US health officials have expanded the recommended age range for people receiving the HPV vaccine to protect against several types of cancer to people in their mid-40s. MSK physician and HPV researcher Abraham Aragones offers advice for people considering the vaccine in their 20s, 30s, and 40s.
The vaccine for the human papillomavirus (HPV) is sharply lowering rates of infection among younger people, especially girls and young women, according to research published in June 2019.
These efforts have significantly reduced precancerous lesions and genital warts among people 15 to 24 years old. Experts believe this means fewer people in the future will develop cancers linked to HPV, including cervical cancer, anal cancer, and some mouth and throat cancers.
There is also encouraging news for people in their 20s, 30s, and 40s who want to protect themselves, as US health officials have made it clear that getting vaccinated later in life can still reduce the risk of getting HPV.
In October 2018, the US Food and Drug Administration announced it had expanded the approved age for the HPV vaccine up to age 45 for women and men. In June 2019, a key advisory committee for the US Centers for Disease Control and Prevention (CDC) recommended the vaccine for all men and women up to age 26. The panel also advised women between 27 and 45 to ask their doctor’s advice about getting the vaccine because it could be beneficial.
So if a person in their 20s or older is considering vaccination, what should they know? And what should they discuss with their doctor? Memorial Sloan Kettering physician Abraham Aragones, a doctor and public health researcher who specializes in HPV and its link to cancer, has some answers.
How common is HPV?
The virus is extremely prevalent. Nearly 85% of adults between the ages of 18 and 65 will have at least one strain of HPV at some point in their life. As many as 50% of Americans have it at any given moment.
For most people, their immune system will fight back and clear the virus, sometimes after a few years. But about 10% of people develop a persistent infection. There are many different strains of the virus, and the most dangerous are HPV16 and HPV18. These are the strains that are most likely to grow into cancer, which can take years or even decades.
Cervical cancer is the disease most associated with HPV. The vast majority of cervical cancer cases are caused by HPV. The virus also causes anal cancer and cancers in the back of the throat, as well as vaginal and penile cancer.
The CDC estimates that every year, about 33,000 cancers caused by HPV are diagnosed.Back to top
The age of people who are recommended to get the HPV vaccine has expanded. What do these age ranges mean?
First, it’s important to know that it’s still best for children to be vaccinated when they are about 11 or 12 years old. That’s the most important age range. Getting the vaccine before first sexual contact protects a person over their entire life.
When the vaccine was approved in 2006, anyone up to age 26 could get it. In October 2018, US health officials said anyone up to age 45 could get it. US health officials have taken a further step and now recommend that anyone up to the age of 26 — man or woman — get the vaccine.
If a person didn’t receive the vaccine as an adolescent, as a rule of thumb, it makes the most sense to get it as early as possible, rather than waiting until later. People tend to have the most sexual partners in their twenties. Also, since HPV-associated cancers often take years to develop, you are protected longer if you get the vaccine when you are younger.Back to top
What should people over 26 consider if they want to talk to their doctor about the vaccine?
People should recognize that life circumstances can change. A monogamous relationship may end and a person may start dating again. Getting the vaccine later in life won’t cure HPV if a person already has it. But if a person has one strain of the disease, getting vaccinated will protect against other strains, which may include the high-risk forms.
I weighed some of these factors after I was divorced. I decided it made sense to get lifelong protection. So I got the vaccine as a man in my early 40s.
It’s also worth pointing out that people are living longer. Newly diagnosed cases of sexually transmitted diseases are on the rise among older people, meaning that sexual activity when older is not free of risk. HPV among unvaccinated older people could very likely be rising as well.Back to top
Are there reasons to not get vaccinated later in life?
Women who are pregnant are recommended to wait, as is true of many vaccines.
For the rest of the population, this is an incredibly safe and helpful vaccine. The benefits far outweigh any potential risks, which have proven to be negligible. It’s also important to understand that the vaccine’s safety record is based on strong data from a very large number of people who have received the vaccine.
There have been concerns that supplies of the vaccine may be in low in some countries where rates of HPV and cervical cancer are particularly high, such as in many parts of Latin America.
However, there is plenty of vaccine in the United States. And it’s not clear that adequate supplies in one country will solve a shortage in a different country. Pharmaceutical markets are not that simple.
One of the most serious drawbacks to getting the vaccine later in life is cost. The vaccine costs around $600 and many insurers do not cover it after adolescence. However, that appears to be changing recently. And with federal health officials expanding the recommended age range for vaccination, more insurers are expected to cover it.Back to top