Cervical cancer vaccine

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Cervical cancer vaccine

Running Time: 0:10:00

Rich Dietman: Welcome to Mayo Clinic podcast. Our topic today is the new cervical cancer vaccine — who it's for and is it effective. I'm your host, Rich Dietman.

In today's podcast, we're talking about the vaccine for cervical cancer, who it's designed to protect, and what to consider in deciding whether or not to get it. My guest is Lois McGuire, a nurse practitioner in the Division of Obstetrics and Gynecology at Mayo Clinic Rochester, Minnesota. Ms. McGuire holds a master's degree in nursing and has worked at Mayo Clinic for more than 15 years. She's also the author of the Safe sex blog on MayoClinic.com. Lois, thanks for being with us today.

Lois McGuire: Thank you very much.

Rich Dietman: Well, to start with Lois, tell us about this vaccine for cervical cancer and why it's so important.

Lois McGuire: The vaccine for cervical cancer is important because it will help us prevent cervical cancer in the future. Cervical cancer is caused by HPV, and by the time a woman is 50, 80 percent of us have been exposed to HPV.

Rich Dietman: And HPV is ...

Lois McGuire: Human papillomavirus. In the United States alone, there's 20 million people that have been diagnosed with HPV. And so this is — and most of them don't have any symptoms at all — so this is very high numbers for a sexually transmitted disease. There are 40 different HPV viruses that we know of — 40 different strains of the HPV virus — and the immunization will cover four of those. Two of them are responsible for genital warts, and that is 90 percent of the genital warts that we diagnose. And two of them are responsible for cervical cancer, and that is 70 percent of the cervical cancer that we diagnose. So it will, even though it's only covering four of the forty strains of HPV — it's the big hitters. And then when you put that all together, the part that makes me really excited about this is, it is the first time we've had a vaccine for cancer. And that's huge.

Rich Dietman: So talk a little bit about how the vaccine actually works. You talked about HPV, the vaccine really protects initially against that. Is that correct?

Lois McGuire: That's exactly it. And many people have the misconception that the vaccine is actual live virus, and many moms ask me about that: "Are we giving my daughter a live virus? Because I don't want to do that." They don't want to expose them to HPV. It is not — it's a viral-like particle that obstructs the woman from being able to be receptive to the virus itself.

Rich Dietman: So you can't get HPV from getting the vaccine.

Lois McGuire: That's exactly right.

Rich Dietman: Who's this vaccine primarily for, and when should it be given?

Lois McGuire: The FDA and the CDC recommend it for girls and young women, ages 9 to 26. And the reason why it's confined to that age group is that's who's been studied extensively. But newer studies are showing that women up to age 45 get some benefit from this. And so I think that door's going to be open where it's going to be available to more than just that 9 to 26 age group in the future.

Rich Dietman: It's my understanding that most young women are exposed to HPV through sexual activity. What if a woman has already been sexually active? Is this vaccine still of any use for her?

Lois McGuire: The best time to give the vaccine is before any sexual activity occurs, and that is the reason why it's suggested to be given in girls at such a young age. A lot of parents have a lot of, have trouble with suggesting their daughters have an immunization for sexually transmitted diseases at age 12. But we do want to capture that group before they become sexually active. Seventy-four percent of HPV occurs between the ages of 15 and 24, and when you think that 2 million people in the United States are infected with HPV, that's a big number. And so if we can grab that group of adolescents in particular and protect them before they even become sexually active, that will be imperative to the success of the vaccine.

Rich Dietman: The Pap smear is a test that's still given routinely to test for cervical cancer or pre-cervical cancer. If a woman has a positive Pap smear test, does that mean that she should forget about getting this vaccine?

Lois McGuire: No, because once again, a Pap smear can be falsely positive for one thing. But also remember that she probably doesn't have all four strains of the HPV type that it covers and protects against, so she should go forward with having the HPV immunization.

Rich Dietman: So not to make just a blanket assumption that, well, I've had a positive Pap smear, that I can't get protected anymore.

Lois McGuire: Absolutely not.

Rich Dietman: Are there side effects to this vaccine?

