HONOLULU -- (January 17, 2017) At Tripler Army Medical Center, commonly known as TAMC, health care professionals recognize there is more to Cervical Cancer Awareness Month than you might expect. Cervical cancer is a potentially fatal cancer found in middle-aged women which is almost always caused by the most prevalent sexually transmitted disease (STD) in the U.S., the Human Papillomavirus (HPV).
Cervical Cancer Awareness Month is not only about preventing cervical cancer in women, it is also about preventing other fatal HPV-associated cancers in males, and HPV infections in young adolescents; both male and female.
"Research shows if cervical cancer is caught in the earliest stage, the survivability rate exceeds 90 percent," said Col. Charles Dietrich, Tripler's residency program director for the Department of Obstetrics and Gynecology. "The Papanicolaou test or Pap smear, is one of the most effective cancer screening tests available to detect pre-cancers in women. It has dramatically reduced the incidence of cervical cancer in the U.S. and is recommended for women ages 21-65."
Recently, Tripler began offering co-testing for females which include the Pap test and HPV test. While the Pap smear test checks for precancerous cells, the HPV test checks specifically for the HPV virus that can cause pre-cancers, significantly increasing overall detection rates.
In addition to co-testing to detect cervical cancer and HPV in women, doctors strongly recommend the HPV vaccination in young adolescents which can actually help to prevent HPV.
In 2006, the FDA approved the first HPV vaccine providing immunization for the most common types of HPV that cause cancer and genital warts, HPV types 6, 11, 16, and 18. As advances are made in medicine and vaccinations, a vaccine called Gardasil 9 was FDA approved in 2015 that provides immunization for up to nine different types of HPV.
"As pediatricians, one of our primary goals is to prevent harmful diseases from affecting our children," said Dr. Kris Baik, director of Tripler's Pediatric and Adolescent Patient Centered Medical Home. "Immunizing our adolescents could protect them from anal and genital warts as well as cancers of the head, neck, anus, cervix and penis. It also reduces the transmission of the virus to future sexual partners."
The HPV vaccine series can be started as early as 9 years of age, but routinely advised for 11-12 year olds and up to 26 years of age.
Despite the significant benefits to include the HPV vaccine as part of routine immunizations for adolescents, Dietrich voiced concerns over the low HPV vaccination rates in the U.S. "With the HPV vaccine available for boys and girls and co-testing available for women, cervical cancer is now the most preventable type of cancer that can develop in a woman's reproductive organs. It is also the only gynecologic cancer with a screening test. However only 42 percent of U.S. teen girls and 28 percent of teen boys have received the HPV immunization series, the lowest rate among all of the adolescent immunizations."
Dietrich also noted that a recent study shows six years after introduction of the original vaccine in the U.S., a 64 percent reduction in HPV 6, 11, 16, and 18 prevalence has been seen in females aged 14-19.
In late January 2016, all National Cancer Institute (NCI) designated cancer centers released a consensus statement commenting on the vaccination rates. "The low HPV vaccination rates are alarming given our current ability to safely and effectively save lives by preventing HPV infection and its associated cancers."
The 69 NCI designated cancer centers urged all parents to have their sons and daughters immunized for HPV in accordance with recommendations made by the Centers for Disease Control and Prevention (CDC). The recommendations encouraged all young men up to age 21 and young women up to age 26 who are not already vaccinated, to complete the three-dose vaccine series and encouraged all healthcare providers to be advocates for cancer prevention by making strong recommendations for childhood HPV vaccination.
In December 2016, the CDC Advisory Committee on Immunization Practices published an official updated recommendation to allow the use of a two-dose schedule for the HPV vaccination of girls and boys who initiate the vaccination series at ages 9-14 years old, with the second dose given between six-12 months following the first dose.
Studies evaluated by the CDC have shown that two doses of the HPV vaccine given at least six months apart to adolescents at ages 9-14 years worked as well, or better than three doses given to older adolescents and young adults. The three-dose schedule is still recommended for those starting the vaccination at ages 15-26 and should be given over the course of six months.
Currently at Tripler, all clinics are working to update their own policies and procedures to reflect the latest guidance recommended by the CDC.
For women who have received the HPV vaccination, providers also recommend routine Pap smear tests to help detect precancerous cells on the cervix that might become cancer if not treated properly.
For more information on cervical cancer or the HPV vaccination contact your Primary Care Manager at 808-433-2778.
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