The question: I'm so confused by all the news about the HPV vaccine. Some doctors says it's absolutely necessary, and other experts aren't sure if it's even needed. Where do you stand on it?
The answer: Any vaccine that can prevent my daughters from getting cancer gets a big thumbs up from me. As such, I have no hesitation in recommending the HPV vaccine to all my patients.
HPV stands for human papilloma virus, a very common virus that will infect about a quarter of Canadian women by the age of 25. HPV infection is necessary for the development of cervical cancer, a condition that will afflict about 1 in every 150 Canadian women. 1 in every 400 Canadian women will die of this preventable disorder. The HPV virus has many strains, but two in particular, HPV-16 and HPV-18, account for 75 per cent of cervical cancers.
Human papilloma virus is transmitted through skin-to-skin contact, typically by sexual touching or intercourse. Transmission can also occur from infected mothers to newborn infants through the birthing process. Using a condom significantly decreases, but does not eliminate, the risk of infection. Abstinence will do the trick. It is important to remember that many people will not experience any symptoms from their HPV infection, and as such may pass it along unwittingly to a sexual partner.
The HPV vaccine, also known as Gardasil, provides protection against both of these strains. The vaccine also provides protection against HPV strains 6 and 11, which are responsible for the vast majority of genital warts.
Gardasil has been approved for use in Canada since 2006 and is currently offered publicly in all provinces and territories. Three doses of vaccine are required. It is absolutely critical that youth be vaccinated prior to HPV infection in order to be protected. Since the vaccine provides long-lasting protection, it is always better to administer early, rather than too late.
I recommend children be vaccinated by no later than 13 years old. When administered early, the vaccine is 95-per-cent effective in preventing HPV infection. Gardasil is not only for girls: I also recommend vaccination of boys in order to protect young men from genital warts in the short term, and to protect future girlfriends and wives from cervical cancer.
Without a doubt, I have fielded more questions from parents about this vaccine than any other vaccine in the past two years. In my opinion, it is the fact that this infection is sexually acquired that troubles parents the most. As a parent of two teenage girls, I can sympathize with how difficult it can be to imagine your 11- or 12-year-old daughter being at risk for anything sexually transmitted. Believe me, the statistics are frightening. Denial is bliss. My experience has been, however, that once parents understand that there is nothing to be gained by procrastination, they are usually quite agreeable to proceeding with this cancer-preventing intervention. (For the record, both my daughters have received the vaccine!)
Opponents of the HPV vaccine have worried that vaccination of adolescents may encourage early sexual activity and promiscuity. Research has recently disproved this theory, showing equivocal rates of sexual activity in both vaccinated and unvaccinated teens.
Of course, like most vaccines, chances are good that there will be some pain and redness at the injection site. Some teens may even faint. Fortunately, severe allergic reactions have not been reported.
Since Gardasil doesn't protect against all strains of HPV, women still need to be proactive in cancer prevention strategies such as avoiding smoking, staying active, eating well and getting a regular Pap test.
Dr. Michael Dickinson is the head of pediatrics and chief of staff at the Miramichi Regional Hospital in New Brunswick. He's a staunch advocate for children's health in Atlantic Canada through his involvement with the Canadian Paediatric Society.
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