Lois McGuire: Yes. The primary side effect that 80 percent of people do complain of is pain at the injection site. This vaccine does hurt. It seems to be very irritating to the tissues under the skin, so it does hurt going in, and that's unfortunate. But I always warn my patients about that so they're prepared for it. Otherwise, there's a small percentage of people that may get fever or low redness at the injection site, but mostly it's just the discomfort when the immunization is given.

Rich Dietman: And how long does it typically last?

Lois McGuire: A day or two at the most.

Rich Dietman: Has there been a decrease in cervical cancers since the vaccine has become available?

Lois McGuire: It's too early to pick up on a decrease of cervical cancer. The average age to diagnose someone with a cervical cancer is age 47. And the women that are diagnosed with this probably were infected many years prior to that. But these HPV viruses that are oncogenic, or cancerous, take a long time to grow into a cancer. And so we haven't had that time period yet to wait and see what the outcome is. But we have every reason to be very confident that this will reduce cervical cancer incredibly. When you think back in history about how the Pap smear reduced cervical cancer by 70 percent in our country — just by doing a screening tool — and now we can add to that an immunization that will reduce the risk of somebody acquiring cancer by giving this immunization, I think we're going to reduce the amount of cervical cancer, but we have not seen the results of that yet.

Rich Dietman: Does a woman still need a regular Pap smear if she does get the vaccine?

Lois McGuire: Yes, she does. The guidelines for Pap smears have changed significantly over the last few years. But we still want to screen because remember there are these other 36 types of HPV viruses that the immunization does not cover at this point. And so we do want to make sure that you aren't exposed to one of those that occur less frequently.

Rich Dietman: So it's something that can't be just forgotten about?

Lois McGuire: No, no.

Rich Dietman: How do you suggest that parents talk to their daughters about this vaccine — when they're explaining what it's for and why they should get it?

Lois McGuire: I think this is one of the biggest obstructions parents have as far as should they have their daughter get the immunization or not. Think about hepatitis B. That was for sexually transmitted diseases, but hepatitis B is given to an infant, and so they don't have to have a discussion with their daughter. And for many patients this, or many parents, this is a difficult conversation to have. And I think when it's a very young girl, 9 to 12 or 13, it can be a very simple answer. "You need this vaccine to protect you from getting cancer" — it can be just that simple if she's young and not ready to talk about sexual issues yet. And yet when you're talking about an adolescent young woman, the conversation should be more detailed. Young women or adolescents are the most at-risk population for sexually transmitted disease that we have. And there's two reasons primarily for that: One is, when you think of an environment that bacteria and viruses can grow easily, you think of a dark, warm, moist environment, and that's what the vagina is. It's dark, warm and moist, so it's a perfect environment to grow bacteria, viruses, and cause problems for her downstream; secondly, the cervix is the lower portion of the uterus, and the cervical opening is made up of very unstable cells. And these cells are more susceptible to disease and viral changes than any other part of the body for these genital HPV viruses. And so, once again, the young woman is the person that's most at risk. So having that conversation — and an honest conversation with your daughters about how important it is to take care of their body and be responsible for their bodies — is a very important conversation, and one I don't think we've done very well in our society. So this can be an opportunity to talk about that whole spectrum of protection from different levels than just this immunization.

Rich Dietman: And if there are parents who just, for whatever reasons, can't have that conversation with a daughter, do you have any suggestions for them in terms of finding help to have that conversation?

Lois McGuire: I think it is a difficult conversation to have with your own daughter. I do better with other people's daughters than my own, even. And yet I have the words, so I can definitely be empathetic to parents about that. If this is a difficult conversation and you feel like you just don't have enough information to share with your daughter and talk with her about it, possibly there's a nurse in your community or a nurse practitioner, a physician that your daughter would feel comfortable discussing this with, and I would recommend that you use those resources.

Rich Dietman: And go there with your daughter and have that conversation — the three of you have it together.

Lois McGuire: Exactly. Yup, exactly.

Rich Dietman: Thanks very much, Lois. We've been talking about the vaccine for cervical cancer with Lois McGuire, a nurse practitioner in the Division of Obstetrics and Gynecology at Mayo Clinic, and author of the Safe sex blog on MayoClinic.com. You've been listening to Mayo Clinic podcast. I'm Rich Dietman.

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Last Updated: 2008-12-30
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