Washington, DC — Girls ages 11 to 12 should receive either of the two FDA-approved vaccines to prevent cervical cancer, ideally before they become sexually active, according to The American College of Obstetricians and Gynecologists. In its recommendations issued today, The College emphasizes that routine Pap screening is still necessary for all women beginning at age 21, including those who have had the cervical cancer vaccine.
Cervical cancer is caused by HPV, a sexually transmitted viral infection. More than 100 different strains of HPV have been identified, 15 of which are associated with cervical cancer. Approximately 70% of cervical cancers are caused by just two strains—HPV 16 and 18. About 90% of genital warts, another consequence of HPV infection, are associated with two other strains known as HPV 6 and 11. There are now two HPV vaccines approved by the FDA. The Cervarix® vaccine protects against the cancer-causing HPV strains 16 and 18. The Gardasil® vaccine protects against HPV 16 and 18, as well as HPV 6 and 11.
“The ideal time for girls to receive the HPV vaccination is before they become sexually active and become exposed to HPV,” said Diane F. Merritt, MD, chair of The College’s Committee on Adolescent Health Care. “For this reason, we recommend that girls get vaccinated by age 11 or 12 and possibly as early as age 9, depending on risk factors. For those already sexually active, we also recommend the HPV vaccination for adolescents and young women up to age 26.” Dr. Merritt said it’s important to tell patients that vaccination may be less effective if they have already been exposed to HPV. “We don’t know yet whether the HPV vaccines are going to be useful to women over age 26, but research is ongoing.”
The College does not recommend HPV testing for adolescents or young women before vaccination. There are no reliable, widely available tests to identify specific HPV strains, Dr. Merritt pointed out. “More importantly, it’s unlikely that someone would have been exposed to all of the HPV strains that the vaccines protect against, so testing is somewhat pointless.”
Adolescents and young women who have had genital warts or cervical dysplasia can get the HPV vaccine but the benefits may be limited. HPV vaccination is not recommended during pregnancy, and Dr. Merritt noted that patients should be counseled to use contraception until the vaccination period is complete. If pregnancy occurs during the vaccination period, the series should be stopped and resumed after birth. Breastfeeding women can get the HPV vaccination.
Committee Opinion #467, “Human Papillomavirus Vaccination,” is published in the September 2010 issue of Obstetrics & Gynecology.
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The American College of Obstetricians and Gynecologists is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of approximately 53,000 members, The American College of Obstetricians and Gynecologists strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care.