According to the CDC, as many as 14 million Americans, including teens, get infected with the HPV Virus every year.
HPV infection most often comes from sexual contact and is the virus that causes genital warts. Women and men can get certain cancers from HPV. The good news is, HPV vaccines offer protection against the types of HPV that are most likely to cause cancer. Vaccination is one of the best ways parents can protect their children from HPV related cancer.
Philip Boucher, MD, is here to dispel myths and misunderstandings surrounding the HPV vaccination as a means of prevention of the HPV virus.
Selected Podcast
Important Vaccination For All Pre-Teens: HPV
Featured Speaker:
Philip Boucher, MD, Lincoln Pediatric Group
Phil Boucher is a pediatrician with Lincoln Pediatric Group. Transcription:
Important Vaccination For All Pre-Teens: HPV
Melanie Cole (Host): According to the CDC, as many as fourteen million Americans including teens get infected with the HPV virus every year. Women and men can get cancer from HPV. But the good news is, the HPV vaccine can offer protection against the types of HPV that are most likely the cause certain cancers. My guest is Dr. Philip Boucher. He’s a pediatrician with Lincoln Pediatric Group. Dr. Boucher, what is HPV and how common is this infection?
Philip Boucher, MD (Guest): HPV is a virus and it causes skin diseases, a common virus that we see in the population and it causes skin disease that we don’t worry so much about, but then it causes some other diseases that we worry more about. So, HPV is spread through skin to skin contact and it is very common. So, probably about 80% of adults in the United States are infected with HPV at some time during their adult life.
Melanie: What kinds of problems can HPV infection cause and how do people get it?
Dr. Boucher: HPV is spread through mostly through sexual contact and the most worrisome consequence of HPV infection is cancer. There are several types of cancer that are associated with the HPV infection. So, cervical cancer, over 80% of cervical cancer is caused by human papilloma virus infection and 70% of cancers of the head and neck, throat and mouth are caused by HPV.
Melanie: Wow. So, let’s talk about vaccination. It used to be just girls, now it’s boys too. Tell us a little bit about the HPV vaccine and the dosing schedule. When should kids start getting this vaccine?
Dr. Boucher: Right, so the reason that we vaccinate against HPV, it is a very common infection and for many people, the infection just causes no symptoms at all or genital warts, but it leads to the cancers that I was talking about before and so that is the reason that we vaccinate for it is to protect out teens and young adults from these strains that cause cancer. We recommend it for boys and for girls for a couple of reasons. You are right, initially it was recommended for girls because of the risk of cervical cancer and as we have learned more about HPV vaccine especially the realization that it causes a lot of head and neck cancers as well, that both boys and girls are susceptible to cancer from HPV vaccine. Since it is sexually transmitted, obviously boys and girls are spreading it to each other and so that’s why we recommend vaccinating both boys and girls for it.
As far as the scheduling of the vaccine, we recommend it begin between age 9 and 11 and the earlier that you vaccinate against HPV, the stronger the immune response is. So, I, for my patients try and vaccinate them against HPV at around age 9, if they come in for a well-check or a sick visit, we can vaccinate at that time. Because we know, looking at the antibody response, the earlier that you vaccinate, the higher the immune system build up of antibody is, the more robust the immune response.
Melanie: The immune response is more robust when they are younger, but if a child is not sexually active, why is it so important that it is early. Because if they are not going to get sexually active until they are in their later teens, hopefully maybe even later; then how do you explain to a parent the rationale of that immune response?
Dr. Boucher: The reason that – the way that I explain it to parents, in terms of why are you vaccinating my third, fourth, fifth grader for a sexually transmitted disease? One is in part, because as I said, the earlier that we give it, the more robust the immune response is and two, we know that once teens or adolescents have their sexual debut where they start becoming sexually active; they acquire HPV very quickly. Once they have acquired HPV, the vaccine is no longer effective at preventing cancer or HPV infection. You have to have those antibodies on board before the child is or the teen is exposed to HPV in order for the vaccine to work and for it to be protective.
Melanie: How many doses do our teenagers or preteens need, and does that change if they haven’t gotten it as early as you have discussed?
