Episode Transcript
Dr. Rebecca Cooper:
Even if we can prevent one case of cancer in someone you know or love, that’s so important. Right? Yeah. I don’t know anyone that looks back and says, “oh, I wish that I did the same thing,” knowing that you had the chance to prevent this.
Courtney Collen (host):
This is the “Health and Wellness” podcast brought to you by Sanford Health. I’m your host, Courtney Collen with Sanford Health News. In this episode, we are addressing some of the most common myths around the HPV vaccine.
Dr. Ashley Sands is a specialist in pediatric infectious disease treating infants, children and young adults at Sanford Children’s Specialty Clinic. And Dr. Rebecca Cooper cares for people of all ages as a specialist in family medicine at the Sanford Health Family Medicine Clinic in west Sioux Falls. Dr. Sands, Dr. Cooper, welcome. Thanks so much for being a part of this conversation.
Dr. Ashley Sands and Dr. Rebecca Cooper (guests): Thank you so much for having us.
Courtney Collen:
There’s a lot of conversation around vaccines right now in general, and thankfully a lot of science-based evidence and data to support the efficacy of so many of them. Today we’re focusing specifically on the HPV vaccine. We’re going to focus on some of those myths one by one.
But first, before we dive into those, I want to level set with a quick overview of the HPV vaccine, what it protects against, maybe a little bit about its history and why we are recommending it for our patients.
Dr. Sands, I’ll start with you.
Dr. Ashley Sands:
Sure. So the human papillomavirus (HPV) is a virus that is sexually transmitted and generally causes genital warts. So little bumps on your genitals or person’s genitals. 80% of the virus will go away without ever knowing maybe that you even had the virus or that you were infected. It’s that 20% that stays around and then can cause in a number of years, 15, 20 years, cancers.
So we know that it is the leading cause of cervical cancer in females. It can also cause vaginal and vulva cancer, and it also causes anal (cancer), and people often don’t realize this, but it can cause oral cancers as well, so head and neck cancers.
Courtney Collen:
Dr. Cooper, why do we recommend this vaccine for our patients?
Dr. Rebecca Cooper:
Great question. It’s one of only two vaccines that we have that actually prevents cancer. So if we give this vaccine before kids or young adults are exposed to this, we can actually completely prevent this from infecting cells and later causing cancer, which is huge.
Courtney Collen:
Let’s dive into these different myths one by one in no specific order. The first one, my child is way too young to worry about HPV. What would you have to say about that?
Dr. Ashley Sands:
I think that’s a fair question. But we know that when we give the vaccine well before a child or an adult is exposed to that pathogen, we are able to build immunity in the person’s body and so when they do come in contact with that virus, 10, 15, 20 years down the line, their body has immunity and just gets rid of the virus without causing any of the harmful effects.
There was a study that just came out of Scotland that showed children who were vaccinated by 13 years of age had zero cases of cervical cancer 15 years later. Whereas children who were vaccinated later, even starting at age 14, there were some breakthrough cases of cervical cancer in that population.
The important thing to know is that the sooner that you get it, the more prevention of cancer your child or you will have in the future.
Photo by Sanford Health
Courtney Collen:
Yeah. So important. Thank you. Myth number two, boys don’t need the HPV vaccine. What would you say to that, Dr. Cooper?
Dr. Rebecca Cooper:
It’s just not true. We know that one, men can get anal cancers and head and neck cancers from HPV, but not only that – they can contribute to spreading this cancer to women. So for parents that tell me that, oh, my boy doesn’t need this. He doesn’t have a cervix, sure, that’s fine, but you would never want to know that your son contributed to a cancer case in his future partner.
And again, we’re looking at population health here as well, and so we’re trying to reduce the risk across the population. And every person that can be part of this helps decrease this incidence.
Dr. Ashley Sands:
It also causes penile cancer. HPV can cause penile cancer.
Courtney Collen:
Oh, really?
Dr. Rebecca Cooper:
You don’t want that.
Dr. Ashley Sands:
You don’t want that.
"The important thing to know is that the sooner that you get it (HPV vaccine), the more prevention of cancer your child or you will have in the future." Dr. Ashley Sands
Courtney Collen:
No, certainly not.
Dr. Ashley Sands:
You don’t want that for your child at all. So it does help prevent cancers in both boys and girls.
Courtney Collen:
Thank you. If my child gets the HPV vaccine at age 9, the benefits will wear off before my child is at risk of getting HPV. That’s the third myth. What would you say to that?
Dr. Ashley Sands:
I say, that’s also incorrect. We know that this vaccine gives lifetime immunity. And as I said, we’ve had this vaccine around for 15 to 20 years, and we have seen that adults who received it as a child do not have cancer, do not have cervical, do not have HPV-related cancers as adults. So the immunity lasts.
