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Rhea Vedro
Madison, WI
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http://latinainstitute.org/sites/default/files/publications/HPV_FAQ-24Sept07-FINAL.pdf
NATIONAL LATINA INSTITUTE FOR REPRODUCTIVE HEALTH
50 Broad Street, Suite 1825, New York, NY 10004
www.latinainstitute.org · nlirh@latinainstitute.org
THE HUMAN PAPILLOMAVIRUS (HPV),
CERVICAL CANCER AND THE HPV
VACCINE
FREQUENTLY ASKED QUESTIONS · SEPTEMBER 2007
GENERAL OVERVIEW OF HPV, CERVICAL CANCER AND THE
HPV VACCINE
1. WHAT IS HUMAN PAPILLOMAVIRUS (HPV)?
Human Papillomavirus (HPV) is the name of a group of viruses, many of which are spread through
skin to skin contact, particularly during sexual activity. HPV has been linked to both cervical cancer
and genital warts. There are approximately 120 types of HPV, but two types (strains 16 and 18) are
responsible for approximately 70% of all cases of cervical cancer.
HPV is the most common sexually transmitted infection in the United States with an estimated 6.2
million people newly infected each year. It is estimated that a quarter of teenage girls and half of
women in their early 20s have the virus. It is important to note that there is currently no cure or
treatment for HPV and oftentimes there are no symptoms. According to the American Cancer
Society, the infection usually disappears without any treatment and any abnormal cell growth or
warts caused by HPV can be treated effectively. It is important to note that HPV is not the same as
HIV or Herpes (Herpes simplex virus or HSV)i.
2. HOW IS HPV ASSOCIATED WITH CERVICAL CANCER?
Approximately a dozen strains of HPV can infect a woman's cervix (lower part of the womb) and
cause the cells to change.ii While most cases of HPV infection are resolved on their own, certain
strains can lead to cervical cancer if not treated over time.iii The strains most associated with cervical
cancer are 16 and 18.
According to the Center for Disease Control and Prevention (CDC)iv, about 40 types of HPV can
infect the genital areas of men and women. These types also have been linked to other less common
genital cancers- including cancers of the anus, vagina, and vulva (area around the opening of the
vagina). Other types of HPV can cause warts in the genital areas of men and women.
3. HOW COMMON IS CERVICAL CANCER AND HOW DOES IT IMPACT LATINAS?
According to the American Cancer Society, there are approximately 10,000 cases and 3,700 deaths
from cervical cancer in the U.S. per year.v The incidence of cervical cancer for Latina women in the
United States is almost twice as high as non-Latina white women. Latina women have the 2nd
highest mortality rate from cervical cancer (after black women), although mortality for Latina
women is higher in communities along the Texas-Mexico border.vi This is largely due to Latina
women's low rates of routine gynecological care, particularly pap smears and cervical cancer
screening. These low rates are caused by lack of insurance, fear associated with their immigration
status, embarrassment, lack of knowledge, and limited English proficiency.vii About 85% of women
who die from cervical cancer never had a pap smear.
4. WHAT IS THE HPV VACCINE?
In June 2006, the federal Food and Drug Administration (FDA) approved the first vaccine,
Gardasil®, manufactured by Merck & Company, developed to prevent cervical cancer and genital
warts caused by four strains of HPV; two strains (strains 16 and 18) that are responsible for 70% of
cervical cancer incidences and two strains (strains 6 and 11) which are responsible for 90% of genital
warts caused by HPV. Subsequently, the CDC's Advisory Committee on Immunization Practices
(ACIP) recommended that the vaccine be administered to all girls ages 11-12, and approved it for
administration to women from 9 to 26 years old.
The vaccine requires a three-shot regimen over the course of 6 months and is quite costly at
approximately $120 per shot, for a total of $360 for the series. Administrative charges tacked on by
the doctor may increase the cost, and anecdotal reports indicate that some women have paid as much
as $700 for the three-shot series.
