It's time for my 12-year-old daughter's yearly doctor visit, but first I have to decide where we stand on HPV. It should be a no-brainer: The Centers for Disease Control and Prevention recommends that all 11- and 12-year- old girls be vaccinated against the sexually transmitted human papillomavirus, which infects 80 percent of women. The vaccine protects against four HPV types, two of which cause genital warts and two of which are responsible for 70 percent of cervical cancers. But I'm worried—and her pediatrician agrees—that the protection will wear off before she might need it.
Since I don't like flouting government health recommendations, I figured I'd find out the rationale behind them. Researchers believe that most of the HPV infections eventually leading to cervical cancer are acquired soon after a woman becomes sexually active, often in her late teens or early 20s. Another factor is that the $360 cost of the three injections will be picked up by the government for uninsured girls; adults often don't qualify for such programs.
Untested. But no one knows exactly how long Gardasil, the only vaccine currently on the market, will be effective. It's only been studied for about six years. Many experts believe that a booster will be needed before or around the 10-year mark. More disturbing, while the vaccine has been tested for safety in girls as young as 9, there's no ironclad proof that it even works in preteens. "The efficacy trials of this vaccine didn't include anyone under age 16," says gynecologist Diane Harper, a professor of women's and gender studies at Dartmouth College who conducted some of the trials. Assuming that the vaccine does work in younger girls, she adds, it doesn't matter whether they're vaccinated at age 11, 13, or 17—though better that it happen before they're sexually active.
Harper tells me she's far more concerned that the vaccine, which was tested only in women up to age 26, isn't approved for those ages 27 and above. "It's absolutely artificial to say that we shouldn't vaccinate older women," she contends, or that the vaccine only works in virgins. Half of the women she inoculates are in their 30s, 40s and 50s, many hitting the dating scene again after divorcing or becoming widows. Although the vaccine doesn't do any good against active infections, HPV goes away on its own about 75 to 95 percent of the time. That means women can get infected, have the virus clear from their system and then get infected again. In fact, British research found that 21 percent of women in their 50s, who were HPV-free at the beginning of the study, tested positive for the virus three years later. The potential benefits of expanding vaccination are huge. Statistical models show that if all females ages 12 to 26 were given the vaccine, the incidence of cervical cancer would be reduced by half in 25 to 30 years; adding women to age 55 would achieve the same result in a decade.
HPV vaccine researcher Kevin Ault, an associate professor of obstetrics and gynecology at Emory University School of Medicine, vaccinates beyond the age limits on a "case-by-case basis." A patient may be a good candidate if she's having unprotected sex with a new partner. She also has to be willing and able to pick up the tab, since insurance won't cover women for whom it's not recommended. A fix for this problem may come soon: Gardasil is likely to be approved for women up to age 45 if ongoing studies show it's effective. And a new vaccine called Cervarix could be approved by the Food and Drug Administration in January for both younger and older women since the manufacturer's trials show the vaccine to be effective in women up to age 55. As for vaccinating my daughter, I've decided to wait a bit longer, and perhaps I'll include her in the decision.