Courtney Collen:
Do you recommend this for adults as well?
Dr. Rebecca Cooper:
Absolutely. So it used to really only be recommended ages 9 to 26. They’ve really expanded this now from 27 to 45 as well. That doesn’t mean that every single person needs to get that, but really most of us do recommend it.
Unfortunately, we never know what’s going to happen in our lives and so really it’s only protective for people. There’s very minimal risk. And so almost everyone that I know in primary care recommends this up until age 45 for anyone that wants it.
Photo by Sanford Health
Courtney Collen:
Myth number four: the HPV vaccine is about preventing STDs and my child won’t be sexually active for a long time, so it’s better to wait until my child is older. What do you think?
Dr. Ashley Sands:
Yeah, so as we’ve said, the earlier that you get the vaccine, it does have life lifetime immunity. So the earlier you get it, you just don’t have to worry about it. And we don’t know when children will become sexually active. So getting it before they come in contact with that virus is really the best thing to do.
Dr. Rebecca Cooper:
Additionally, we don’t know what your child’s future partner is going to choose in their life. Maybe they made different choices than what you would have or what you wanted for your child and that’s not something that your child deserves. To have a long-term consequence of cancer is just not an appropriate consequence for choices that you wouldn’t agree with.
Courtney Collen:
Thank you. Are there any side effects to this vaccine?
Dr. Rebecca Cooper:
I mean, same side effects as you get with any vaccine. People get a sore arm. You can feel kind of run down from your immune system ramping up and making those great antibodies. But overall, it’s very well tolerated for people.
Courtney Collen:
Myth number five. The HPV vaccine hasn’t been around long enough to know it’s safe. You said it’s 15 to 20 years old. Dr. Sands, what would you say about that myth?
Dr. Ashley Sands:
So over these 15 to 20 years of vaccines, we have had all of these studies. It used to be two strains of HPV, then it turned to four, and now we’re at nine strains. So we, we know that it’s well tolerated. We know that it prevents cancer. It really has been studied quite well for a vaccine that is still an adolescent, if you will.
Dr. Rebecca Cooper:
And I think there’s actually been over a hundred million doses administered now to date, which is just a ton (laugh).
Courtney Collen:
I have 135 million doses distributed.
Dr. Rebecca Cooper:
Yes. And so, which is good. That’s good support. That’s good support.
Courtney Collen:
And when in the clinic, when you come, when young adults come to see you or adults, at what point do you bring up the HPV vaccine? Is there a certain age range or conversation appointment that you bring this up? What does that look like?
Dr. Rebecca Cooper:
I bring it up starting at age 9 and pretty much every at least wellness visit after that, I try to ask every time that I see people if they would like any vaccines today or have any questions. But certainly at least once a year, starting at age 9. But I bring it up almost until it is completely out at age 45. Because even if we start at 44, you can still get three doses.
Courtney Collen:
Myth number six, adults don’t need the HPV vaccine. Again, remind us how young or how old we can be to receive this vaccine and why.
Dr. Rebecca Cooper:
We start giving it now at age 9 and it’s approved up until age 45. So it used to only be until 26, but now they’ve expanded because we found that it literally prevents cancer. And so why would we not do that?
Most of the thought is that after age 45, the risk of obtaining new strain of HPV significantly decreases, and that’s why we, it’s not really approved beyond that. But really it’s only protective for people.
Courtney Collen:
Another myth here, the HPV vaccine causes infertility in young women.
Dr. Ashley Sands:
I’ve talked about this with some of the parents of my patients. So as we said, over 135 million vaccines have been given. We do not see a link of infertility with the vaccine. We do see a link of infertility in cervical cancer related to HPV. So I would say that the HPV vaccine could actually work to prevent infertility if you’re preventing the cervical cancer.
Dr. Rebecca Cooper:
Additionally, the way that we treat these early cases of cervical dysplasia, which is the pre-cancer and then cervical cancer, is by surgery and removing those abnormal cells. So most of the time with pap smears, we try to detect those pre-cancerous or cancers.
But we literally remove the abnormal cells and so that even if it’s not cancer, can increase the risk of pregnancy complications for young women because that’s who this is happening in. It increases their chance of delivering early, of having issues with their pregnancy.
And to treat cervical cancer, most of the time we take out the abnormal cells, including the cervix and potentially the uterus, and that you can’t have a baby if you don’t have a uterus.
Courtney Collen:
One of the other myths here, along that same line, you don’t need pap smear tests if you’ve had the HPV vaccine. Is that true?