5. WHAT'S IN THE VACCINE? HOW DOES IT WORK?
The vaccine is made from non-infectious HPV-like particles that trigger an antibody response that
prevents recipients from contracting HPV strains 6, 11, 16, and 18. It is important to note that,
according to the FDA, because the vaccine only contains a protein, and not the actual virus, the
vaccine will not cause HPV.viii
6. HOW DO I ACCESS THE HPV VACCINE?
Many gynecologists or pediatricians have the vaccine available, although recent reports indicate that
some doctors are not stocking the vaccine because of its hefty price tag. Publicly funded access to the
HPV vaccine varies state-to-state, although all low-income adolescents between the ages of 9
through 19 who are either uninsured, Medicaid-eligible, American Indian, or Alaska Native, have
access to the vaccine through the federal Vaccines for Children (VFC) Program. For women over the
age of 19 with private health insurance, 96% of private plans cover the vaccine; for women who are
uninsured and Medicaid-eligible, it is imperative that they verify if their state has chosen to provide
optional vaccine coverage. Additional publicly-funded or Merck-funded programs may be available
to provide vaccine access for low-income women, but these programs are not universally available
nationwide.
7. WHEN SHOULD I GET THE VACCINE?
The HPV vaccine is approved by the FDA for use by girls and women ages 9 to 26. It is ideal to
obtain the shots prior to the onset of sexual activity, but women who are sexually active are still
recommended to receive the vaccine up to age 26. The FDA has not approved the vaccine for use in
women over the age of 26, and it is not recommended for women who are pregnant. Also, women
who already have HPV can still benefit from the vaccine because it targets particular strains that the
woman may not have contracted. However, the HPV vaccine does not treat existing HPV infections.
8. I ONLY HAVE SEX WITH OTHER WOMEN; DO I NEED TO RECEIVE THE
VACCINE?
Yes! Lesbian and bisexual women are also at risk of acquiring HPV. According to research
conducted by National Network for Immunization Information, cervical pre-cancers and cancerous
changes have been found in women who exclusively have sex with women.ix Lesbian and bisexual
women oftentimes practice oral sex, genital to genital sex, vaginal finger penetration, and/or sharing
of sex toysx; all which could contribute to the transmission of HPV. In addition, women who have
sex with women face barriers to preventive reproductive health services, including encountering
health providers with negative or judgmental attitudes, and misperceptions about the diversity of
their health needs.xi
9. WHAT DOES THIS NEW APPROVAL OF THE HPV VACCINE MEAN FOR
LATINAS?
While cheered in the medical community as a breakthrough for women's health, the HPV vaccine is
still out of reach for many women with its price tag of over $360 for the recommended three-shot
regimen. Barriers to accessing the HPV vaccine are compounded for Latina and immigrant women,
who may have limited English proficiency, may be without health insurance and/or may be
undocumented. Latina women are less likely to receive adequate reproductive health care services
and often forgo critical pap smears and screenings that could provide early detection of abnormal
pre-cancerous cells that can lead to cervical cancer. More than half of all U.S. women diagnosed with
cervical cancer have not had a pap smear in the last three years. Researchers have found that Latina
women were more likely than other women to be diagnosed with cervical cancer at an advanced
stage, largely because of the lack of education about the importance of pap smears and their link to
early detection of pre-cancerous cells. The lack of education is often a result of poverty, language
barriers and cultural stigma around discussing issues of sex and sexuality in the Latino community.
10. HOW SHOULD THE HPV VACCINE BE PROVIDED?
NLIRH advocates a standard of care that will provide Latinas with all the possible options for
preventing cervical cancer. This standard of care includes: regular HPV and cervical cancer
screenings during gynecological visits, comprehensive sexuality information, affordable access to
reproductive health technologies such as the HPV vaccine, and accurate information on preventing
HPV and other sexually transmitted infections. NLIRH supports Latina's full access to new
reproductive technologies when they are coupled with unbiased information and implementation
that is free from coercive policies and practices. Additionally, policy makers should advance
legislation that provides universal access to the vaccine through public funding such as Title X,
Medicaid and the State Children's Health Insurance Program (SCHIP), and private insurance
coverage requirements for girls and women ages 9 to 26 years old.
11. I DON'T WANT TO GET THE VACCINE; ARE THERE OTHER WAYS TO PREVENT
HPV?
HPV is very common, and both women and men are carriers of the virus. There is still much to be
studied about HPV, but according to the CDC, the only way to prevent contracting HPV is to abstain
from all sexual activity.xii HPV could be spread from skin-to-skin contact, and recent studies have
found HPV under the fingernails of men. While utilizing condoms during sex can reduce the
transmission of HPV, it does not provide full protection because areas not covered by a condom can
be exposed to the virus.xiii However, condom use is highly encouraged because of protection against
other sexually-transmitted infections.
