Transcription:
HPV: Get the Facts

Melanie Cole (Host): HPV is the most common sexually transmitted infection but there are vaccines that can stop these health problems from happening. My guest today is Dr. Thomas Murwin. He is a pediatrician with Dean Clinic Stoughton. Welcome to the show, Dr. Murwin. Let’s start by talking about what is HPV? People have heard a lot about it in the media. Tell us what it is.

Dr. Thomas Murwin (Guest): HPV is a skin and soft tissue infection that can be chronic in your skin and soft tissues and lead to cancer which is what we’re trying to prevent.

Melanie: It’s a sexually transmitted infection. How is it transmitted?

Dr. Murwin: It’s transmitted by skin to skin contact. That may be oral skin. That may be genital skin. That may be anal skin. We’re not entirely sure if all of those are equally effective in transmitting it. It’s basically skin to skin contact. Any skin to skin contact can potentially transmit this. There are over 200 types of HPV and the ones that we are targeting with this vaccine have to do with mucus membranes in the head and neck and anal-genital area specifically.

Melanie: Does this cause other health problems?

Dr. Murwin: It can cause warts in a lot of people. It causes a lot more warts than it does cancer but warts don’t kill you, so we’re not as worried about those even though we don’t want to say they’re not a problem. It can cause wart-like growths in the airway that we call “papillomatosis” that can lead to airway blockage problems in any age.

Melanie: Dr. Murwin, you mentioned cancer. People don’t typically think of sexually transmitted infections and cancer. Tell us about that link.

Dr. Murwin: The link between cervical cancer, specifically--which is what started this whole HPV vaccine movement--the link between cervical cancer and HPV is 99% of all cervical cancer in the United States in 2016 is caused by HPV infections – 99%. That is as strong of a correlation as we have between a viral infection and cancer. We also know that HPV can cause head and neck cancer--we call them oral pharynx cancers--as well as anal-genital cancers. The correlation with those is lower. For head and neck cancer, it’s more like 50%. For anal-genital cancer it’s more like 70-80%. There is a range of cancers that are less strongly associated than cervical cancer but the more we know about HPV, the more we know we know we can protect people against a lot more than just cervical cancer.

Melanie: How can someone avoid HPV and the health problems it causes?

Dr. Murwin: Don’t have sex. I mean, that’s really the only way that you’re never going to get HVP is if you’re celibate your whole life which most of us choose not to be. By 50 years of age, 80% of women will have been infected at some point with HPV. That’s a big percentage. Most of us are going to get infected with it. Most of us do not know we have the infection because unless you get warts or cancer you really don’t know that you’re infected. The problem is just because the person that’s infected, their skin looks normal doesn’t mean that they are free of HPV.

Melanie: Is this something that we can get tested for?

Dr. Murwin: Currently, males – no. With females, there is some HPV typing. You know the old PAP smear that women have gotten every 3 years?

Melanie: Yes.

Dr. Murwin: That is going to, in my mind, be replaced in the next decade with HPV testing because basically the PAP smear says you’re chronically infected with HPV if you have an abnormality. It’s kind of an indirect marker. We know we can get much more specific and do HPV typing on any abnormal PAP smear and tell us which type of HPV you have, which tells us whether you have a high risk for developing cancer or a low risk for developing cancer. Yes, HPV typing is available when you have your PAP smear done and it’s getting more specific every year.

Melanie: Let’s talk about the HPV vaccine because now the American Academy of Pediatrics is recommending that all boys and girls ages 11-12, in that age range, should get vaccinated. Tell us, Dr. Murwin, about that vaccine.

Dr. Murwin: That vaccine will prevent the initial infection with HPV. So, you want to get it in before they’re infected. If you get all three doses into a female before she’s infected with HPV virus by sexual activity you will reduce her cervical cancer risk by 90% in her lifetime.

Melanie: Wow.