Dr. Rebecca Cooper:
No. Pap smears certainly detect HPV. That’s the most common cause of cervical cancer and pre-cancer. But there are other things that can contribute to this. And the vaccine is not a hundred percent for all types of HPV. We vaccinate against the nine most common and the ones that are most likely to cause cancer. But we know that there are other ones that contribute. And so we still certainly recommend pap smears.
Courtney Collen:
The HPV vaccine is only effective if given before the first sexual encounter.
Dr. Rebecca Cooper:
It’s most effective if given before the first sexual encounter. So the HPV vaccine doesn’t cure any strains of HPV that you’ve already acquired. It only protects against new strains. So when women have abnormal pap smears and cervical dysplasia, we still recommend it because it’s still protective against anything they may acquire. But unfortunately, it doesn’t do anything for strains that you’ve already acquired, which is why it’s so important to get the vaccine before any contact may occur.
Dr. Ashley Sands:
So it is two doses if you start your vaccine series before the age of 15. If you are 15 or older, then you would need to complete three doses of that vaccine over a six-month period.
Courtney Collen:
OK.
Dr. Rebecca Cooper:
And we’re happy to catch people up anytime. I have a lot of patients that maybe got it initially and then they got very nervous and afraid or, you know, or all the propaganda that’s around this on social media and they waited a few years. It’s OK. We can continue the series. We will complete it very happily.
You don’t have to restart.
Courtney Collen:
You don’t have to restart it. OK. Good to know. Let’s talk about that for a moment, because there is so much conversation online, and that could be influencing people one way or the other.
How would you combat some of this misinformation or encourage parents to talk to their pre-teens, their teens, their young adults to get this vaccine? You know, how would you kind of lay it out for them to have the conversation to eventually get them protected before it’s too late?
Dr. Rebecca Cooper:
I usually just try to address it head on and ask what their fears are, what their concerns are. I don’t know any primary care doctor that would not be happy to have this conversation with you or infectious disease, anyone.
But we love to talk about this stuff because it’s something that most of us are incredibly passionate about. And so most of the time, if you can tell me your specific fears and questions, things that you saw on social media or Dr. Google, it’s easier to just have that conversation and put it all out in the open.
Parents still get to make their choice. We’re not going to hold you down and vaccinate your kid against your will. So just know that. But it’s a safe place in our clinic to have that conversation, and no one is ever going to fault you for asking those questions.
Courtney Collen:
Sure. And it’s not – go ahead.
Dr. Ashley Sands:
I was going to say the same thing, and I’m happy to point parents and patients to the data and the sources that have all of these doses that have been given and no cervical cancer or show this rate of decrease of HPV-associated cancer so that they can see some of the source material and make the decision themselves.
Dr. Rebecca Cooper:
I mean, even if we can prevent one case of cancer in someone you know or love, that’s so important. Right? Yeah. I don’t know anyone that looks back and says, “oh, I wish that I did the same thing,” knowing that you had the chance to prevent this.
I do a lot of pap smears. I do a lot of pap smears in my clinic, and I follow all up, a lot of abnormal pap smears and women are so terrified. When you get that phone call that you had an abnormal pap smear, most often, it really ends up fine. Truly.
Like Dr. Sands said, we clear a ton of this virus on our own – 80% of this gets cleared. But if you’re in the 20% that doesn’t, it’s terrifying for young women. I have women in my clinic all the time that are just terrified of what might happen and the implications of what that looks like and the procedures that we go through to confirm if this is pre-cancer or cancer, they’re not great. They’re not fun, and this vaccine can prevent all of that. So not only the cancer itself, but the anxiety that comes with everything that leads up to that.
Courtney Collen:
Such valuable information. Dr. Sands, do you have anything else you want to add to that?
Dr. Ashley Sands:
I say just bring the conversations and come ask the questions. As Dr. Cooper said, we never shy away from having these conversations. We want to understand your concerns and want to help address them and talk through the information that we know and things that we can share with you to help make that informed decision for yourself or your children.
Courtney Collen:
Absolutely. And that’s what it’s about at the end of the day. Dr. Sands, Dr. Cooper, thank you so much for your time, your insights and helping us address some of these myths head on. Really appreciate your insight and expertise here in this conversation.
Dr. Ashley Sands:
Absolutely. Thank you.
Courtney Collen:
Thank you. This episode is part of the “Health and Wellness” podcast series by Sanford Health. For additional series by Sanford, listen wherever you hear your favorite podcasts and on news.sanfordhealth.org. Thanks for being here.
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Posted In Cancer, Children's, Family Medicine, General, Health Information, Immunizations, News, Parenting, Sioux Falls, Specialty Care
