years. Find out which vaccines every adult needs—and why.
