Host (Vanessa Gomez): Hello and welcome. You’re listening to the Her Kind of Healthy podcast series from Sanford Health. I’m Vanessa Gomez with Sanford Health News. Our conversation today is with Dr. Brooke Jensen, specializing in family medicine at Sanford Health. We’ll learn of the importance of the HPV vaccine and its relation to cervical cancer. Welcome Dr. Jensen and thank you for being with us.
Brooke Jensen, MD: Thank you for having me.
Host (Vanessa Gomez): So first, just give us a little bit of your background. How long have you been here at the 32nd and Ellis clinic location? And tell us more about what you specialize in?
Host (Vanessa Gomez): Our main focus today is on the HPV vaccine. And when you think HPV vaccine, the conversation tends to go more towards women, young girls. What is the HPV vaccine?
Brooke Jensen, MD: So, the HPV vaccine is a vaccine against high-risk types of the human papilloma virus that is a common cause for cervical cancer and other cancers for men and women alike.
Host (Vanessa Gomez): So when should people be getting this vaccine? And I mentioned, this conversation really surrounds women in girls, but you mentioned young men as well.
Brooke Jensen, MD: So, we encourage HPV vaccination between the ages of nine and 12 to start as evidence shows that starting at a younger age improves the immune response and better protection against different forms of cancer. We like men and women to both get their HPV vaccines starting at the nine, if we can, but we also do that clear up to the age of 25. So even if you missed out at that younger age, you can still get it later on for protection.
Host (Vanessa Gomez): Why do we want people to get it when they’re younger?
Brooke Jensen, MD: So, when they’re younger, they actually have a better immune response and produce greater antibodies. There was a study out in the UK recently that was published that showed cervical cancer rates and those who received the HPV vaccine between the ages of 12 and 13 experienced greatest reduction in cervical cancer at around 87%. There were still high percentages in those other age groups, but they gradually decreased the older ages that they got the HPV vaccine at.
Host (Vanessa Gomez): So bottom line is just get it when you can.
Brooke Jensen, MD: Absolutely.
Host (Vanessa Gomez): And it’ll help. When parents come in with their kids to the clinic and this conversation gets brought up, what are some of the concerns, the common concerns or common misconceptions that parents have?
Brooke Jensen, MD: A lot of times parents are concerned that “well, is this part of this school requirements, and if it’s not a requirement, why do I need to get it?” So it’s really educating and showing this benefit, although yes, it does not prevent a spread of other viruses or things that are commonly spread just through the air that often we are concerned about in school, this will prevent cervical cancers, anal cancers, penile cancers, and some head and neck cancers down the road for these young men and women, and to help protect them.
Host (Vanessa Gomez): What are some of the side effects that kids experience when they get the vaccine?
Brooke Jensen, MD: Common side effects that have been re reported are very similar to the other vaccines in adolescents. The most common reported have been syncope followed by injection site redness, pain, and swelling.
Host (Vanessa Gomez): How can we encourage more parents to get this vaccine for their kids, talk to their kids about, you know, this is why you’re getting it?
Brooke Jensen, MD: Yeah. So, a lot of it’s just education. Encouraging them to come to the table and ask these questions because often there’s been stigma around this vaccine in the past because people know HPV can be spread through sexual contact. And so there’s always concern that this is just gonna encourage my kid to have sex. And that’s really not the case. The studies show that there has not been any increase in risky sexual behavior in children that have had HPV vaccine than those that haven’t. So just educating on them on this and that this is long term protection. This is not just for right now at their adolescent age. This is protection throughout their lifetime.
Host (Vanessa Gomez): What can you tell us about the safety and efficacy, which the efficacy, we talked a little bit about the beginning?
Brooke Jensen, MD: Some of the efficacy that we have found, it shows that the estimated efficacy of the nine Valeant HPV vaccine is combined against incidents of cervical, vaginal and vulvar cancers is around 96%. So it has really good benefit data from the vaccine safety data link show that more than 600,000 doses of the four Valeant HPV administered to females when this was studied, showed no statistically significant increased risk of Guillain-Barré syndrome, stroke, venous thromboembolism, appendicitis, seizures, or allergic reactions or anaphylaxis. So that really shows good data for this vaccine.
Host (Vanessa Gomez): And in that study, did you mention just girls were studied in it?
Brooke Jensen, MD: Of this report that they looked at, the 600,000 doses was just primarily reported on the females.
Host (Vanessa Gomez): So, what can we tell parents about the safety for boys then?
Brooke Jensen, MD: The other current studies that are coming out, they have not found any statistical difference between males and females that are currently being produced.
Host (Vanessa Gomez): So how can parents schedule these vaccines for their kids?
Brooke Jensen, MD: To schedule the vaccine, you just call your primary care clinic or provider, and you can schedule a nurse visit to set up for the vaccines, or if you have further questions and would like to discuss further with your doctor, just schedule an appointment, and they’d be happy to discuss that with you.
Host (Vanessa Gomez): Can we talk a little bit about what are some of the limitations that you wouldn’t be able to get the HPV vaccine? And I guess one more time, what’s the oldest age that you’re able to get the vaccine?
Brooke Jensen, MD: We routinely do it through, up to the age of 26 currently but we definitely encourage to get that at that youngest age to get the maximum benefit of the vaccines. And actually, if you do it at a younger age, between the ages of nine and 14, you only have to get two doses instead of three, compared to if you were at an older age.
Host (Vanessa Gomez): So, for older women, what are some of the limitations that they wouldn’t be able to get the vaccine at a certain time?
