Dr. Luisa López-Luciano hangs an immunization schedule in her Homestead family practice office so parents can see whether their children’s shots are up to date.
Along with the more commonly known shots against tetanus, measles and chicken pox, López-Luciano also recommends her young female patients get vaccinated against the strains of human papillomavirus (HPV) that cause most cervical cancers.
“It’s a pretty straightforward conversation,” said López-Luciano, whose practice is affiliated with Homestead Hospital at Baptist Health South Florida. “Most parents are receptive to it once I explain that the vaccine helps prevent against cervical cancer and that it’s best to get started early, before a girl becomes sexually active.”
In the United States, cervical cancer isn’t as common as other cancers because most women have access to regular screenings, such as Pap smears, that can detect its early stages. Cervical cancer also develops over several years, giving doctors plenty of time to detect, monitor and treat abnormal cell growth as long as women go in for regular gynecological exams.
“Most women who develop cervical cancer are those who have never had a Pap smear or haven’t had one in the last four years,” said Dr. Nigel Spier, an obstetrician and gynecologist with Memorial Regional Hospital in Hollywood.
About 12,000 new cases are reported each year, according to the Centers for Disease Control and Prevention; by comparison, more than 200,000 new breast cancers are reported annually. Despite the low cervical cancer rates, doctors recommend that young girls get the HPV vaccine as an added safeguard — and to avoid uncomfortable and potentially invasive procedures later on.
“The greater impact of the vaccines will be in terms of the number of patients who have to go through the process of evaluation for abnormal Pap smears or biopsies,” said Spier, adding that women who’ve gotten the shots still need to get regular checkups.
Research shows that more than half of sexually active men and women will, at some point in their lives, become infected with one of the dozens of known HPV subtypes. Normally, the body fights off HPV as it does other viruses without the person ever knowing they had it. In cases where the body can’t clear it, the virus can cause normal cells to turn abnormal, which can then lead to genital warts or cancer.
There are four known high-risk HPV subtypes associated with cervical cancer, two of which are common in the United States. Both of the HPV vaccines on the market, Cervarix and Gardasil, protect against these two high-risk subtypes. Gardasil also protects against some of the most common HPV subtypes that cause genital warts.
The HPV vaccination is given in three shots within a six-month time period. It can be given to girls as young as 9 but is typically recommended at the age of 11 or 12. Women can get the shots up through the age of 26, but it’s unclear how effective they are if a woman is already sexually active.
“The idea behind the vaccine is that you’d hopefully get it before you’re exposed to HPV, and women and men are exposed through sexual contact,” said Dr. John Diaz, an assistant professor in the division of gynecologic oncology at Sylvester Comprehensive Center at the University of Miami Miller School of Medicine. “By the time a woman sees someone like me, the horse has left the barn. Pediatricians are really on the front lines of this.”
Dione, a Miami native who declined to give her last name, was in high school when she first heard of the vaccines from television commercials about six years ago. Her older sister, a physician, encouraged her to get vaccinated.
“I’m actually glad I was encouraged to do it, especially because you hear stories about people my age who have to go through scary moments and things that I’m glad I don’t have to go through because I got the shots,” said Dione, who is 24. “Whether or not someone wants to discuss that people in high school and college are getting sexually involved, even if a parent is squirmy about talking about it, they should.”
Spier empathizes with parents’ natural unease when talking about their children and sex.
“My approach is that, well, obviously we would all prefer our kids to delay sexual activity until they’re in a long-term committed relationship with someone with whom they plan to raise a family,” he said. “But the reality is that in today’s society the majority of the time it’s not what happens. We have to be responsible in limiting risk and exposure.”
Monica, a Miami mother who declined to give her last name, said that many of her friends who are also parents have expressed more concerns about the vaccine’s potential side effects than an uncomfortable sex talk. Like many vaccines, the HPV shots can be painful and many girls report feeling dizzy after receiving the shots.
Still, Monica said she was glad to follow her pediatrician’s advice to get the shots for her 13-year-old daughter.
“It made sense to me as a preventative measure,” she said. “I’m all for it if it can prevent cancer.”