HPV-associated cancers in Minnesota
My name is Amber Blomme, and I am a family nurse practitioner student graduating this May from Creighton University. I was born and raised in Marshall and following high school graduation I moved to Omaha, Nebraska. As part of my Doctor of Nursing Practice (DNP) education, I completed a project related to the HPV vaccine in Marshall. With the new approval from the FDA to expand vaccine eligible recipients to age 45, this vaccine has been a hot topic and there have been a lot of questions.
I want to share that until I started my graduate program, I was unaware of the many complications of HPV and its high prevalence. After working in an urban hospital as a registered nurse, I realize many people in Marshall and the surrounding communities may not see these complications I am mentioning. I have seen and cared for such patients suffering from HPV-associated cancers and this truly has driven my desire to advocate for the HPV vaccine. If you can prevent cancer for your children, why wouldn’t you? I decided to write an article for my hometown to discuss HPV-associated cancers in Minnesota, the importance of the HPV vaccine, and considerations for adult vaccination.
Human papillomavirus (HPV) is not a disease which affects females only. While most people are aware that HPV can cause cervical cancer, not all are aware that it can also cause vaginal, vulvar, anal, penile, and head and neck cancer.1 There are more than 120 types of HPV. The Minnesota Department of Health reported just over 3,200 Minnesotans were diagnosed with an HPV-associated cancer from 2011 to 2015.2 During this time frame, there were 1,811 cases in women and 1,405 cases in men. While these rates are not as high when compared to other cancer types, these types of cancers are easily preventable. A misconception of HPV is its association with high-risk sexual activities, multiple partners, or those who are “promiscuous” (I had this misconception in the past!). While multiple sexual encounters do increase the risk for acquiring an HPV type, the virus is actually very common. More than 90 percent of sexually active men and 80 percent of sexually active women will be infected with HPV at some point in their lifetime.2 Screening programs for cervical cancer have been successful in detecting early cervical changes (precancerous or cancerous changes) since the late 1990s. While HPV-associated cervical cancer continues to decline, oropharyngeal cancer, particularly in men, has continued to increase.2 Oropharyngeal cancers can be located in the back of the throat, including the base of the tongue and tonsils.
The Gardasil 9 vaccine is a safe and effective vaccine that can prevent the most serious types of HPV. The efficacy of Gardasil 9 for cervical cancer is at 98 percent, 100 percent for vulvar/vaginal cancer, 75 percent for anal cancer, and 89 percent for genital warts in males, and 99 percent for genital warts in females.3 The vaccine is generally well tolerated with common side effects including pain, swelling, redness, and bruising at the injection site.3 Routine HPV vaccination begins as early as age 9.4 If the series is initiated before age 15, only two doses are needed. If the series is initiated after age 15, three doses are needed to complete the series. The vaccine is recommended at these early ages, as it provides the best protection when it is given before the onset of sexual activity.5
The primary focus of the HPV vaccine is to vaccinate adolescents. Most adults have already been exposed to a HPV type prevented by the Gardasil 9 vaccine, however, they may not have been exposed to all of the nine viruses covered by the Gardasil 9 vaccine.6 A new sexual partner is a risk factor for the development of an HPV infection.6 If you are between 26-45 years of age (new FDA approved age) and are curious whether you might benefit from the vaccine, visit with your healthcare provider.
1Hamborsky, J., Kroger, A., & Wolfe, S. (2015). Epidemiology and prevention of vaccine-preventable diseases. Centers for Disease Control and Prevention, 13th ed, ch. 11.
2Minnesota Department of Health (MDH). 2018. HPV associated cancer: Facts & figures. Retrieved from https://www.health.state.mn.us/data/mcrs/data/qfhpv.html
3Food and Drug Administration (FDA). (2018). Highlights of prescribing information, Gardasil 9 (human papillomavirus 9-valent vaccine, recombinant). Retrieved from https://www.fda.gov/downloads/BiologicsBloodVaccines/Vaccines/ApprovedProducts/UCM426457.pdf
4Meites, E., Kempe, A., & Markowitz, L. E. (2016). Use of a 2-dose schedule for human papillomavirus vaccination–Updated recommendations of the Advisory Committee on Immunization Practices. Weekly, 65 (49), 1405-1408.
5Centers for Disease Control and Prevention (CDC). (2016). Human papillomavirus (HPV). Retrieved from https://www.cdc.gov/hpv/index.html
6Markowitz, L. (2018). Expanded age range for 9-valent HPV vaccine background for policy considerations. Advisory Committee on Immunization Practices. Retrieved from https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2018-10/HPV-03-Markowitz-508.pdf