The U.S. is doing a dismal job of getting young women vaccinated for human papilloma virus (HPV), a strain of viruses that can cause cervical cancer. This is a particularly serious issue in Arkansas, said Kristin Zorn, MD, associate professor in the Department of Obstetrics and Gynecology and division director for Gynecological Oncology, University of Arkansas for Medical Sciences (UAMS).Zorn was in Pennsylvania for eight years before moving to Arkansas in May. She has seen more cases of cervical cancer since moving to Arkansas in a few months than in a couple of years in Pittsburgh, Pa. “We have a lower rate of HPV vaccination than many other parts of the country, and a high rate of cervical cancer in Arkansas,” Zorn said. “It is particularly important to improve the healthcare of Arkansas women and to prevent the next generation from having to suffer from cervical cancer the same way the current generation of Arkansas women have.”The vaccine for the HPV virus, which requires three shots, is remarkably effective, Zorn said. Researchers monitored women vaccinated for abnormal Pap smears and found 98 to 100 percent success rates. That type of extremely high efficacy is so unusual in medicine that researchers watched and waited to see if there were more failures. But there weren’t.“It is really remarkable to me the success that has been achieved,” Zorn said. “The challenge when taking it from the study setting to the practice setting is that conditions are less controlled. Women might not complete all three shots. But too few women are even getting vaccinations to begin with.”Vaccination rates are dramatically lower than in other parts of the world. Most countries have a 70 percent or higher vaccination rate. Rwanda has a 90 percent vaccination rate. “The U.S. has an average rate of 35 percent or lower,” Zorn said. “In the U.S., rates of vaccinations are grouped into four regions. The region with the highest vaccination rate for adolescent girls to receive all three doses is 45-50 percent. The lowest rate is 17.6 to 25 percent. Arkansas is in that group, along with most other Southeastern states.“With boys we are seeing only a one percent vaccination rate. Even with low vaccination rates, however, we already are seeing a dramatic drop in the number of young women who have the highest risk strains of HPV. The prevalence of seeing those strains is lower even with partial vaccination. Already we are seeing in clinical practice a difference with those we are getting vaccinated.”There are a lot of factors in the low vaccination rates in Arkansas. There is a certain very vocal group that opposes vaccinations claiming they aren’t safe and have preservatives that can be harmful.“The anti-vaccine groups have lost sight of the fact we have completely altered the face of human healthcare with vaccination strategies,” Zorn said. “For example, in the past many people suffered from and died of infectious diseases in childhood and adulthood. We have turned the tide with measles, mumps and polio. And we have dramatically reduced suffering and death rates through the use of vaccinations. Because we have been so successful, people have forgotten what it is like to suffer through measles, mumps and polio.”Zorn said another reason is that many people may have not known someone with cervical cancer. And there is a stigma around it because HPV is spread through sexual contact.“Most people who have ever been sexually active have been exposed to HPV,” Zorn said. “The truth is it is part of being human to be exposed to HPV. It is a remarkable revolution in women’s healthcare that we have the ability to prevent the side effects of HPV.”Some women may have had abnormal Pap smears that ultimately cleared up. Only a small percentage go on to have cervical cancer. The FDA has approved the vaccine for females age nine through 26. The 11- and 12-year-old population is targeted because it is better to get the protection in place before sexual activity begins. “People are hesitant about the vaccine because it is associated with sexual activity,” Zorn said. “It is uncomfortable to think of your child becoming sexually active. We want to get vaccines on board before that happens at whatever age. Any skin-to-skin contact can spread HPV. Even a girl who is a virgin on her wedding night can be exposed by skin-to-skin contact or can be infected by her husband.”The vaccine doesn’t treat HPV, but even women who have HPV can still benefit from a vaccination because it can protect against other strains of HPV that they don’t have. If a young woman has had an HPV infection as evidenced by genital warts or an abnormal Pap smear, Zorn recommends vaccination. The vaccines cover the two strains (HPV 16 and 18) that cause 70 percent of cervical cancer cases.“We know from previous studies that it is highly unlikely that the woman is already infected with both,” Zorn said. “She would therefore benefit from being vaccinated against a strain that she doesn’t already have. One the vaccines also includes two additional strains (HPV 6 and 11), which are the most common source for genital warts and contribute to abnormal Pap smears as well.”Zorn advocates that the HPV vaccination become a routine part of healthcare offered. It needs to be commonplace rather than treating it as a special case. “Although early stage cervical cancer is treatable and curable, it could affect fertility if it requires a hysterectomy,” Zorn said. “Even if a woman is done having children, it is a major surgery to go through that pulls women away from work and family life. In more advanced stages, even with surgery, chemotherapy and radiation, there is a possibility we won’t be able to cure it.”Commonly women are in their late 30s and 40s when they are diagnosed with advanced cervical cancer. They are in the prime of life and having to deal with a life threatening disease. “This is one of the most difficult cancers to deal with,” Zorn said. “It metastasizes widely, and can go into the bones and cause tremendous pain. It is a terrible cancer from that perspective. From a personal perspective, I want to see fewer and fewer women with cervical cancer. I want it to be a great rarity to see a woman with advanced stages of cervical cancer that we can’t treat effectively. In my ideal world, we would be preventing the vast majority of cervical cancer, and the few that happen would be caught early through Pap smear strategies.”
