Alarming HPV Statistics for Kansas City
Why an East African nation provides more life-saving vaccinations than Kansas or Missouri
Dr. Barbara Pahud, pediatric infectious disease specialist at Children's MErcy Hospital
Dr. Barbara Pahud shakes her head in disbelief. As a pediatric infectious disease specialist at Children’s Mercy Hospital in Kansas City, she finds it difficult to believe that people aren’t jumping up and down with joy because a vaccination is available that prevents certain kinds of cancers.
And yet, Kansas and Missouri have two of the lowest vaccination rates in the nation.
“I remember thinking, ‘Gosh, imagine when we create a vaccine that prevents cancer,” Pahud says. “The world’s going to go out and celebrate like we did the Royals. Right? Everybody’s going to go out and be like, ‘Yay!’ And yet, here we are at 30 percent rates.”
The vaccine in question is for human papillomavirus (HPV), the most commonly sexually transmitted infection in the United States. It can cause cancers of the genital regions in men and women, as well as cancers of the throat, tongue and tonsils. It is one of only two vaccines that prevent cancer; the other is for the Hepatitis B virus that prevents liver cancer.
The three-dose HPV vaccine, administered over a six-month period, is FDA-approved to be given at age 9, and recommended for preteen boys and girls at age 11 or 12 because, at this age, children have a higher immune response than older teens. Although the vaccine is recommended for men up to age 21 and for women up to age 26, Pahud and other physicians urge that male and female preteens receive the vaccinations in their primary physicians’ offices as a standard health care protocol, like vaccines for diphtheria-tetanus-pertussis, or DTaP.
The HPV vaccine series, covered by insurance, offers lifetime protection for the recommended age ranges.
A Grim Reality
Recent statistics for Kansas and Missouri are actually even grimmer than the 30 percent Pahud quoted. Sitting in an office at Children’s Mercy’s downtown location, she looked up 2016 statistics:
“Rwanda,” Pahud says emphatically.
The area stats beg the question: Why? Pahud and other physicians believe part of the reason begins with educating their own. Some primary care physicians or pediatricians don’t know enough about HPV and the vaccine to urge patients to get their children immunized.
“Some of the ignorance is at the physician level,” admits Terry T. Tsue, physician-in-chief at the University of Kansas Cancer Center and an ear, nose and throat cancer specialist whose waiting room is full of men in their 50s who have throat cancers because of HPV. “I think in modern-day medical school that’s less so. It’s some of the older-school people who aren’t pushing it, but you’re hearing that less and less.”
The conservative nature of Kansas and Missouri, with state governments that mandate DTaP vaccines for school-age children but not for the HPV vaccine, also plays a part, doctors surmise. Eastern and western states, as well as other parts of the country, for example, have much higher vaccination rates. Washington, D.C., Rhode Island and Virginia require the vaccine. However, U.S. rates are significantly lower than other countries, such as Australia (75 percent) and the United Kingdom (84-92 percent.)
Many parents, too, are uniformed here about HPV and therefore do not even know enough to ask for the vaccine, first introduced in 2006. Some hear the opinions of celebrities who are anti-vaccine and believe that rhetoric to be true. And some who do know about the vaccine and request it have been told by their physicians not to worry about it now. Still others worry the HPV vaccine is a sex vaccine that will give their children the green light to engage in sexual activity, and thus, do not want their children to receive it.
“The fear is that, ‘My kids aren’t going to have sex, and if I give it to them, they’re going to have sex,’” Tsue says. “The parents don’t know that it prevents cancer. They just know it prevents (genital) warts, which is a sex disease.”
In truth, studies show that there is no difference in sexual promiscuity outcomes between children who get the vaccine and those who don’t.
Unfortunately, bad press about the vaccine and its safety have stopped many parents from pursuing it for their children, says Tsue, who stresses that the vaccine is as safe as other vaccines approved for U.S. adolescents.
In fact, Pahud is so sure it’s safe that she plans to get her own daughter vaccinated as soon as she reaches age 9.
“What I try to tell parents and pediatricians alike is you don’t want to give the vaccine to a girl who’s already wearing makeup and is all sassy,” Pahud says. “You want to give it to the girl who’s still holding onto her teddy bear and has her ponytails because she’s 9. When you give the vaccine to that girl, there should be no question in that parent’s mind that giving her the vaccine is going to increase sexual activity.”
Dr. Pahud with her Daughter, Laila
How It Works
HPV is a very common and widespread virus that affects both males and females. The Centers for Disease Control and Prevention says it spreads by having vaginal, anal or oral sex with someone who has the virus, even if they have no signs or symptoms. Anyone can get HPV, even if they have had sex with only one person. There is no test to find out a person’s HPV status.
According to promotional materials in a “Stick It to HPV” campaign underway by KU Cancer Center and Children’s Mercy designed to get the word out about the importance of kids getting vaccinated, most sexually active adults will get HPV at some point in their lives, with 90 percent of cases clearing without medical intervention. Because HPV is typically asymptomatic, HPV infection can persist and develop into harmful cancers, including cervical cancer and cancer of the genitals, anus, mouth and throat. About 20 million people in the United States are infected with HPV annually, and infection rates are increasing by about 5 percent a year. The death of actress Farrah Fawcett from anal cancer has been linked to HPV, and actor Michael Douglas survived a harrowing HPV-related tongue cancer.
By 2020 worldwide, HPV-related throat cancers will surpass the 500,000 gynecological cancers caused by HPV worldwide, Tsue says.
