THE DETAILS: Merck, the company that markets HPV vaccine Gardasil, sponsored the newly published study and has an obvious financial stake in expanding the market for its vaccine. However, Diane Harper, MD, an internationally recognized HPV expert, and author of a commentary accompanying the study, agrees the vaccine can be beneficial to older women. She also thinks targeting 11- to 12-year-old girls is misguided advice, citing the possibility that the vaccine’s protection will fade and require another vaccination. Dr. Harper, a lead researcher in the development of the HPV vaccine and vice-chair and professor of obstetrics and gynecology, community and family medicine, and bioinformatics and personalized medicine at the University of Missouri-Kansas City School of Medicine, says that until evidence shows that the vaccine lasts 15 years, it would be more reasonable and cost-effective to vaccinate young women in their late teens or early 20s.
In the new study, which was conducted in Columbia, a group of 1,900 women between 24 and 45 years old with no history of HPV infection received the three-shot Gardasil vaccine, while 1,900 got vaccine-free placebo shots. After 2 years, four vaccinated women developed HPV infections or HPV-triggered cervical disease, while 41 women in the unprotected group developed similar infections or disease. This suggests that the HPV vaccine can be effective in sexually active older women, says Dr. Harper, negating the idea that vaccination has to be administered before sexual activity begins. Besides helping prevent new infections, the vaccine may help your body stop existing infections from reproducing and causing health problems.
WHAT IT MEANS: The main issue with the new HPV vaccines is that we just don’t know how long their protection lasts, and that complicates the decision-making process. Booster shots may be needed if it turns out the vaccines don’t offer lifelong protection, and of course, vaccine or no, Pap tests will continue to be an important part of every woman’s cervical cancer preventive care.
Here are things to consider when mulling over the HPV vaccine:
• If you’re a parent: There’s a debate over how old girls should be at vaccination. From a cost-effectiveness perspective, the answer depends on how long the protection lasts: Studies show no cervical cancer will be prevented by vaccinating 11- to12-year-old girls if the vaccine wears off in less than 15 years. If the vaccine lasts longer than 15 years, and at least 90 percent of all girls 11 to 12 years old get vaccinated, then in 60 years we will see a drop in the number of cervical cancer cases.
Perhaps the most controversial aspect of the discussion is that some side effects, including death, have been reported in young teenagers receiving Gardasil. But Michael Brodman, MD, professor and chairman of the department of obstetrics and gynecology at The Mount Sinai School of Medicine in New York City, says the benefits of the vaccine far outweigh the risks. He notes that the likelihood of having cervical cancer is much higher than that of having a problem from getting the vaccine. While Brodman agrees that the vaccine can be protective in older women, he also believes 11- and 12-year-olds should be vaccinated before they become infected. He points out that often parents can’t be sure when their children are becoming sexually active, so waiting too long could leave a child vulnerable.
• If you’re an adult: Along with women through age 26, for which Gardasil is approved, Harper says she strongly recommends the HPV vaccine for women older than that who have already had abnormal Pap smears (which suggests an HPV infection and possible precancerous cells), and those who find themselves back on the dating scene, perhaps because they’re separated, divorced, or their partner had an affair. Others can also get it for peace of mind. But just know that since you’re stepping outside official recommendations, you’ll likely have to pick up the tab. “It’s a choice. If women have $500 of disposable income, they can buy a few pair of shoes and some dresses, or they can spend it on the vaccine,” says Dr. Harper.