No clear guidance for older women about HPV vaccine
The Food and Drug Administration has approved the HPV vaccine for ages 9 through 26.
By GRACE RUBENSTEIN
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Millions of adolescent girls and young women around the country have by now received a vaccine that protects them from cervical cancer.
The vaccine blocks HPV, an extremely common sexually transmitted disease that in its fiercest form causes most cases of cervical cancer, along with rarer cancers that also strike men.
That's good news for prevention-minded young women and parents who want to protect their daughters. But it has left some older women feeling a bit left out.
"Should I get the HPV vaccine?" one Sacramento, Calif., woman asked her gynecologist last month. The woman, a Sacramento State graduate who asked that her name not be used, said the doctor replied, "No. You're too old. It's too late for you. I'm sorry you didn't get it before."
The Food and Drug Administration has approved the vaccine for both genders ages 9 through 26. The aim is to immunize youths before they start having sex, as the vaccine can't stop an infection that's already taken hold.
HPV, a virus that also causes genital warts, is so widespread that the federal government estimates one in two people will get it at some point in their lives. The vast majority of infections cause no symptoms and go away on their own, but a handful stick around, with potentially devastating consequences.
By the time women reach their late 20s, federal health officials say, they've probably already been exposed.
However, the FDA's recommended age range doesn't mean older women couldn't benefit from the vaccine or can't get it. That's up to their doctor's discretion.
Yet doctors rarely recommend it, and the scarce information available makes it hard for an older woman to figure out her chances of getting meaningful protection.
Should she shell out the money — typically $400 or more for the three-shot series, which insurance generally won't cover for women over the age limit — or resign herself to the idea that it's too late?
The federal Centers for Disease Control and Prevention doesn't recommend what older women should do.
"For the individual person, it's confusing,"said Lauri Markowitz, team leader for epidemiology research in the CDC's Division of STD Prevention.
Research on the vaccine has suggested it can help certain older women who have had few sexual partners and not much exposure to HPV. But when FDA regulators looked at data for the whole group of women studied — many of whom had already contracted the virus — they found the vaccine made little difference.
Given the odds, Markowitz said, women should focus on getting regular Pap tests, rather than the HPV vaccine. There's no practical way for a woman to know if she's already exposed to HPV — or to which of the more than 40 strains of HPV that infect the genitals. Only a few of those cause cancer or warts.
The most commonly used vaccine, Gardasil, protects against four of the most prevalent ones. So, the CDC says, women who haven't already encountered all four strains could gain some protection.
"We don't have a good test,"Markowitz explained. HPV tests during routine Pap screenings tell only if a woman has an active infection, not if she's ever been exposed, she said. Plus, the usual tests won't show which strain a woman has.
So what's a 27-plus woman to do?
Dorothy Furgerson, chief medical officer for Planned Parenthood Mar Monte, said she would recommend the shots to a woman over 26 only if she's had fewer than five sexual partners in her life.
"The chance of it doing any good if a woman has had multiple partners is very, very small, and it's expensive,"she said.
America's most common sexually transmitted disease, HPV, is not just a killer of women anymore.
Rates of throat cancer have risen dramatically in the U.S. over the past few decades — mostly among men — and new research shows that HPV is the cause.
HPV, or human papillomavirus, causes almost all of the 12,000 cases of cervical cancer in women in the United States each year. It's spread through sexual, skin-to-skin contact — no bodily fluids necessary — and can infect the genitals and anus of a person of either gender.
What's becoming alarmingly clear now is that it can also spread through oral sex, and infect the mouth and throat. And that is causing the rates of throat cancer nationwide to skyrocket.
In late October, the CDC vaccine committee recommended that all boys receive a vaccine against several of the most common and virulent strains of HPV.
Several weeks earlier, a study published in the Journal of Clinical Oncology found that between 1984 and 2004, the proportion of throat cancers caused by HPV exploded from 16 percent to 72 percent.
Throat cancer due to HPV seems to strike men far more often than women; scientists don't yet understand why. cases of throat cancer than cervical cancer in the United States.
"In the U.S., HPV is poised to become the dominant cause of head and neck cancers within the next few decades,"lead researcher Maura Gillison of Ohio State University said in a podcast about the study.
The silver lining to the findings was that survival rates are much better for HPV-caused throat cancers than for those with other causes.