A lot of your patients probably don’t realize they could benefit from an HPV vaccine

I work in cervical cancer screening. I’m in the clinic two or three times weekly, and my waiting room is always full. It shouldn’t be that way. Cervical cancer is a vaccine-preventable disease. All of this worry, all of this pain, all of this death, is completely preventable.Have you had your HPV vaccine? NACI guidelines say that any person, of any gender, of any age, who’s at risk for infection, can consider vaccination.Perhaps you don’t have a cervix, so you think you don’t need the vaccine. HPV also causes oropharyngeal cancer (OPC), which is even more common in men than cervical cancer is in women. There’s no screening for OPC—it’s usually diagnosed on biopsy of a painless enlarged lymph node and has a five-year survival rate of 60%.OPC is preventable with HPV vaccination. If you have a throat, you should consider the HPV vaccine!In addition, 91% of anal cancers are caused by HPV. Anal cancer is preventable with HPV vaccination. Busy family physicians may not prioritize offering HPV vaccination to their patients, as it’s part of the school-based vaccination program, so it’s assumed that it’s been administered in the target population. Unfortunately, vaccine-hesitant parents have been putting their kids at risk. The HPV vaccination rate in Ontario has been around 50% for many years, meaning half of kids aren’t being protected against cancer. The pandemic has made this even worse. Only 23% of pandemic grade 7s are vaccinated, and as they progress unvaccinated through high school, they become more likely to engage in sexual behaviour that puts them at risk. If your EMR allows it, consider reminder calls to the parents of 12 to 17-year-olds in your practice to encourage follow-up with public health to ensure kids got meningitis, hepB and HPV vaccinations.Although NACI recommends vaccination for all youth up to age 26, most provinces do not offer funded vaccination for young adults if they missed it in high school. An opportunity for vaccination may arise if patients have private insurance plans through their work or spouse. Many of these plans pay a portion of vaccine costs. Alternatively, we have good study data showing that a single shot works well in young people for up to five years. I tell patients that one shot is better than none. The WHO endorses a two-dose schedule with doses at least six months apart, so a second shot sometime in the following year likely offers adequate protection for the long-term.Why consider vaccination in middle age? You’re at risk of infectionRegardless of age, you're at risk if you’re out in the dating world. One Canadian study showed that among new couples, 64% were HPV positive. Humans are bad at monogamy. 40% of marriages end, and at least 20% of people admit to infidelity, so 60% of people who think they are safe may be exposed to the virus at some point.It’s harder to clear the virus as we age. Your risk of infection may be low, but it is never zero and the consequences of infection are greater as we age.80% of teens will clear the virus within two years, but in midlife, only 60% of people clear the virus in two years.As we age, our risk of needing immunosuppressant medication to treat chronic illness is greater and this increases the risk of HPV-associated cancers.It can save you $600 if life changes and you become at higher risk in future years. If you have private insurance through work, many plans cover a portion of the cost up to age 46.If your marriage ends, you may lose your partner’s health insurance or be too old to qualify under your own insurance.If you can get it covered under insurance, get it now. As far as we know it works for life and no booster is required. If you can’t get coverage, Costco pharmacy has the best price.The other population that should absolutely be offered HPV vaccine is your severely immunocompromised patients. Many of these people are on provincial disability and will qualify for the vaccine manufacturer's Patient Assistance Program. The form is simple to complete and can be found with an internet search. It requires a patient sticker, your office stamp, and “for the prevention of HPV-associated cancers” written in the “Indication” box. For these patients, the consequences of HPV infections can be extremely high and it’s a worthwhile topic to discuss. Even more effective would be to offer vaccination before transplant.The HPV vaccine is not associated with any of the complications that people worry about with vaccination. It does not cause Guillain-Barré syndrome, myalgic encephalomyelitis, or chronic pain. Getting the vaccine keeps you safe going forward regardless of age, but it can’t get rid of a virus that you already have. Thus, the best way to keep your patients protected is to vaccinate them before any sexual exposure, which is why we discuss HPV vaccination proactively with the parents of children entering middle school.I would love to retire from this work knowing that everyone is protected from HPV-related cancers. Australia has been more effective with its vaccination campaign and is on track to eliminate cervical cancer by 2028. Canada is about 20 years behind them due to systemic failures in vaccination programs. You have the power to keep your patients safe from cervical, oropharyngeal and anal HPV-associated cancers. That’s pretty amazing.

A lot of your patients probably don’t realize they could benefit from an HPV vaccine

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