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HPV Vaccine for Childhood Cancer Survivors

Human papillomavirus (HPV) is a common virus that can cause 6 types of cancer. HPV vaccination can prevent more than 90% of cancers caused by HPV.

Cancer prevention is particularly important for childhood cancer survivors. Several studies have shown that as childhood cancer survivors become older, they have a slightly higher risk of developing a second cancer compared to people their same age in the general population.

What Is HPV?

HPV will affect 80 percent of people in their lifetime. Nearly all sexually active men and women get HPV at some point in their lives. HPV infects about 14 million people each year in the U.S. The second most common sexually transmitted infection is chlamydia with about 3 million new cases annually.

About 90 percent of HPV infections go away within a year or two, occur without any symptoms, and do not cause cancer. A strong immune response will help to clear most HPV infections.

However, some immune systems are not able to fight HPV. If the infection persists for many years, it can lead to cancer.

HPV can cause 6 types of cancer:

  • Anal
  • Cervical
  • Oropharyngeal (mouth and throat)
  • Penile
  • Vaginal
  • Vulvar

HPV is the leading cause of cervical cancer in women. After tobacco and alcohol, HPV causes more cases of oropharyngeal (throat) cancer in men.

What is the HPV Vaccine?

A vaccine helps your immune system fight certain infections. The HPV vaccine causes the immune system to produce antibodies that protect the body from HPV infection.

The American Cancer Society recommends that boys and girls between the ages of 9-12 get the HPV vaccination, including childhood cancer survivors.

The HPV vaccine is most effective when given before exposure to HPV, which is spread through intimate sexual contact. The best time to vaccinate against HPV is ages 11-12. The immune response is best at these ages. Almost all children will not have been exposed to HPV. Children have the strongest immune response before age 16.

Children should get the HPV vaccine even if it is not required for school attendance. HPV vaccination at ages 11-12 ensures you will have the best protection against HPV cancers. HPV vaccination is safe, it works, and it lasts.

Childhood cancer survivors should get the HPV vaccine. The best time to vaccinate against HPV is ages 11-12.

Childhood cancer survivors should get the HPV vaccine. The best time to vaccinate against HPV is ages 11-12.

If someone was not vaccinated between ages 9-12, vaccination is approved through age 26 for everyone and for some people who are 27-45 years old.

For healthy children ages 9-14, HPV vaccination is given through 2 doses over a 6-month period if the first shot is given before the 15th birthday.

However, cancer survivors, other children with weakened immune systems, and people ages 15-26 require 3 doses.

Why Do Cancer Survivors Get 3 Doses of HPV Vaccine?

Even though CDC has recommended just 2 doses of HPV for kids under 15 years, children who have had cancer require 3 doses because they have a health condition that can weaken the immune system.

How HPV Is Spread

More than 200 types of HPV exist. Of those, 40 types are easily spread through sexual contact, including vaginal, anal, or oral sex or finger-to-genital contact. Direct sexual contact of the skin and mucous membrane causes the virus to transfer from an infected person to a partner.

Types of HPV

There are two types of HPV:

  • High-risk HPVs: These types can cause cancer. HPV types 16 and 18 cause more than half of cervical, anal, mouth, throat, and vaginal cancers. HPV types 31, 33, 45, 52, and 58 cause an additional 14% of cancer in females and 4% in males. These types are all covered by the HPV vaccine.
  • Low-risk HPVs: These types do not cause cancer. They can cause skin warts in the genital, anal, lips, mouth, tongue, and throat areas. HPV types 6 and 11 cause 90% of genital warts cases and most cases of recurrent respiratory papillomatosis (warts in the airways). These two types are also covered by the HPV vaccine.

An infected person can still pass HPV to other people even if the infected person’s immune system eventually clears the infection. The other person’s immune system may not be able to. People who do not have symptoms of HPV can spread HPV to another person and symptoms may develop in that person.

The Centers for Disease Control and Prevention (CDC) estimates that 80% of sexually active women and more than 90% of sexually active men will become infected with HPV– half with a high-risk or cancer-causing type of HPV. About half of the population (both males and females) are currently infected with HPV (42.5% of females aged 14-59, 53.8% females aged 20-24, 52-69% of males aged 18-70).

Ways to Prevent HPV

To prevent HPV, survivors should:

  • Get vaccinated. The HPV vaccine is safe, effective, and durable.
  • Use condoms the right way during sexual intercourse. This will lower risk of getting HPV but not all areas are covered by a condom.
  • Be in a mutually monogamous relationship – or have sex only with someone who only has sex with you.
  • Participate in routine Pap tests to screen for cervical cancer. Women between the ages of 21 and 29 should be tested every 3 years. Women ages 30 through 65 can be tested every 5 years with the combined Pap and HPV, or every 3 years with the Pap test alone.

Myths and Facts about HPV Vaccine

Because HPV is associated with sexual activity, there are a number of myths about the infection, how it is spread, and the effects of the vaccine itself.

  1. Fact: The HPV vaccine is one of the safest vaccines on the market.

    According to the National Cancer Institute, no serious side effects have been shown from HPV vaccines. The most common problems are similar to those experienced with other vaccines — pain, tenderness, redness, or swelling at the injection site. A headache may also occur.

    By law, the Food and Drug Administration (FDA) determines that any vaccine must be safe and effective before it is licensed and used.

    The CDC and the FDA are continually monitoring the safety of all vaccines on the market to ensure no new or late-onset side effects are occurring in the population. The Vaccine Adverse Event Reporting System (VAERS) captures information regarding reactions from vaccines. Contact your healthcare provider and use the online form or downloadable form to report a reaction.

    People who are currently ill should wait until the infection has cleared and have not had fever for at least 24 hours prior to receiving the vaccine.