The best way to prevent developing cervical cancer is to obtain regular pap smears-ideally, once a
year beginning with the initiation of sexual activity. Pap smears are the most effective way to screen
for the pre-cancerous cells that can lead to cervical cancer. For women over 30, there is a HPV test
that can be used along with the pap smear as part of routine cervical cancer screening.xiv
Additional studies have shown that maintaining a healthy lifestyle with a diet rich in fruits and
vegetables can help reduce the risk of developing cervical cancer.xv Furthermore, women who do not
smoke are less at risk than those who smoke. According to the American Cancer Society, tobacco
by-products have been discovered in the cervical mucus of women who smoke, leading to the damage
of DNA cells in the cervix.xvi This exposes women to the risk of developing cervical cancer at a rate
twice as high as non-smokers.xvii
ADDRESSING THE CONTROVERSY: WHY HAS THE HPV
VACCINE BECOME SO POLITICAL?
1. WHAT ABOUT BOYS? WHY CAN'T THEY BE VACCINATED?
The studies are currently being conducted on boys to see if the vaccine will be effective. While boys
cannot get cervical cancer and HPV remains symptom-less, they can transmit it to their partners. It
is more difficult to track boys and cervical cancer because to participate in the study, researchers
must track their sexual partners and their incidence of cervical cancer.
HPV impacts boys in a different way. According to the New England Journal of Medicine, a team of
researchers at Johns Hopkins University confirmed that infection with HPV via oral sex is by far the
leading cause of throat cancer, which strikes 11,000 American men and women each year.xviii HPV is
also a major cause of anal cancer and genital warts, both of which affect either sex; HPV is also linked
to penile cancer in boys and men. It is not clear whether the HPV vaccine could prevent anal, penile
or throat cancer or if it will be effective for boys, but research and data are forthcoming.
2. WHAT KIND OF SIDE EFFECTS HAVE THEY FOUND?
According to the CDCxix, the most common side effect is soreness at the injection site. The CDC,
working with the FDA, will continue to monitor the safety of the vaccine after it is in general use.
Despite rumors that have been circulating, there is no thimerosal or mercury in the HPV vaccine. It is
made up of proteins from the outer coat of the virus (HPV). There is no infectious material in this
vaccine. In addition, claims of three deaths associated with the vaccine have proven unrelated and an
FDA spokesperson states that the deaths occurred independently of the vaccine.xx
3. DID THEY REALLY TEST THE VACCINE ENOUGH TO KNOW ABOUT LONG TERM
SIDE EFFECTS?
According to Merck & Co., Gardasil® has been studied for more than a decade in more than 25,000
individuals, including 1,124 adolescent girls ages 9 to 15.xxi These studies have shown no serious side
effects. The most likely long term effect might be the necessity for a booster (similar to the Tetanus
vaccine) after five years, although this is not a conclusive finding.
4. WHAT ABOUT THE CONTROVERSY WITH MERCK AND THEIR LOBBYING? ARE
THEY JUST TRYING TO MAKE MONEY?
Our pharmaceutical industry is for-profit, which means that companies invest a lot of money in
research on new technologies. Many of those technologies do not turn into effective medicines, and
so when one technology does prove effective (and is approved by the FDA) the company has to make
up its losses on all the experimental research, as well as make a profit. This results in high prices for
medicines. High prices often result in new reproductive technology becoming out of reach for many
women in our community.
Merck led a strong campaign to make the vaccine mandatory in public schools, and ended up having
to rescind its push for state legislation due to the controversy. While pharmaceutical lobbying is
controversial, the matter of the fact is that this vaccine is an important tool to fight a deadly form of
cancer, and we need legislation to help increase access to it.
5. WHAT ABOUT THE HISTORY OF ABUSES AGAINST WOMEN OF COLOR? HOW
DO WE KNOW THIS ISN'T JUST ANOTHER FORM OF GENOCIDE AGAINST OUR
COMMUNITY?