Dr. Boucher: For teens that get it before age 15, you only need two doses. They are supposed to be spaced about six months apart. So, typically, I have – if I can have the child immunized either when they are 9, 10 or 11, then at their next annual check-up, I have them get their second dose at that time. If parents wait until they are older, the immune response isn’t as strong and so we have to do three doses of the vaccine. So, doing it earlier also saves them one additional poke.
Melanie: So, now there’s the question of obviously, sexually transmitted disease, this vaccine and then cancer screening for cervical cancer and there has been a lot of talk in the media Dr. Boucher, about whether you need a PAP smear if you have been vaccinated with the HPV vaccine. Speak about this relation, just a little bit.
Dr. Boucher: Sure. So, the whole reason behind doing PAP smears is essentially to detect the cancer or precancerous changes to the cervix that are caused because of HPV vaccine. So, we know that if we vaccinate large amounts of the population, that the incidence of cervical cancer will decline rapidly and that the immune system protection from HPV extends for a number of years. they looked at a study of 12,000 women in northern Europe who had been vaccinated for HPV vaccine; ten years later not a single person, not a single woman in the entire 12,000 person study population had contracted the cancer causing strain of HPV and so, what we recommend in terms of PAP smears is to continue getting PAP smears for surveillance, but overtime, we may see that recommendation change and the frequency of it if we have not had HPV exposure or infection because we are protected from HPV infection by the vaccine.
Melanie: Let’s start the conversation Dr. Boucher, how do you encourage parents to start this discussion with a 9 or a 10-year-old about the reason that they are getting this vaccine, if children have questions about it and have you heard from parents that they think that by discussing it, it’s going to give the green light to children to sexually active?
Dr. Boucher: That is a somewhat common concern. The way that I talk to parents and their teens about it, when they come in for their visit is I tell them that we only have a couple of vaccines that prevent cancer and that HPV vaccine protects them against cancer of both the cervix and head and neck and that the cancers associated with HPV often strike those that are in the prime of parenthood, so in their thirties and forties and talking with moms about how cervical cancer is a disease of childbearing and child rearing mothers for the most part and so we want to protect them from cancer. The cancer is transmitted by a virus that you can get as you go through adolescence and into adulthood and if teens have more questions then about that, then I am frank with them and tell that it is sexually transmitted. Most people acquire it during their teen years or their twenties and that we can prevent the infection and prevent the infection from leading to cancer. In terms of your question regarding does that give them permission to then become sexually active? There has been numerous studies that show that talking about HPV, talking about cervical cancer and talking about STDs, does not cause teens to be more sexually active, in fact, it probably protects against it because they understand the ramifications better and so I try and help parents to understand that just like the many things that we do where we are trying to protect our child from danger and keep them safe, that we have to explain what the dangers are and where they come from in order for the child to understand what we are doing to protect their safety.
Melanie: Wrap it up for us doctor, with your best advice about the HPV vaccine, the safety of it, the studies and why it is such an important cancer prevention vaccine which we haven’t really seen to much of before, the importance of parents discussing this with their kids and getting this vaccine as early as possible.
Dr. Boucher: If you look at all of the things that we vaccinate against that parents have legitimate concerns about measles, mumps, diphtheria, whooping cough; the likelihood that any one child is going to acquire one of those vaccine-preventable illnesses during their life is very low and yet we vaccinate against those to protect them from the disease and the side effects of those diseases. For HPV, the likelihood that they are going to be exposed to HPV during their lifetime is very high. The vast majority will be exposed to HPV during their lifetime and so if we are looking at which vaccine gives you the most likelihood of preventing a disease that you could otherwise catch, it’s flu vaccine and HPV vaccine because those are the most common things that we see that we can protect against with vaccination. The safety record for HPV vaccine is very strong. It has been studied for more than a decade and shown to be very safe and provides long-term immune protection from HPV infection. When I talk about the side effects and risks of the vaccine, the main one is pain at the injection site and it does hurt and I tell teens that it hurts and then teens are more susceptible to fainting with any vaccine administered and so we have the teens wait for ten or fifteen minutes after the vaccine is given to make sure that they don’t pass out, because that can happen and you don’t want that to happen after they leave the office and are driving or anything along those lines. Otherwise, the side effects profile is very safe for HPV vaccine. It has been well-studied and has well-documented effectiveness and safety.
