Dear Dr Mitchell,
I have an 11-year-old daughter who is in grade seven, and who I will be giving permission to get the HPV vaccine. However, my concern is this: We are Christians, and I don't foresee my daughter becoming sexually active before marriage, years from now. What is the point of getting the vaccine for a child her age who might not be sexually active for another decade and a half? Wouldn't the vaccine's effectiveness have worn off by then?
The Human Papilloma Virus (HPV) is the virus that causes cervical cancer. It is transmitted by sexual contact and is present in over 80 per cent of women and men who have been sexually active at least once, even if sexual activity is discontinued. There are four main sub-types that cause over 80 per cent of cases of cervical cancer, and these are types 16, 18, 31 and 45. The other sub-types contribute to a lesser degree. The four main sub-types are considered high-risk HPV sub-types. The low-risk sub-types 6 and 11 cause genital warts and are not usually screened for, since they do not cause cancer.
HPV can be contracted by oral sexual activity, contact with skin in the genital area without penetrative sexual activity, and also by anal sexual activity.
It causes cancer of the throat, anus, vulva, cervix and penile cancer in men. Young women under 30 years have a high rate of HPV infection, but because their immune system is good they tend to clear the infection spontaneously. Cancer of the cervix is seen in women under 30 years old but is not as common as in older women over 40 years. Women under 30 years old also die from aggressive forms of cervical cancer.
Vaccination will prevent cervical cancer and pre-cancerous changes in over 93 per cent of cases. The best time to get vaccinated is ideally before exposure to the HPV virus, but sexually active women also benefit from late vaccination. Cervarix can be given up to age 55 years and has been shown to be effective in preventing cervical cancer in at least 93 per cent of cases.
The vaccination of young girls from the age of 10 is nothing new. HPV vaccines have been used globally with very good results and have proven to be safe and effective in young girls and women up to 55 years old. The younger you are, the better the response from vaccination with significant production of antibodies that last to protect you from cervical cancer in later life. The two-dose schedule given to young girls works well and is projected to provide lifelong protection from cervical cancer without the need for a booster dose.
Studies done globally show that, despite Christian upbringing and socialisation, some young girls do have sexual contact, both oral and genital. Penetrative sexual activity might not occur, but the viruses can still be transmitted. Vaccination of young girls and boys is important to reduce the HPV burden globally. Cervical cancer and penile cancer are real. Cancer of the cervix is the second most common cancer in women globally, and deaths do occur, especially in developing countries where most women do not have access to Pap smear screening.
Prevention of HPV infection by vaccination alongside Pap smear screening or HPV testing is the recommendation to reduce the risk of dying from cervical cancer. Death from cervical cancer is painful, debilitating and preventable.
We should vaccinate our children to ensure that they have a full reproductive and fulfilling life. The aim is that cervical cancer will become a disease of the past. The vaccines have been shown to be safe so you should not worry. The most common side effect is injection site pain which resolves rapidly.
Vaccination of children in Jamaica is nothing new. Parents who can afford it have been paying for their children to be vaccinated for several years. The only thing that has changed is that the Government is now paying for the vaccine in schools, and this is a positive move in the right direction. This should be commended, and parents should ensure that their children are vaccinated in order to have a life free from the fear of cancer of the cervix.
This is the global practice and is the way forward in significantly reducing cervical cancer and the burden of HPV infection. Best wishes.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to firstname.lastname@example.org; write to All Woman, 40-42 1/2 Beechwood Ave, Kingston 5; or fax to 968-2025. All responses are published. Dr Mitchell cannot provide personal responses.
The contents of this article are for informational purposes only, and must not be relied upon as an alternative to medical advice or treatment from your own doctor.