15 Years Later, What Have We Learned About the HPV Vaccine?

CURECURE® Women's Cancers 2021 Special Issue

The HPV vaccine has been shown to help prevent cervical cancer, but what if you didn’t get the vaccine in time to prevent the disease?

The HPV vaccine Gardasil was first approved by the Food and Drug Administration in 2006 to prevent cervical and other cancers. An updated version of the vaccine, Gardasil 9, was approved in 2014; it protects patients against the same four types of HPV as the previous version plus five additional types of the virus.

“The current vaccine protects against the HPV strains that cause 90% of cervical cancers,” Dr. Anna L. Beavis, assistant professor of gynecology and obstetrics at the Kelly Gynecologic Oncology Service at Johns Hopkins Medicine in Baltimore, told CURE ®. “We have been giving the vaccine since 2006, and, in addition to seeing how safe it is, we are already starting to see reductions in cervical precancer rates in many countries, including (regions of the United States) where vaccination rates are good.”

According to the American Cancer Society, 8 in 10 people will get HPV throughout their lifetimes, and it affects an estimated 35,000 people in the United States per year. The Centers for Disease Control and Prevention (CDC) recommends vaccination for males and females between 9 and 26 years old.

“The vaccine works best if given before any possible exposure to the virus,” Beavis explains. “HPV is transmitted sexually, so giving it well before sexual activity (starts) is best. Second, the immune response to the vaccine is stronger in younger children. In fact, this means that children under the age of 15 who get the vaccine only need two doses, not three.”

Although the vaccine has been available for years, some patients may have missed the chance to get the vaccine in time to potentially prevent cancer. Kate Weissman,
35, is one of those women who missed that window of opportunity. She received the vaccine when it first came out (around 2006 or 2007), but she received a diagnosis of HPV in 2013. She believes she already had HPV before she was vaccinated and adds that the problem is that co-testing for HPV was not performed as often as it should have back when she was first vaccinated.

“It was absolutely the right decision for my family at the time. And for me, unfortunately, the timing didn’t work out in my favor,” Weissman says.

In May 2015, Weissman was having bleeding after sex and sporadic, unexplained bleeding. She underwent tests at the guidance of her OB/GYN, which led to a colposcopy, a procedure that examines the cervix for potential cancer, in October 2015. She received a diagnosis of cervical cancer and was given a referral to Dana-Farber Cancer Institute in Boston, where she set up an appointment with an oncologist to discuss her next steps.

“I think the thing a lot of people don’t realize ... about cancer is that you don’t get all the information at once,” Weissman notes. “It’s a really awful waiting game. You find out you have cancer, but there (are) six more steps that have to happen before they can get you a prognosis or go through your treatment plan with you.”

Weissman adds that she underwent a series of MRIs, positron emission tomography scans and other tests to determine whether the cancer had spread and what stage it was. The disease had spread to her lymph nodes, which led to her receiving a diagnosis of stage 2b cervical cancer. Her initial treatment included six rounds of chemotherapy and 30 rounds of radiation, which surprised her.

“I already had this perception of cervical cancer that if you do get it, you have a surgery and then you go on with your life, which is such an awful perception to have,” Weissman says. “Now that I’m on the other side of it, I’m so much more educated (about) it, but it’s something people don’t know a lot about cervical cancer.”

Her treatment ended on Dec. 23, 2015, but a post-treatment scan later indicated the cancer had spread through her lymphatic system, so she was rushed into surgery to remove her lymph nodes. She underwent treatment again to target the new cancer location, which included 25 rounds of radiation and five rounds of chemotherapy. Afterward, she underwent an 18-week course of chemotherapy to target any possible microscopic cancer that may remain, which lasted until October 2016, when cancer was no longer in her system. “It was a tough year to say the least,” Weissman says.

Based on Weissman’s experience with cervical cancer, she says that had the HPV vaccine come out sooner, she “absolutely” would have had it. She advocates for others to follow CDC recommendations for the HPV vaccine by speaking to high school students (under the supervision of teachers), doctors, nurses and patients. She also lobbies in Washington, D.C., and Boston, where she lives, for bills to increase access to screening, vaccination and treatment for minority communities and for those who live in rural areas.

“I once had a pediatrician say, ‘You put your helmet on before you ride your bike, not after, not during,’” Weissman says. “That’s exactly what it is. These kids need to get vaccinated before any sort of (sexual) activity in their life or contact with other people is introduced because that will protect them.”

There is a lot of misinformation about HPV, such as people get HPV only from sexual intercourse.

“I think one of the most important things to know is that this virus can be transmitted without necessarily having penetrative intercourse,” Beavis says. “Put another way, you can get this virus from ‘fooling around.’ These days, most parents understand that their child will be sexually active at some point, so I also focus on the proven safety of the vaccine.”

Weissman says she’s not afraid to talk about cervical cancer and HPV because it is important to discuss these topics without an attached stigma.

“Cervical cancer is so personal,” she says. “It’s an intimate cancer, and a lot of people understandably are not comfortable talking about their cervical cancer journey. I am, so I’m going to be a voice for people who aren’t comfortable, because the more we talk about it, the more awareness we’ll get out there.”

Weissman and her husband are having a child via a surrogate, as she is unable to bear children because of cervical cancer. She plans to have her child vaccinated for HPV at the appropriate time. “I will absolutely get my daughter vaccinated,” she says. “We’ll make sure that anyone in my orbit is educated on the vaccine, as well, and will encourage them to speak to their pediatrician about doing the vaccination for them.”

HPV-related cervical cancer is different from other cancers, as the origin of the disease is known, and it can be prevented with a vaccine.

“This vaccine has been heavily studied and scrutinized,” Beavis says. “It is incredibly effective and very safe. It now has (more than) 20 years of data supporting it, and the immune response to the vaccine is better than (its response) to the virus. We always talk about curing cancer, but what if we had the potential power to prevent cancer before it even developed? Parents have the potential to give this to their children by vaccinating them with the HPV vaccine.”

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