Melanie: Thank you so much Dr. Boucher for being with us today sharing your expertise on this very important topic for parents to hear. Thank you again for being with us and a special thank you to our podcast partner Sampson Construction. This is Bryan Health Podcast and for more information on today’s topic please visit bryanhealth.org, that’s bryanhealth.org This is Melanie Cole. Thanks so much for tuning in.
Important Vaccination For All Pre-Teens: HPV
Melanie Cole (Host): According to the CDC, as many as fourteen million Americans including teens get infected with the HPV virus every year. Women and men can get cancer from HPV. But the good news is, the HPV vaccine can offer protection against the types of HPV that are most likely the cause certain cancers. My guest is Dr. Philip Boucher. He’s a pediatrician with Lincoln Pediatric Group. Dr. Boucher, what is HPV and how common is this infection?
Philip Boucher, MD (Guest): HPV is a virus and it causes skin diseases, a common virus that we see in the population and it causes skin disease that we don’t worry so much about, but then it causes some other diseases that we worry more about. So, HPV is spread through skin to skin contact and it is very common. So, probably about 80% of adults in the United States are infected with HPV at some time during their adult life.
Melanie: What kinds of problems can HPV infection cause and how do people get it?
Dr. Boucher: HPV is spread through mostly through sexual contact and the most worrisome consequence of HPV infection is cancer. There are several types of cancer that are associated with the HPV infection. So, cervical cancer, over 80% of cervical cancer is caused by human papilloma virus infection and 70% of cancers of the head and neck, throat and mouth are caused by HPV.
Melanie: Wow. So, let’s talk about vaccination. It used to be just girls, now it’s boys too. Tell us a little bit about the HPV vaccine and the dosing schedule. When should kids start getting this vaccine?
Dr. Boucher: Right, so the reason that we vaccinate against HPV, it is a very common infection and for many people, the infection just causes no symptoms at all or genital warts, but it leads to the cancers that I was talking about before and so that is the reason that we vaccinate for it is to protect out teens and young adults from these strains that cause cancer. We recommend it for boys and for girls for a couple of reasons. You are right, initially it was recommended for girls because of the risk of cervical cancer and as we have learned more about HPV vaccine especially the realization that it causes a lot of head and neck cancers as well, that both boys and girls are susceptible to cancer from HPV vaccine. Since it is sexually transmitted, obviously boys and girls are spreading it to each other and so that’s why we recommend vaccinating both boys and girls for it.
As far as the scheduling of the vaccine, we recommend it begin between age 9 and 11 and the earlier that you vaccinate against HPV, the stronger the immune response is. So, I, for my patients try and vaccinate them against HPV at around age 9, if they come in for a well-check or a sick visit, we can vaccinate at that time. Because we know, looking at the antibody response, the earlier that you vaccinate, the higher the immune system build up of antibody is, the more robust the immune response.
Melanie: The immune response is more robust when they are younger, but if a child is not sexually active, why is it so important that it is early. Because if they are not going to get sexually active until they are in their later teens, hopefully maybe even later; then how do you explain to a parent the rationale of that immune response?
Dr. Boucher: The reason that – the way that I explain it to parents, in terms of why are you vaccinating my third, fourth, fifth grader for a sexually transmitted disease? One is in part, because as I said, the earlier that we give it, the more robust the immune response is and two, we know that once teens or adolescents have their sexual debut where they start becoming sexually active; they acquire HPV very quickly. Once they have acquired HPV, the vaccine is no longer effective at preventing cancer or HPV infection. You have to have those antibodies on board before the child is or the teen is exposed to HPV in order for the vaccine to work and for it to be protective.
Melanie: How many doses do our teenagers or preteens need, and does that change if they haven’t gotten it as early as you have discussed?
Dr. Boucher: For teens that get it before age 15, you only need two doses. They are supposed to be spaced about six months apart. So, typically, I have – if I can have the child immunized either when they are 9, 10 or 11, then at their next annual check-up, I have them get their second dose at that time. If parents wait until they are older, the immune response isn’t as strong and so we have to do three doses of the vaccine. So, doing it earlier also saves them one additional poke.