Dr. Murwin: There are about 10,000 cases every year of cervical cancer. It’s been happening for the last 50 years. If we can get this vaccine into everybody, we can prevent 9,000 of those 10,000 cases of cervical cancer. But, you’ve got to get the vaccine in before they get infected because this vaccine doesn’t do anything if you’re already infected with the virus. The problem is, you don’t know you’re infected because we don’t do HPV typing and we don’t do PAP smears under 21 years of age anymore. So, for all the women under 21 we have no idea who’s infected and who’s not. The whole idea is give this vaccine to 11-13 year olds before they get infected so you prevent that infection.

Melanie: How many vaccines do they get?

Dr. Murwin: It’s 3 doses separated by 6 months total. For boys – the reason boys should get it is there are about 4,500 cases of head and neck cancer in males per year. So, it’s about half of what female cervical cancer is and we can prevent 50% of those if we get the HPV vaccine in before they get infected with the wrong HPV type.

Melanie: Why do you think some parents are hesitant to give this vaccine to their children? Some parents are worried by giving it you’re giving your children the okay to have sex.

Dr. Murwin: There’s no evidence that giving them the vaccine causes kids to have more sex any more than saying, “Wear your seatbelt every time” and if you do that they’re going to drive crazy because they know they’re protected. There’s no evidence that giving the vaccine changes their sexual behavior. There are really two reasons that people don’t want to give it. One – “My 11 year old is not sexually active. I’ll wait until she’s sexually active.” They don’t want to think about their 11, 12, 13-year-old as being sexually active, so their defense mechanism is, “I’m not going to worry about that right now.” My response to them is your child is not going to ask you when they have sex the first time for your permission. Don’t wait for them where you think they’re going to have it, just get this vaccine in before they have sex. Two, there’s a lot of false information out on the internet of quote-unquote problems caused by the HPV vaccine. I tell parents, “These are isolated incidents. America has looked at them. Australia has looked at them. United Kingdom has looked at them. Germany has looked at them. Canada has looked at them. Tens of countries around the world have done studies and there are no associations with the HPV vaccine with any bad side effects.” The worse thing about the HPV vaccine is it hurts and some people faint from it. I fainted from vaccines when I was 10-15 years of age, so that’s nothing new. These vaccines do not cause any major problems. I would flip it around to parents and say, “Okay, in 10 years if you don’t do anything there is a 100,000 cases of cervical cancer in the United States of which 90,000 could have been prevented had we got the vaccine into women before they got infected.”

Melanie: That’s so important.

Dr. Murwin: Yes, that 90,000 so trumps any of these so-called problems that people are trying to say are caused by the HPV vaccine.

Melanie: When you tell parents this is a cancer preventive vaccine, which is one of the only ones that we have. It is an amazing vaccine to give your kids.

Dr. Murwin: Yes it is.

Melanie: What if your kids didn’t get it? How late can your kids – if you’re 26 years old is it then too late?

Dr. Murwin: For women it’s approved up to 25 years of age. For men it’s approved up to 21 years of age. Both of those are based on the fact that when they do the studies to look at these vaccines and they look at a number of people that are already infected with HPV, as you go from 15 to 18 to 20 to 23 to 26 the percentage of people who are already infected go up, so the effectiveness of the vaccine goes down because, again, it doesn’t do anything if you’re already infected; it just prevents the initial infection. It’s not recommended for women over 26 or men over 21.

Melanie: Just in the last few minutes, Dr. Murwin, this is such a great topic and so important and you put it forth so beautifully and so easy to understand. Give your best advice to the listeners, to parents, about the importance of getting this vaccine, talking to their pediatricians and why they should come to Stoughton Dean Clinic for their care.

Dr. Murwin: They should come to the Dean Clinic because we provide better care. They should consider getting the vaccine for their children because unless their children are going to be celibate their whole lives, they have an 80% chance of seeing this infection and you have a 90% chance in girls of reducing their risk of cervical cancer and a 50% reduction of head and neck cancers in boys. Men and women, boys and girls should get this vaccine before they’re infected.

Melanie: Thank you so much. What great information. You’re listening to Stoughton Hospital Health Talk and for more information you can go to StoughtonHospital.com. That’s StoughtonHospital.com. This is Melanie Cole. Thanks so much for listening.