History has demonstrated that women of color were often coerced into sterilization and were used as
guinea pigs in contraception trials. Many of these coercive practices were in place until the 1970's
and were seen as part of a wide-spread eugenics movement that discriminated against people of
color. This history has led many Latinas to mistrust the medical system and to be suspect of new
medical policies that infringe upon their reproductive self-determination. However, legislative
mandate proposals, ethical standards and clinical research procedures have evolved through the
establishment of the Office for Human Research Protections. In addition, vaccine approval by the
FDA is a very strenuous process and all vaccines must be thoroughly tested before deemed safe and
effective. This vaccine has been recommended for use by all girls and women up to the age of 26
(with some limited exceptions), and efforts to expand access to the vaccine should be embraced. The
somber reality is that cervical cancer disproportionately impacts women of color; Latina women have
the highest rates of cervical cancer (almost twice the rate of non-Latina white women), followed by
Black women and Asian Pacific Islander women. Black women are most likely to die from cervical
cancer, followed by Latina women. This is due to the tremendous health disparities that exist in our
country that are perpetuated by race, class, socio-economic status, English-language proficiency and
immigration status. The HPV vaccine could help reduce some of the disparities that exist for women
with cervical cancer, and would serve as a tool to protect the fertility of women of color by
preventing cancer treatment surgeries such as hysterectomies. However, access to the vaccine
remains a challenge. Unless states take action to expand access to the vaccine for low-income and
uninsured women, the cervical cancer disparities in this country will continue.
6. WHY DO THE GIRLS NEED TO GET IT SO YOUNG? AND WHAT ABOUT WOMEN
OLDER THAN 26?
The HPV vaccine has proven most effective for girls who receive it prior to onset of sexual activity.
According to the CDCxxii, nationwide, 6.2% of high school students had sexual intercourse for the
first time before age of 13; for Latinas, the rate is 3.6%. By the time students reach the 12th grade,
46.8% will have had sexual intercourse, including 44.4% of Latinas. Sexual activity increases the
likelihood of exposure to HPV, so the vaccine is recommended for administration to girls 11-12 years
of age, and girls as young as 9 years old can receive it.
Regarding women over the age of 26, research on the vaccine's safety and efficacy is currently being
conducted. Another pharmaceutical company, GlaxoSmithKline, is currently testing a cervical
cancer vaccine on women up to age 55. However, at this time, the Gardasil® vaccine is approved by
the FDA for girls and women only between 9 to 26 years of age.
7. DOES THE VACCINE PROMOTE PROMISCUITY?
No! Although religious and conservative groups have purported that the vaccine would promote
promiscuity and that encouraging wide-spread vaccination goes against their "abstinence-only"
message, the general public (including parents, health care providers, and sexual health advocates)
have largely rejected that message.xxiii Studies have shown that young people do not abstain from
sexual activity due to fear of contracting HPV (the vaccine does not protect against other sexually
transmitted infections) and there has been no scientific evidence that the HPV vaccine will promote
sexual activity.
8. IF I PLAN ON ABSTAINING FROM SEX UNTIL I MARRY, DO I STILL NEED THIS
VACCINE?
Yes. While abstaining from sexual intercourse is one of the best methods to prevent contracting
HPV, it can be misleading. Individuals that abstain from intercourse but engage in other forms of
sexual activity, such as fondling and other forms of intimate partner contact, can still be exposed to
the virus through skin-to-skin contact. In addition, individuals who have abstained from sexual
activity may marry a spouse or commit to a life partner that has been exposed to HPV through
previous sexual activity.
For more information on Cervical Cancer, HPV and the vaccine, visit the National Latina Institute
for Reproductive Health at
www.latinainstitute.orgAdditional Resources: Center for Disease Control and Prevention (CDC):
www.cdc.govAmerican Cancer Society:
www.cancer.org
i Centers for Disease Control and Prevention (CDC), "HPV Vaccine Questions and Answers", August 2006.
ii Ibid.
NATIONAL LATINA INSTITUTE FOR REPRODUCTIVE HEALTH
50 Broad Street, Suite 1825, New York, NY 10004
www.latinainstitute.org · nlirh@latinainstitute.org
7
iii Henry J. Kaiser Family Foundation, "Fact Sheet: HPV Vaccine: Implementation and Financing Policy", January 2007.
iv Centers for Disease Control and Prevention (CDC).
v American Cancer Society, "Detailed Guide: Cervical Cancer", October 2005.
vi Byrd, Chavez and Wilson, "Barriers and Facilitators of Cervical Cancer Screening Among Hispanic Women", Ethnicity & Disease, Volume 17,
Winter 2007.
vii Ibid.
viii Food and Drug Administration, "Product Approval Information- Licensing Action, Gardasil® Questions and Answers", June 8, 2006.
ix National Network for Immunization Information, "HPV Vaccines: HPV Infection in Women who have sex with Women", March 1, 2007.
x Ibid.
xi Ibid.
xii Centers for Disease Control and Prevention (CDC).
xiii Ibid.