    Pregnant women should not have the vaccine because it has not been sufficiently tested during pregnancy. Anyone with a severe allergy to yeast or aluminum should not receive the vaccine. Allergic reactions to the vaccine may include hives, breathing difficulties, and weakness. Other reactions to the vaccine that would warrant immediate healthcare attention would be a high fever or change in behavior.

    The most common side effects were dizziness, fainting, headache, nausea, and fever. Additionally, in the shot arm, pain, redness and swelling were reported.

    As fainting can be associated with any vaccination, it is recommended that the vaccinated patient be seated or lie down for up to 15 minutes after vaccination.

  2. Fact: The vaccine has been available since June 2006. Continued studies and monitoring of the vaccine show only rare side effects and late effects.

    Over 100 million doses of the HPV vaccine were distributed in the United States from June 2006 through December 2017. In a 10-year follow-up study, the vaccine was found to be extremely safe. Dozens of additional studies have looked into possible associations with a number of autoimmune disorders, such as Multiple Sclerosis (MS), as well as Guillian-Barre Syndrome, postural orthostatic tachycardia syndrome (POTS), chronic regional pain syndrome (CPRS), and chronic fatigue syndrome and have found no increased risk for those who receive the HPV vaccine.

    For more information, read the 2020 New England Journal of Medicine article on HPV Vaccination and the Risk of Invasive Cervical Cancer.

  3. Fact: There is no increased risk of death following the HPV vaccine.

    The CDC and the Vaccine Safety Datalink have conducted studies investigating reported deaths following the HPV vaccine. The majority of deaths following vaccine were confirmed to be unrelated to the vaccine (e.g., accidents, suicide, etc.) and that there was no evidence to suggest HPV vaccine can cause death.

  4. Fact: Men get HPV-related cancers, too, and also need the vaccine.

    Almost 20,000 men get cancers caused by HPV every year in the U.S. That is 43% of all HPV-related cancer cases. These figures are on the rise in young adult males. The most common HPV-related cancer for men is oropharyngeal (throat) cancer, but men can also get cancers of the anus and rectum, mouth, and penis. And unlike cervical cancer in women, there are no routine screening tests for these cancers. That means they are often detected at a later stage when the cancers become more difficult to treat.

    Males also get and pass on the types of HPV (types 6 and 11) that cause genital warts.

    Males can pass HPV to their partner, even if they aren’t showing any signs or symptoms of HPV.

    For more information on the cancers associated with HPV, visit the CDC’s U.S. Cancer Statistics Data Brief on the topic.

  5. Fact: The vaccine is most effective when given before sexual activity begins.

    HPV vaccines offer the best protection to boys and girls who complete the series of immunizations and have time to develop a strong immune response well before they begin sexual activity with another person.

    Vaccination prior to sexual activity provides the strongest correlation to prevention. Most new infections are found among those who are newly sexually active. It’s important to remember that sexual activity can mean a lot of things. Even using hands to explore genital areas can result in transmission – but penetration has consistently been thought to be the source of most transmission.

  6. Fact: Each dose is exactly the same.

    No matter the sex of the patient or the timing when a patient receives a dose of the vaccine, doses are the same.

  7. Fact: Clinical evidence finds no connection between increased sexual activity and the HPV vaccine.

    A number of respected studies have looked closely at this issue. Each has concluded that the HPV vaccine does not have any effect on sexual behavior and should not keep parents from vaccinating their children.

  8. Fact: The HPV vaccine is on the CDC schedule of recommended vaccines.

    Because schools don’t require the vaccine, that doesn’t mean it’s not necessary. The CDC recommends HPV vaccination. It is important to vaccinate at ages 11-12 if possible or as soon as practicable.

  9. Fact: There isn’t a need to discuss specifics with children when they get this vaccine.

    As with other shots such as Hepatitis B (Hep B), MMR (measles, mumps and rubella), TDaP (tetanus, diphtheria, and pertussis also known as whooping cough), inform children that the shots are being provided to keep them healthy and, in the case of HPV, free from worry about HPV cancers.

  10. Fact: Studies find no evidence of a link between fertility issues and the vaccine.

    CDC studies specifically reviewed amenorrhea (when a woman of reproductive age doesn’t have a period) and primary ovarian insufficiency (premature menopause). There were no differences in rates of amenorrhea between the females who received the HPV vaccine and those who did not. From 2009-2015, more than 60 million doses of Gardasil were distributed for use in the United States. During this time period, the Vaccine Adverse Event Reporting System (VAERS) received 17 reports of primary ovarian insufficiency. Fifteen reports were considered hearsay which did not provide enough information to confirm diagnosis. Two reports were from physicians. 

  11. Fact: No correlation has been shown that the vaccine causes cancer. Rather, it prevents cancer.

    The vaccine series prevents infection from the HPV types that most cause 6 types of cancer affecting men and women.

How to Get HPV Vaccine

Ask your child’s primary care provider about getting the vaccine or contact the local health department.

The vaccine is covered by most private insurance plans.

The Vaccines for Children (VFC) program provides vaccines for children ages 18 years and younger, who are uninsured, Medicaid-eligible, American Indian, or Alaska Native. There is no charge for vaccines given by a VFC provider to eligible children.

Any child who is younger than 19 years of age and meets one of the following requirements is eligible for the program:

  • Medicaid-eligible
  • Uninsured
  • American Indian or Alaska Native
  • Underinsured (Means your child has health insurance, but it doesn’t cover the vaccine. There are more than 40,000 health care providers enrolled in the VFC program.)

Additional Information

For more information about the HPV vaccine and its effectiveness in preventing cancer, go to:

Reviewed: November 2020