Human Papillomavirus vaccine offers protection against cervical cancer

• Dr. Adria Suárez Mora of Cleveland Clinic explains that the Human Papillomavirus vaccine is the main tool for preventing cervical cancer.

(May 2022.) Human Papillomavirus is considered the most common viral infection passed from person to person, through direct skin contact during sexual activity, causing millions of new cases worldwide.

Since 2006, the US Food and Drug Administration has recommended the HPV vaccine for children from age 9 to adults aged 26. It has now extended that age range to 45.

Dr. Adria Suarez Mora of Cleveland Clinic gives a broad overview of Human Papillomavirus and the importance of vaccination to prevent this disease.

What is HPV?

HPV stands for Human Papillomavirus, a sexually transmitted virus that is very prevalent in the population. This means that almost all of us who have been sexually active at some point in our lives will be exposed to HPV or Papillomavirus. That doesn’t mean the infection will stay in our body forever; in most infections, more than 80%, the body simply fights it off. It is only in a minority of people with the infection that it can persist and cause problems in the future.

How long after the sexual contact in which HPV is transmitted can a papilloma test detect it?

Papillomavirus is not like other sexually transmitted infections for which we have treatments or other measures to detect the infection early. This virus only has effects many years after the infection was acquired. Because we have no treatment for the infection, it is not a routine test for young people who are sexually active, since at that point it doesn’t matter whether they have the infection or not, as the body will fight off most of these infections, as I explained. In the minority of people in whom the infection remains active, years or decades can pass from when the infection was acquired until changes begin to appear and are detected in a test such as a Pap smear.

HPV is not a single virus. What kinds of health problems or cancers does HPV infection cause?

HPV covers different types of virus. We have currently identified high-risk types, sometimes more than thirty, but there are two very high-risk types, followed by around ten that make up the rest of the high-risk types. The type of virus determines what problems the infection can cause.

High-risk virus types can cause cancers in the body, mostly involving the tissues of the cervix, vagina or vulva in women. Men can also contract the virus, and in men it can lead to cancer or precancers of the penis. The virus can also infect other areas of the body such as the throat or mouth, areas that are very similar, and skin tissue can be affected by HPV.

The other types of virus that are not high-risk for cancer can cause genital warts or other non-cancer-related problems in women and men, but these are benign conditions that can be treated.

Does the virus itself cause any symptoms or discomfort that could be a warning sign?

Normally the infection itself unfortunately has no symptoms; symptoms only appear when papillomavirus starts to cause certain problems. If warts, itching or irritation start to appear, it can be determined that they are caused by papillomavirus. Similarly with cancers, the virus alone won’t cause symptoms, but when it starts to cause changes in cells that can become precancers or cancer of one of these organs, that is when symptoms begin to appear.

How important is HPV vaccination and why?

HPV vaccination is vitally important, and the reason is very simple: it is one of the only vaccines that can fight all the cancers I have described in my field as a gynaecologic oncologist, where I specialise in cervical, vulvar and vaginal cancers.

In my field, this is the only way to prevent, rather than treat or treat early: “it’s preventing our children from having problems with these types of cancer in the future”. We can’t say that about many vaccines. The HPV vaccine is very effective and safe, and has become one of the best ways to fight cervical cancer, which is often very difficult to treat.

What level of protection does the HPV vaccine provide?

The vaccine is very effective, but it is more effective if given at a young age. This means that if we give the vaccine before a child or adolescent is exposed to HPV for the first time, it is much more effective than if given after exposure, because the defences will no longer be the same due to exposure to and the strength of the virus.

If the vaccine is given before becoming sexually active, that is, before being exposed to the virus for the first time, it will be 97 to 100% effective, meaning children and adolescents will never develop cancer or precancers caused by Papillomavirus.

If they have already been exposed to some types of Papillomavirus, but not all, protection falls to 50 or 60%. It is still effective, but much more so if given at an early age.

At what age is HPV vaccination recommended?

Vaccination is best between the ages of 11 and 12, but it can start from age 9. If you didn’t get the chance to be vaccinated at that age, it can be given up to age 25; the vaccine is suitable for children, adolescents and young adults. As I explained, the earlier HPV vaccination begins, the more protection the person will have, because the vaccine will be more effective.

In some high-risk women or men, meaning those whose immune defences are weakened for any reason and who are exposed to HPV, the vaccine can be given up to age 45, with the caveat that it won’t be as effective, but it can provide some protection against HPV types they haven’t been exposed to.

Some studies have shown that in women with precancers, the HPV vaccine can help the immune system fight them and help prevent further precancers in the future.

How does HPV affect boys and men? Should they be vaccinated too?

The HPV vaccine is recommended for both boys and girls for two reasons. First, it protects them against types of cancer they may be exposed to, such as cancer of the penis, mouth or throat. Second, if we vaccinate boys and girls, we protect each other from transmitting the virus and having problems with the opposite sex.

Can an HPV-positive woman or man be vaccinated?

Yes. Whether or not you have been exposed to HPV in the past, there are still known benefits to being vaccinated. As we mentioned, there are different types of HPV, so even if someone has been exposed to one or two types, we can still protect those men and women from problems with other types of HPV, and there is evidence that it can help the immune system fight Human Papillomavirus if it reactivates in the body. Regardless of past exposure, if you are within the recommended age range, or if you have immune system problems that affect your ability to fight Human Papillomavirus and are between 25 and 45, vaccination is still recommended.

How can people contact a Cleveland Clinic doctor for advice on this topic?

At Cleveland Clinic, we have a group of gynaecologists to treat this type of condition. I am a gynaecologic oncologist and I am always available for virtual or in-person consultations on these issues. For oncological problems, precancers, cancers and high-risk women, we have a group of general gynaecologists and experts in the field who will guide and advise on whether vaccination is an effective option for the person.

 

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About Cleveland Clinic

Cleveland Clinic is a nonprofit multispecialty academic medical centre that integrates clinical and hospital care with research and education. Located in Cleveland, Ohio, it was founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based on the principles of cooperation, compassion and innovation. Cleveland Clinic has pioneered many medical breakthroughs, including coronary artery bypass surgery and the first face transplant in the United States. U.S. News & World Report consistently names Cleveland Clinic as one of the nation’s best hospitals in its annual “America’s Best Hospitals” survey. Among Cleveland Clinic’s 67,554 employees worldwide are more than 4,520 salaried physicians and researchers, and 17,000 registered nurses and advanced practice providers, representing 140 medical specialties and subspecialties. Cleveland Clinic is a 6,026-bed health system that includes a 165-acre main campus near downtown Cleveland, 18 hospitals, more than 220 outpatient facilities, and locations in southeast Florida; Las Vegas, Nevada; Toronto, Canada; Abu Dhabi, UAE; and London, England. In 2019, there were 9.8 million outpatient visits, 309,000 hospital admissions and observations, and 255,000 surgical cases throughout Cleveland Clinic’s health system. Patients came for treatment from every state and 185 countries. Visit us at clevelandclinic.org.

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