“It’s because we’re so far behind,” he says. “We’re just protecting people 20 years down the line. We haven’t been protecting people 20 years beforehand, and they’re getting this cancer. So now my waiting room that used to be filled with tobacco-smelling, older alcoholic men is now filled with attorneys, doctors, businessmen. It’s higher socio-economic, and the risk factors are male, Caucasian or North American, or northern European descent. Usually the median income is greater than $60,000. So it’s a completely different demographic getting this disease now. It’s not something you can sweep away.”
With 150 or more strains of HPV, the vaccination protects against the strains that most commonly cause these cancers. The vaccine has been carefully studied for many years by medical and scientific experts, who have concluded that there is no data to suggest that getting the vaccine will have an effect on future fertility. However, women who develop cervical cancer could require treatment that would limit their ability to have children.
“This virus is the known cause of several types of cancer, of which female cancers are the best known and most public,” Tsue says. “People know that HPV causes cervical and anal cancers, and many are afflicted by that, and many have died from that disease.
“But there still is that lack of education in the public about what HPV is, especially in guys. I mean, this has been a female disease and so guys really haven’t learned that much about it. So what is happening is in the last 10 to 15 years there has been this explosion of an epidemic of HPV-related throat cancers. Three times more men than women get this disease. They usually present in Stage 3 and 4, so they usually present very late in the disease. Although the survival is better than if someone had a smoking-related throat cancer, we still have 80 percent survival in five years or so, which means 20 percent of these people are still dying of this disease.
“The sad thing is it is very preventable.”
It takes 10 to 20 years for the cancers to develop, much like smoking.
“So if you get exposed to this virus, certain strains of this virus, and that virus sets in and you don’t know it, then you won’t develop that cancer until 20 years later,” Tsue explains. “But if you have the vaccine prior to exposure, then it’s protective against that. So it truly is a cancer vaccine.”
Like Pahud, Tsue believes it is illogical for a parent not to have their child vaccinated.
“We have pap smears for female cancers, but for throat cancers, we don’t have anything like that,” he explains. “The next thing you know, you have cancer. If your spouse or partner has HPV-related cancer, you’re two to three times more likely to get cancer from HPV. We have no screenings. That’s why it presents so late.”
In fact, dentists are often the first to notice throat cancers because they present as a neck mass.
Tina Hillhouse’s Story
Tina Hillhouse, 51, of Overland Park, contracted HPV in an unusual way and wishes she had had an HPV vaccine in her youth. She was diagnosed five years ago with Stage 3 tonsil cancer. A medical aesthetician, she believes she was exposed to the virus while performing a laser ablation on a patient with warts on her hands. She didn’t wear a mask.
“Her DNA and mine didn’t mix,” Hillhouse says. “I inhaled. The very next day, I had a clear outbreak of blisters in the back of my throat.”
Now cancer-free, she wouldn’t wish what she went through on anyone. Her hellish treatment included surgery, chemotherapy and radiation, and resulted in lost teeth.
“Even in the last year I’ve lost another tooth,” she says. “It’s just kind of a gift that keeps on giving.”
Hillhouse is making sure her daughter gets vaccinated.
“She is 14 and has had the second round and will go in for the third round in six months,” Hillhouse says.
A simple Google search on HPV reveals scary headlines that may influence reluctant parents: “HPV Vaccine Is Associated with Serious Health Risks,” “Ten Good Reasons to be Concerned about the Human Papillomavirus Vaccine” and “American College of Pediatricians Latest to Warn of Gardasil HPV Vaccine Dangers.”
To that, Pahud and Tsue both utter an emphatic, “Pshaw.”
“I’ve only had a few people say, ‘I’m not going to get it because of some crazy website,” Tsue says.
“What I keep telling my residents when I give talks is, ‘Life happens in spite of vaccinations,’” adds Pahud. “So if you were going to get a vaccine and then were in a car crash, the vaccine did not cause the car crash. If you were going to get a brain tumor and you had a vaccine two months prior, it doesn’t mean the vaccine cause the brain tumor. And you can replace brain tumor with anything — autism — whatever.”
Parents are caught up in social media, which hurts the vaccine push, Pahud says.
“Half of what you read is junk, a lie, but how are parents to know?” she asks. “How are they going to weed that out? We have to combat social media, but we also have to educate our physicians so that when parents come, they can educate them.”
And people need to realize that the HPV vaccine is not a sex vaccine.
“We need to get past that stigma,” Pahud says. “This is cancer.”
National Cancer Institute-designated cancer centers have recognized that low rates of HPV vaccination as a series public health threat, so all 69 have issued a call to action urging HPV vaccinations. The NCI says each year in the United States, 27,000 men and women are diagnosed with an HPV-related cancer, and that must stop.
By the end of this decade, the U.S. Department of Health and Human Service’s Healthy People 2020 hopes to reach the goal of an 80-percent vaccination rate. According to a 2015 CDC report, nationwide only 40 percent of girls and 21 percent of boys are receiving the recommended three doses of the HPV vaccine.
Locally, in addition to the Stick It to HPV campaign, KU Cancer Center has implanted a taskforce for which Dr. Melinda Wharton, director of the CDC’s National Center for Immunization and Respiratory Diseases, has three times visited here to address the issue.
And Pahud is working to develop a nationwide HPV curriculum for medical residents. Recently receiving a $500,000 grant from Pfizer, the curriculum will be piloted in 10 medical schools.
“We’re all trying to do what we can, where we can,” she says.