HPV-Related Cancer: Why Risk It?

Published on: 
Heal, Heal Spring 2023,

Vaccines have been a hot-button issue for several years now, but are cancer survivors putting their health at risk by avoiding the HPV vaccine?

HPV is the most common sexually transmitted infection. According to the Centers for Disease Control and Prevention, 2 in 5 people will be infected between the ages of 15 and 59.

Although many infected people will be either asymptomatic or only develop skin symptoms, HPV causes 37,300 cancers per year — despite the fact a vaccine to prevent HPV has been readily available for years.

Almost all cervical cancer is caused by HPV; genital cancers and cancer in the back of the throat and tonsils may also be caused by some strains of the virus. There is no way of knowing whether any one case of HPV will quietly go away on its own or linger and develop into a cancer. However, two specific strains of the virus (type 16 and type 18) have the greatest risk of developing into cervical cancer, and the vaccine can prevent infection with these two strains.

The best time to get vaccinated against HPV is at 11 or 12 years, as children in this age range display the greatest immune response to the vaccine.

Vaccination at this age, before many children become sexually active, is also beneficial. Individuals are still recommended to get the HPV vaccine through the age of 26 if they have not been vaccinated earlier. However, cancer survivors up to the 26-year-old cutoff are sometimes reluctant to receive the HPV vaccination, despite its benefit of preventing cervical cancer.

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

Brooke Cherven, an assistant professor of pediatric oncology at Emory University School of Medicine in Atlanta, has been examining the safety and efficacy of the HPV vaccine in cancer survivors, but also has been asking patients who decline what their reasons are for doing so.

“We looked at all reasons that participants had (given) or that families had given and realized that about 70% of the reasons were related to vaccine-related concerns,” she said.

Vaccine-related concerns include safety concerns, vaccine hesitancy, external influences, health beliefs and decisional processes, vaccine-related information deficits and disinterest.

Of note, there was a higher rate of vaccine-related refusal in younger survivors whose parents were making their medical decisions (76%) than in older patients who were likely deciding on their own (60%).

Cherven suggests that health care providers could boost HPV-vaccination rates in the childhood cancer survivor population by giving patients and caregivers evidence-based encouragement tailored to their specific situation as survivors, as opposed to passing on information for the general population.

“The HPV vaccine is recommended [for] all cancer survivors to prevent future cancer,” Cherven said. However, she explained survivors who had been treated with “sustained immunosuppression are at the greatest increased risk for HPV persistence and complications.”

“Genital HPV has been described as a significant late complication in a cohort of [patients who received] allogenic stem cell transplant, with one-third of long-term survivors displaying HPV-related disease. The patients at particular risk were those with associated chronic graft-versus-host disease requiring prolonged systemic immunosuppressive therapy.”

All these risk factors for HPV-related disease are specific to childhood cancer survivors, but many survivors or caregivers may be unaware of this unique risk. If the information gap persists, survivors may easily age out of the HPV-vaccine effectiveness age range and open themselves up to the risk of a new cancer diagnosis.

“We’re really focused on helping survivors stay healthy, and interventions that can improve their health and quality of life in the future. And the HPV vaccine is a safe, effective, well-established intervention to prevent future cancers,” Cherven emphasized.

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