xiv Ibid, "HPV. Common Infection. Common Reality" Brochure.
xv Singh, VN and Gaby, SK., "Premalignant Lesions: Role of antioxidant vitamins and beta-carotene in risk reduction and prevention of
malignant transformation", American Journal of Clinical Nutrition, Volume 53, 386S-390S, 1991.
xvi American Cancer Society, "What are the Risk Factors for Cervical Cancer?", August 2006.
xvii Ibid.
xviii Mundell, E.J., "Experts Debate Giving HPV Vaccine to Boys", MedicineNet.com, May 18, 2007.
xix Centers for Disease Control and Prevention (CDC).
xx Food and Drug Administration, www.fda.gov.
xxi Merck & Co. Product News, "CDC Finalizes Advisory Panel Recommendations for Gardasil®, Merck's Cervical Cancer Vaccine", March 22,
2007.
xxii Centers for Disease Control and Prevention (CDC), Youth Risk Behavior Surveillance, US, 2005.
xxiii Gibbs, Nancy. "Defusing the War over the ‘Promiscuity' Vaccine", Time, June 21, 2006.
http://www.arhp.org/about-us/position-statements#hpv
HUMAN PAPILLOMAVIRUS AND CERVICAL CANCER
Vaccines for human papillomavirus (HPV) represent the next major breakthrough in prevention of cancer and sexually transmitted infections. The Association of Reproductive Health Professionals (ARHP) supports the development of and widespread access to HPV vaccines as part of a comprehensive prevention screening and treatment strategy for cervical cancer and other HPV-related conditions, such as genital warts. HPV vaccines will be able to prevent some of the most virulent strains of HPV that cause cervical cancer and genital warts.
Cervical cancer has become the second most common female malignancy worldwide and kills nearly 250,000 women each year.[1,2] In the United States alone, every year close to 12,000 women are diagnosed with cervical cancer, resulting in 4,000 deaths.[3] Nearly half of the women who are diagnosed with cervical cancer in the United States have not been properly screened.[4] For this reason, routine visits to a health care provider for ongoing surveillance remain a critical component in the fight against cervical cancer. ARHP encourages health care providers to adopt screening for HPV using the latest technologies available, including the liquid-based Pap test and HPV DNA testing, for all appropriate candidates.
ARHP encourages HPV vaccines to become the standard of care. ARHP supports the recommendation of the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) that HPV vaccines be added to the routine schedule for girls and women throughout the age ranges as deemed appropriate by ACIP. ARHP supports the vaccines' placement on CDC's "Vaccines for Children" program, which helps ensure that girls from low-income families are immunized. ARHP strongly encourages all states within the United States to adopt vaccination policies to ensure that all people can easily access this important method of prevention.
ARHP supports and encourages access to HPV and cervical cancer prevention, screening, and treatment for women and girls, regardless of age, race, ethnicity, income, sexual orientation, or immigration status. Although HPV vaccines are important developments in efforts to eradicate cervical cancer and genital warts, disparities in access to health care continue to be a public health challenge. Lack of access leaves many girls and women without regular and adequate preventive health care services. To encourage equal access to these technologies by all people who need them, ARHP supports private insurance coverage and public funding for the vaccines and related prevention, screening, and treatment technologies and encourages the US Department of Health and Human Services to make the vaccines available through the Title X program initiative.
HPV vaccines can be effective only if providers and the public are educated about their safety and efficacy and are encouraged to offer and receive them. ARHP supports provider training for the vaccine and related screening and treatment technologies and their incorporation into practice and for public education about the benefits of these new tools. While vaccines offer a new approach to preventing HPV and cervical cancer, ARHP encourages health care providers to continue promoting safe sex practices and choices to their patients.
Eddy DM. Screening for cervical cancer. Ann Intern Med 1990;113(3):214-26.
Sawaya GF, Brown AD, Washington AE, Garber AM. Clinical practice. Current approaches to cervical cancer screening. N Engl J Med 2001;344:1603-7.
American Cancer Society. (2004, accessed October 27, 2004) Cancer Facts & Figures 2004. [Online] www.cancer.org/downloads/STT/CAFF_FinalPWSecured.pdf.
National Institutes of Health. Cervical Cancer. NIH Consensus Statement. 1996;14:1-38.
ARHP's position statement on HPV and cervical cancer was recommended by ARHP's policy committee on August 25, 2006 and approved by ARHP's board of directors on September 6, 2006.
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