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Why parents should give their children the HPV vaccine

Portsmouth Herald - 6/10/2018

EXETER - As evidence grows concerning the cancer prevention properties of the HPV vaccine, more doctors are recommending it for adolescent girls and boys.

While some controversy remains about the HPV (human papillomavirus) vaccine, the research is proving that the benefits are many and the Centers for Disease Control amd Prevention have a campaign that aims to educate and vaccinate more of the youth population.

The CDC, the American Academy of Pediatrics, and the American College of Gynecology are strongly recommending the HPV vaccine for routine cancer prevention due to this sexually transmitted disease.

According to the CDC, HPV vaccine is important because it protects against cancers caused by human papillomavirus infection. HPV is a very common virus; nearly 80 million people - about one in four - are currently infected in the United States. About 14 million people, including teens, become infected with HPV each year.

Dr. Robert Kelly of Core Physicians said that most people with HPV never develop symptoms or health problems. He said most of the infections resolve themselves, but sometimes they don't and then there is a risk of several different types of cancer.

HPV infection can cause cancers of the cervix, vagina, and vulva in women; cancers of the penis in men; and cancers of the anus and back of the throat, including the base of the tongue and tonsils (oropharynx), in both women and men.

The CDC reports that every year in the United States, HPV causes 32,500 cancers in men and women. HPV vaccination can prevent most of the cancers (about 30,000) from developing.

Dr. Evelyn Caron, a gynecologist at Partners for Women's Health in Exeter, has seen tangible proof that the vaccine helps to prevent cervical cancers and other problems down the road.

"The guidelines now indicate a young woman should have her first Pap test at age 21," said Caron. "Many of these young women received the HPV vaccine. What we are seeing are much less lesions in the cervix that require surgery to remove the top layer. HPV 16 or 18 are the dangerous ones. In many cases we are seeing no lesions at all."

That may reduce cancer risks, but Caron said it helps prevent another risk for women who want to have children.

"When the LEEP (Loop Electrosurgical Excision Procedure) is used to treat precancerous lesions, it shortens the cervix," said Caron. "The lesions can be treated, but the treatment is not benign. For some women, this can result in difficulties during pregnancy.

There is a risk of preterm labor because the cervix is incompetent. So, if the vaccine is preventing the lesions, the benefit is obvious."

LEEP is a treatment used to prevent cervical cancer. A small electrical wire loop is used to remove abnormal cells from the cervix after abnormal cells are found during a Pap test, colposcopy, or biopsy.

Caron aid the HPV vaccine can be given up to age 26, but younger is better because the vaccine works best before there is an exposure and that means the benefits increase when given to younger adolescents.

Dr. Taraneh Azar of Core Physician Comprehensive Otolaryngology said they are seeing an increase in head and neck cancers, in a newer population.

"Over the past 30-years, there has been a decrease in head and neck cancers related to alcohol and tobacco," said Azar. "We are seeing an increase in tonsil and tongue cancer in younger people. Those are usually related to HPV 16 and 18. People tend to be younger and the prognosis is better, but the vaccine could prevent this."

Azar said younger people tend not to think of oral sex as sex, a mistake that could increase their risk of mouth cancers.

"That's why the goal is to vaccinate the kids before they become sexually active," said Azar. "That means girls and boys."

CDC guidelines for the immunization have changed. Kelly said there used to be a series of three immunization, set six months apart and the recommendation was for girls, age 10 and up. Now, with the newer information about the link to head and throat cancers from the HPV virus, the recommendation includes boys.

Now, if given young enough, before 15, two shots are sufficient. Kelly, who worked for the New Hampshire Department of Health and Human Services before coming to Exeter, said younger children seem to get the best benefit from the vaccine, processing it better.

"There are over 100 strains of HPV and only a few are high risk," said Kelly. "The vaccine targets those dangerous strains. It can be given at older ages, but in younger children, the immune system has a stronger response.""

As new information is learned about the cancer risks, the use of the vaccine is rising, but has not yet reached the levels of other routine childhood vaccinations.

"More established childhood vaccine like Meningococcal and Tdap are at about 80-90 percent in the state and most of the nation," said Kelly. "The HPV use is growing and is now at 40-50 percent. With all the cancers that could have been prevented, we have a push to get that number up to 80 percent by 2020."

From his time at N.H. DHHS, Kelly said what he sees is a need for education, for parents and health care professionals. He said many physicians have older information about the vaccine and that needs to change.

"The New Hampshire Cancer Collaborative and N.H. DHHS are working to increase the vaccine rate," said Kelly. "Core and another agency in the North Country received grants to help with an educational campaign. We will create and distribute educational materials to the various practices in our areas. Parents have question and providers need to be able to answer the questions with the right information."