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Physicians Update

 
Spring 2011

HPV Vaccination for Girls

Approaching Adolescence Should Be Standard of Care

05/13/2011

PU-Spring11-HPV for GirlsThe human papillomavirus (HPV) vaccine — the first vaccine designed to prevent a type of cancer — has been increasingly embraced by parents and the medical community since the U.S. Food and Drug Administration approved it in 2006, and should be routinely administered to girls as they approach adolescence, according to UCLA experts.

The most widely used HPV vaccine, Gardasil, protects against the two strains that cause the majority of cervical cancers as well as the two HPV subtypes responsible for roughly 90 percent of genital warts cases. In addition to being offered to preteen girls, it is recommended for older girls and young women up to the age of 26 who have not yet received it.

“The fact that we now have a simple and safe way to provide protection against viruses that are the causative agent for approximately 70 percent of cervical cancers and at least 50 percent of precancerous lesions is a huge deal,” says UCLA gynecologic oncologist Sanaz Memarzadeh, M.D., Ph.D. “It’s critical to screen all female patients within the recommended age group for whether they have been vaccinated and to offer it to them if they haven’t.”

HPV is the most common sexually transmitted infection in the United States; it is believed that at least half of sexually active people acquire one of the virus’ more than 40 strains during their lifetime, in most cases without knowing it. In some patients, HPV produces cell changes that can lead to cancer — cervical as well as less common but equally serious malignancies, including cancers of the vulva, vagina, anus, and head and neck.

Dr. Memarzadeh notes that although the HPV vaccine is aimed only at two of HPV’s cancercausing subtypes, recent studies suggest it may also carry some protective benefit against other strains that share its key genetic elements. Because the HPV vaccine does not prevent all cervical cancers, women should be strongly urged not to forego regular screenings once they have been vaccinated.

The vaccine is typically recommended for girls at about the age of 11, says Kellie Ernzen Kruger, M.D., a pediatrician and internal medicine specialist at UCLA Medical Center, Santa Monica. “Ideally we want to vaccinate before the onset of any sexual activity,” Dr. Kruger explains. However, she adds, even for non-immunized older girls and young women who might have been exposed to the virus through sexual activity or who know they are HPV positive, it is unlikely that they have all of the strains the vaccine prevents; thus, the vaccine is recommended for them as well.

Initially, Dr. Kruger heard concern from some parents about the potential for their children to receive the wrong message from being given the vaccine. She notes that administration of the vaccine should be accompanied by counseling.

There also is growing awareness that the vaccine conveys benefits for young men as well, but there is still debate about whether giving the vaccine to men is cost effective.





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