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Leigh Vinocur, M.D.

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HPV Vaccine: Why Are So Few People Getting Vaccinated?

Posted: 11/13/10 11:47 AM ET

It is probably one of the most significant medical breakthroughs of this past decade. A vaccine to prevent cancer! We now better understand the link between cancers and viruses and how some viruses such as the human papillomavirus (HPV) can change cells and cause them to become cancerous. In essence we have identified a communicable form of cancer.

HPV is often a sexually transmitted disease, which according to the U.S. Centers for Disease Control and Prevention (CDC) is very common and it infects about 6 million people a year. It's estimated that 50 percent of sexually active men and women have been exposed at some point in their lives. There are hundreds of strains of HPV; about 30 to 40 of the strains are sexually transmitted. In the majority of the infections our body's immune system takes care of it without any treatment. However some of these sexually transmitted infections can cause cervical cancer. It's the high-risk strains the virus that remain in the body and cause a long-term infections. It then invades the cells of the cervix causing changes in the cellular structure and DNA to become pre-cancerous lesions as well as cause genital warts. If these infections aren't detected and treated they can go on to eventually become an invasive cervical cancer.

The National Cancer Institute estimates that 12,200 women in the United States will be diagnosed with this type of cancer and nearly 4,200 women will die from it. Worldwide cervical cancer strikes nearly half a million women each year killing almost a 250,000.

But we now have developed a monumental vaccine that protects against the common HPV strains that cause about 70 percent of cervical cancers. HPV has also been recently linked to 26 percent of head and neck cancers as well as some vulvar, vaginal, penile and rectal cancers. This discovery has opened a new door for prevention of cancer.

Yet, an alarming new study from the University of Maryland School of Medicine finds sadly very few young women are protecting themselves from cancer and taking this precaution of the HPV vaccine. This study led by Dr. J. Kathleen Tracy found that less 30 percent of young women eligible for the vaccine will chose to get it. Added to that, of the women who do initiate getting vaccinated less than one-third complete the series of three booster shots required for full protection of the virus. This was even more of an issue with young African-American women who were the least likely to complete the series of shots.

The CDC currently recommends beginning vaccination of girls 11-12 years of age with completion of a series of 3 shots up to age 26. The hope is to vaccinate young women before they become very sexually active and get exposed to the virus.

There is a debate among scientists on whether adolescent boys should also be vaccinated. While men don't have cervical cancer they do get genital warts, head and neck as well as penile and rectal cancers. Recent research has shown a new demographic of younger men with head and neck cancers that never smoked or drank alcohol which was considered a risk factor in these cancers. Instead these younger demographics of patients were found to be HPV positive. So the same way the virus gets into cells of cervix and changes the cells, it also does the same with the cells in the mouth and throat.

The public health community also advocates vaccination of boys as a form of "herd immunity." What this means is if we vaccinate boys we will see the less men walking around with HPV thus the fewer women will be infected too. However the CDC came in just short of a recommendation for boys, stating physicians and parents have the option to vaccinate them. But this University of Maryland study shows we are not even vaccinating our daughters. And it is disturbing for me as physician and a mother to see a safe and effective vaccine that can protect against cancer, be so underutilized!

Perhaps it is suggestive of our collective lack of emphasis on preventive medicine as a whole. Our sedentary lifestyle and obesity rate is a testament to that. We are so good in the American medical community at fixing and treating chronic diseases after they happen, we need to now concentrate on providing more preventive measures for our patients. As well as emphasizing to them that they must also bear some personal responsibility to maintain their health with good habits.

Add to the mix our misguided distrust of all vaccines. We seem to have short-term memory when it comes to the tens of thousands of children that died every year not long ago from infectious diseases that we now give immunizations for now and take for granted. Now unless vaccines are mandated for things such as school enrollment we don't bother, as evidenced by our yearly battle with the flu vaccine.

Or perhaps it's our prudish mores, which don't approve of vaccines that protects us from sexually transmitted infections. Some groups feel it might in some way be sending the wrong message to young girls. Certainly no one in the medical community is advocating sexually promiscuity for young women, nor trying to send the message that safe sex is no longer needed once you are vaccinated. We are also continuing to advocate pap smears exams for women at the age of 21 or for those who are sexually active.

But whatever the reasons, this vaccination rate is a travesty. We as parents want to protect our children from everything and years ago if someone had told you they have a shot to prevent cancer it would seem like a miracle. It makes no sense now; with all our earnest endeavors and talk of trying to find a "cure for cancer" we are overlooking our children's chances to prevent it in the first place.