When Vanessa Laven was in college and living just outside of New York City, she went to her family gynecologist to get vaccinated against HPV, the human papillomavirus that causes cervical cancer (among others).
He told her she didn’t need it because she was a “good girl” from a “good family” and sent her on her way.
“It was totally about sex,” said Laven, now 29, living in Minneapolis with her husband, and, sadly, positive for both HPV and the precancerous cell growth associated with it. “The discussion of the vaccine was tied up with some old-fashioned notion of virtue.”
The recent Disneyland measles outbreak shone a bright spotlight on parents who refuse to vaccinate their kids against harmful diseases because they’re worried about vaccine safety. But when it comes to refusing to vaccinate children again HPV, it’s usually not safety that’s the sticking point -- it’s sex.
Some fear that if their kids are vaccinated, they’ll be more likely to start having sex.
“It’s a natural concern of parents,” said Dr. Anupam Jena, assistant professor of health care policy and medicine at Harvard Medical School. He is the lead author of a new longitudinal study on HPV vaccination and sexual activity published Monday in JAMA Internal Medicine “And it’s probably also a concern among some pediatricians, as well. One of the challenges is that there’s just not a lot of information out there to shut down this idea. There’s been no evidence to definitely say [a higher rate of sexual activity] is not happening.”
There is now. In the largest study of its kind, Jena and his colleagues pulled data from an insurance database that spanned five years, 2005 to 2010 (the HPV vaccine was approved by the FDA for girls in 2006). First, they measured the rate of sexual activity of more than 21,000 girls ages 12 to 18 both before and after HPV vaccination, using treatment for STIs (sexually transmitted infections) as a proxy for sexual behavior. Then they compared the rate of sexual activity of the vaccinated girls with the rate of sexual activity of more than 185,000 girls ages 12 to 18 who hadn’t been vaccinated. The incidence of STIs increased at the exact same rate.
“If the vaccine caused unsafe sex, what you’d expect to see is that the rate of increase would be greater among vaccinated girls,” he said. “But we didn’t find that. We found that the increase from one year to the next was the same between vaccinated and unvaccinated girls.”
Calming fears
Jena said he hopes the data will help quell the fears of parents – and even doctors – who believe an HPV vaccination promotes or somehow encourages sexual behavior.
Dr. Denise Galloway, the Fred Hutchinson Cancer Research Center scientist who played a major role in both discovering HPV’s association with cancer and paving the way for the vaccine, said the study would provide additional information to pediatricians and family practice doctors to help assure their patients.
“Unfortunately the people who fear vaccination don’t read JAMA,” she added. “Scientific data is not enough to change beliefs and fears. Peer advocacy, word of mouth, and websites are more effective.”
Galloway’s resignation is understandable. According to the Centers for Disease Control and Prevention, last year in the U.S. just one in three girls and one in seven boys received the full three-dose series (a two-dose version of the vaccine that might get better traction is in the works). By comparison, Australia offers the HPV vaccine as part of a free, school-based immunization program. Since its inception in 2007, more than 70 percent of 15-year-old Australian girls had received all three doses of the vaccine.
“The United States is going to be the shame of the developed world because our rates of uptake are so much lower than other countries that have school-based programs to deliver the vaccine,” Galloway said of these numbers in an earlier interview.
Dr. Erin Scherer, a research associate in the Galloway Lab at Fred Hutch, said the lack of faith in a vaccine that’s essentially 100 percent effective in preventing HPV -- a virus that impacts nearly all men and women at some point in their lives and can lead to cervical, anal, vaginal, penile, vulvar and head and neck cancers -- is “very frustrating.”
“It’s my understanding that parents don’t want to have a conversation with their children about sex,” she said. “But you don’t have to have a conversation about sex. The vaccine protects against cancer. When I was vaccinated as a child, my parents never explained tetanus or what an MMR booster was. I just got a shot to keep me from getting sick.”
Laven, who discovered she had HPV and precancerous cells in her cervix six months after finishing chemo and radiation for non-Hodgkins lymphoma, is angry that her former gynecologist refused to provide her with a vaccine that could have effectively kept HPV and its related cancers at bay. She’s also concerned that if she does develop cervical cancer, the treatment will interfere with her plans to have a baby.
“It’s frustrating that I could have avoided this,” she said. “I could not have avoided lymphoma, but I could have avoided this.”
The younger, the better
Both Scherer and Jena emphasized that fear about the HPV vaccine somehow promoting more sexual activity isn’t the only reason why kids in the U.S. aren’t getting vaccinated. Some people are simply anti-vaccination, period, despite mountains of evidence proving both safety and efficacy. Others may find the vaccination series, which costs around $130 a dose, too expensive, although Jena pointed out that insurance often covers it and there are both state and federal vaccine programs that can make it more affordable.
But those parents who have delayed the vaccine because they’re not comfortable broaching the subject of sex and sexually transmitted diseases with their kids may be missing an important window, said Scherer.
“If you’re [younger], you’re going to have a better immune response than you will if you’re older,” she said. “And you’ll have better protection.”
As for Laven, she just wishes she could have a do-over.
“I wish I could go back and shake my younger self and say, ‘Find somebody who will give it to you!’” she said. “I could have saved myself a lot of pain and suffering if I just got the shot. But my mom was like, ‘If he doesn’t think you need it, then why are you doing something unnecessary?’ And other gynecologists that I saw after that never brought it up. They asked if I wanted AIDS testing and STD screening but nobody asked if I wanted the HPV vaccine or if I’d had it.
“This was so not on any medical professional’s radar. And it should be.”
Diane Mapes is a staff writer at Fred Hutchinson Cancer Research Center. She has also written extensively about health issues for nbcnews.com, TODAY.com, CNN.com, MSN.com, Columns and several other publications. She also writes the breast cancer blog, doublewhammied.com. Reach her at dmapes@fredhutch.org.