Brooke Jensen, MD: If they were currently pregnant, we do not give the HPV vaccine. It’s probably safe, but we just do not have big enough studies on that at this time. If you have a severe allergic reaction to components of the vaccine, you should also not get it as well. You are allowed to get it during lactation. as it is not a live virus vaccine.
Host (Vanessa Gomez): Are there any ingredients that someone would be allergic to?
Brooke Jensen, MD: Well, someone would have a severe latex allergy, we actually do not recommend getting the vaccine if it’s from a pre-filled syringe. You would actually have to have the nurse draw it up from a separate and prepare that vaccine.
Host (Vanessa Gomez): I think one of the things that we really need to highlight with the HPV vaccine is that these studies are showing that it prevents cervical cancer and other cancers later on in life. So, it’s not an immediate effect whereas the flu vaccine or the COVID vaccine, we see those immediate effects, but this is protecting kids for the future and it prevents cancer, which is amazing. Do you find that parents are surprised, are they excited for their kids to get it at that point? What are some of the reactions?
Brooke Jensen, MD: A lot of them, I would say it’s a mixed response. Some are very excited and especially when you can kind of show some of those numbers and the high percentage that the HPV vaccine can really truly have a great change of decreasing cancers. It’s currently 96% of the total efficacy of the combined incidence of cervical, vaginal and vulvar cancers of decreasing that. That’s a huge benefit. So when you’re explaining that most parents are very excited. Usually sometimes the limitation is they just don’t wanna get so many vaccines at once. So, a lot of times I encourage, you know, we can always come back if you don’t want all these vaccines at one time, you don’t even have to have a visit with me, so you don’t get charged another office visit, you just have a nurse visit instead and to get that.
Host (Vanessa Gomez): So, who is at risk of cervical cancer?
Brooke Jensen, MD: The majority of those who are at risk for cervical cancer are those that are exposed to the HPV infection. About, out of the HPV 16 and 18, that are the highest risk of causing cervical cancer, they make up 71% of cases of cervical cancer causes. HPV related risk factors that increase your risk of getting HPV include early onset of sexual activity, multiple sexual partners, a high-risk partner, history of sexually transmitted infections, early age at first birth in increasing parity, history of some other forms of vulvar or vaginal cancers and immunosuppression. Other risk factors that are non-HPV related can be cigarette smoking, low socio-economic status, and genetics as well.
Host (Vanessa Gomez): So how do we screen for cervical cancer then?
Brooke Jensen, MD: Our primary method of screening for cervical cancers through pap smears. We start pap smears at the age of 21, and we used to do them at a younger age, but the evidence now shows that younger women should not be screened regardless of age of their first sexual intercourse or other risk factors because currently adolescents clear most HPV infections within one to two year without any neoplastic or cancer changes.
Host (Vanessa Gomez): So once you start screening at 21, and if someone isn’t sexually active, should they still be getting a pap smear starting at 21?
Brooke Jensen, MD: Yes, we encourage all, anyone, doesn’t matter if sexual activity or not, to all start pap smears at the age of 21, because again, HPV causes the majority of cervical cancers but is not the sole cause of cervical cancers.
Host (Vanessa Gomez): And after you start those at 21, how often should you be getting a pap?
Brooke Jensen, MD: For most women from the ages of 21 through the age of through 29, we do it every three years as long as your pap smears have remained normal. And then once you’ve hit the age of 30 to 65, we do pap smear plus HPV contesting and as long as those are both normal, we do it every five years. We typically discontinue pap smears at around the age of 65 or following a hysterectomy if they remove the cervix fully and you have no history of high-grade cervical changes on previous pap smears.
Host (Vanessa Gomez): So why is it that we only do them every three years because the goal of these screenings is to try and find the cancer, catch it early so that you can diagnose it and start treatment if necessary? Why would we not wanna do that every year to try and catch it early?
Brooke Jensen, MD: Because we know a lot of these changes take time and so if someone would have HPV, this gradually changes over time, and we previously actually used to do pap smears every year and it led to more likely unnecessary treatments because we were probably too aggressive on these cervical changes because women again often would clear them. If you’re at a younger age, you typically clear these changes faster than those at an older age so as long as you’ve had these normal pap smears, it’s very reassuring so we started spacing them out to try to decrease your risk of unnecessary procedures.
Host (Vanessa Gomez): In between those every three years, are there different signs or symptoms that women should be looking for when it comes to cervical cancer in particular?
Brooke Jensen, MD: Typically, cervical cancer, most people do not have any symptoms. So it’s very rare that someone would have symptoms. If someone were to have symptoms, you may have irregular spotting or bleeding or bleeding after intercourse and if this were to happen, that would be something to see your provider for and get a pelvic exam for.
Host (Vanessa Gomez): Are there any other preventive measures that women can take when it comes to cervical cancer, besides the HPV vaccine and getting those screenings,
Brooke Jensen, MD: Other things to kind of look for to try to prevent HPV infection and cervical cancer would be safe sexual practices, such as using condoms, avoiding smoking and trying to limit the number of sexual partners.
Host (Vanessa Gomez): And how do people schedule their screenings for a pap smear if they need one?
Brooke Jensen, MD: So typically, all you would schedule is a yearly wellness exam, or if maybe you have gotten off on your yearly wellness and just need only your pap smear, you can just schedule a clinic visit just solely for the pap smear as well.
Host (Vanessa Gomez): Well, Dr. Jensen, thank you so much for your time today.
Brooke Jensen, MD: Thank you.
Host (Vanessa Gomez): To learn more about the HPV vaccine, cervical cancer and the screening services provided, visit Sanfordhealth.org. This was another episode of the Her Kind of Healthy podcast series by Sanford Health. For Sanford Health News, I’m Vanessa Gomez. Thank you for listening.