Melanie: So, now there’s the question of obviously, sexually transmitted disease, this vaccine and then cancer screening for cervical cancer and there has been a lot of talk in the media Dr. Boucher, about whether you need a PAP smear if you have been vaccinated with the HPV vaccine. Speak about this relation, just a little bit.
Dr. Boucher: Sure. So, the whole reason behind doing PAP smears is essentially to detect the cancer or precancerous changes to the cervix that are caused because of HPV vaccine. So, we know that if we vaccinate large amounts of the population, that the incidence of cervical cancer will decline rapidly and that the immune system protection from HPV extends for a number of years. they looked at a study of 12,000 women in northern Europe who had been vaccinated for HPV vaccine; ten years later not a single person, not a single woman in the entire 12,000 person study population had contracted the cancer causing strain of HPV and so, what we recommend in terms of PAP smears is to continue getting PAP smears for surveillance, but overtime, we may see that recommendation change and the frequency of it if we have not had HPV exposure or infection because we are protected from HPV infection by the vaccine.
Melanie: Let’s start the conversation Dr. Boucher, how do you encourage parents to start this discussion with a 9 or a 10-year-old about the reason that they are getting this vaccine, if children have questions about it and have you heard from parents that they think that by discussing it, it’s going to give the green light to children to sexually active?
Dr. Boucher: That is a somewhat common concern. The way that I talk to parents and their teens about it, when they come in for their visit is I tell them that we only have a couple of vaccines that prevent cancer and that HPV vaccine protects them against cancer of both the cervix and head and neck and that the cancers associated with HPV often strike those that are in the prime of parenthood, so in their thirties and forties and talking with moms about how cervical cancer is a disease of childbearing and child rearing mothers for the most part and so we want to protect them from cancer. The cancer is transmitted by a virus that you can get as you go through adolescence and into adulthood and if teens have more questions then about that, then I am frank with them and tell that it is sexually transmitted. Most people acquire it during their teen years or their twenties and that we can prevent the infection and prevent the infection from leading to cancer. In terms of your question regarding does that give them permission to then become sexually active? There has been numerous studies that show that talking about HPV, talking about cervical cancer and talking about STDs, does not cause teens to be more sexually active, in fact, it probably protects against it because they understand the ramifications better and so I try and help parents to understand that just like the many things that we do where we are trying to protect our child from danger and keep them safe, that we have to explain what the dangers are and where they come from in order for the child to understand what we are doing to protect their safety.
Melanie: Wrap it up for us doctor, with your best advice about the HPV vaccine, the safety of it, the studies and why it is such an important cancer prevention vaccine which we haven’t really seen to much of before, the importance of parents discussing this with their kids and getting this vaccine as early as possible.
Dr. Boucher: If you look at all of the things that we vaccinate against that parents have legitimate concerns about measles, mumps, diphtheria, whooping cough; the likelihood that any one child is going to acquire one of those vaccine-preventable illnesses during their life is very low and yet we vaccinate against those to protect them from the disease and the side effects of those diseases. For HPV, the likelihood that they are going to be exposed to HPV during their lifetime is very high. The vast majority will be exposed to HPV during their lifetime and so if we are looking at which vaccine gives you the most likelihood of preventing a disease that you could otherwise catch, it’s flu vaccine and HPV vaccine because those are the most common things that we see that we can protect against with vaccination. The safety record for HPV vaccine is very strong. It has been studied for more than a decade and shown to be very safe and provides long-term immune protection from HPV infection. When I talk about the side effects and risks of the vaccine, the main one is pain at the injection site and it does hurt and I tell teens that it hurts and then teens are more susceptible to fainting with any vaccine administered and so we have the teens wait for ten or fifteen minutes after the vaccine is given to make sure that they don’t pass out, because that can happen and you don’t want that to happen after they leave the office and are driving or anything along those lines. Otherwise, the side effects profile is very safe for HPV vaccine. It has been well-studied and has well-documented effectiveness and safety.
Melanie: Thank you so much Dr. Boucher for being with us today sharing your expertise on this very important topic for parents to hear. Thank you again for being with us and a special thank you to our podcast partner Sampson Construction. This is Bryan Health Podcast and for more information on today’s topic please visit bryanhealth.org, that’s bryanhealth.org This is Melanie Cole. Thanks so much for tuning in.