you're reading...
cancer, HPV, HPV vaccine

HPV vaccine over age 26 – is it worth it?

Currently the HPV (human papilloma virus) vaccines are approved in the United States up to the age of 26. This has nothing to do with safety but due to the fact that the studies submitted to the Food and Drug Administration (FDA) involved this age range. The HPV vaccines were primarily studied in women aged 26 years and younger because age is a significant factor in acquiring HPV. If you want to show that your vaccine can help people you need to study as many of your target population as possible. You also need to make translating your work to the general population practical – doing antibody levels to see who is immune isn’t is an expensive barrier so age became the proxy.

The peak risk of acquiring cancer causing HPV is under the age of 25 so the younger the women the more likely the vaccine will be given before exposure to HPV occurs. That’s why targeting 11 and 12-year-old is important. In addition, the immune response to the vaccine may be more robust around age 11 or 12. However, what if you are 27 and for whatever reason never got vaccinated against HPV or are 38 and the vaccine didn’t exist when you were in the target age range? Could the HPV vaccine be helpful for women over the age of 26?

New data looking at antibodies in the blood against HPV tells us that the risk of having either HPV 16, 18 (the most cancer causing types) or both over the age of 30 is 24% for women with a history of normal pap smears. For those with a history of high-grade dysplasia the risk of having one or both of the viruses jumps to 44%. The highest risk age group for HPV 16/18 is ages 30-39 years – 33% of women in this age range will be positive and if they have a history of high-grade dysplasia it rises to 55%.

The risk of HPV declines after 39, no one know if the natural antibody levels simply drop or if this is due to different cumulative sexual practices in older women (one study shows that antibody levels to HPV 16 don’t decrease with age).

In the study I linked to above the biggest modifiable risk factor for HPV 16 or 18 was the number of sexual partners –  three or more lifetime partners increased the risk six fold. A history of having Chlamydia (a sexually transmitted infection) almost doubled the risk.

It’s easy to see why governments looking for the best impact for each public health dollar have focused on ages 11 and 12. If you get everyone before they are sexually active then everyone can benefit. But what about you as an individual?

There is nothing wrong with getting the HPV vaccine over the age of 26, although in most countries that will mean you have to pay for it yourself. It just means the older you are the less likely you will get the full protection as the risk increases with age that you have already been exposed. Women over the age of 26 who are most likely to benefit would never have had an abnormal Pap smear, have no history of Chlamydia, and have less than three lifetime sex partners. However, 45% of women between the ages of 30 and 39 with a history of high-grade dysplasia will still be negative for HPV 16 and 18 and so almost half will get protection from the HPV vaccine. Australia, a real leader in the fight against HPV, recommends the vaccine for women up to the age of 45. If you want to eradicate the virus getting as many people covered as possible is the way to go.

Given the new vaccine covers nine types of HPV there is a greater chance that more women over the age of 26 regardless of sexual history will get some protection, but whether it’s will be worth the $390 is an individual decision. Since two doses seems to be as effective as three a strategy for women over the age of 26 who are paying out-of-pocket might be to consider 2 doses (which currently costs $260).

However, until we can improve vaccination rates among adolescents in the United States there will be a steady stream of women who have to try to figure out if they want to spend their money on the vaccine or take their chances.

HPVsearch

 

Discussion

29 thoughts on “HPV vaccine over age 26 – is it worth it?

  1. Dr . Gunter I applaud your honesty in telling it like it is, like it or not for those of us who read your tweets or posts. As for my opinion it is absolutely worth the out of pocket cost for someone to get vaccinated. It is definitely not worth the risk in taking your chances on catching something that can destroy the rest of your life physically,mentally, and emotionaly . I think you are fabulous and truly admire your work . Wish I could speak with you personally you are one of the most honest Dr’s. It’s amazing!

    Posted by Anna | May 20, 2015, 9:06 pm
  2. I attempted to post my previous comment as anonymous, but the system wouldn’t let me do so, so please delete it? Thanks.

    Posted by QueerFemme | May 25, 2015, 7:12 am
  3. Thank you for writing on this topic! So many women are “too old” for the vaccine according to their insurance or their doctor…and often are turned down even when willing to pay entirely out-of-pocket, simply because of their age! I know a woman who is in her mid-30s but has never been sexually active. She asked for the vaccine and was declined! When she told me about her experience, I asked my own doctor, and I, too, was declined. Now we’ve got something to show the health care providing naysayers. THANK YOU.

    Posted by Melanie | June 12, 2015, 9:30 pm
  4. I wanted to verify something from this paragraph:

    “New data looking at antibodies in the blood against HPV tells us that the risk of having either HPV 16, 18 (the most cancer causing types) or both over the age of 30 is 24% for women with a history of normal pap smears. For those with a history of high-grade dysplasia the risk of having one or both of the viruses jumps to 44%. The highest risk age group for HPV 16/18 is ages 30-39 years – 33% of women in this age range will be positive and if they have a history of high-grade dysplasia it rises to 55%.”

    You say women age 30-39 are at the highest risk of contracting HPV 16/18 at 33%. But you also say women over the age of 30 are at a risk of 24%. Does this percentage differ because it includes ages over 39 into the mix?
    Thank you.

    Posted by sky | October 18, 2015, 12:44 pm
  5. Will mass. Physicians administer HPV for 32 year old who was treated for mild cervical Dysplasia with negative test for HPV??? I assume insurance will not cover cost.

    Posted by Marilyn | October 26, 2015, 8:06 am
  6. The HPV vaccines last three years, after that a person needs to get revaccinated. Some publisher have incorrectly written that once the patient get the initial HPV vaccine series that this will provides lifetime protection, it does not. I reviewed the clinical trial information in a public lecture (for health care professionals) I attended several years ago. The speaker was one of the physicians who was performing the clinical trials. I appreciate the clarification in this article regarding the age parameters, it is refreshing.

    Do not contact me, I do not reply to emails. Also, if you have questions, it is always best to go to the source, not hear say, or second or third parties.

    Posted by alex barger | December 20, 2015, 6:13 am
    • I have no intention of contacting you! LOL, but your information is completely wrong. The vaccines last much longer than 3 years. And the original articles are, of course, the source.

      Posted by Dr. Jen Gunter | January 16, 2016, 2:38 pm
      • I just completed my cancer treatment for HPV related. 35 radiation and 3 chemo- a brutal treatment with life altering side effects. Why would I not vaccinate now? I’m 59 but would like to eradicate this virus and promote keeping the cancer reoccurrence under check
        Chris

        Posted by Chris Weatherman | May 23, 2016, 5:40 pm
    • Alex,

      Your assertions are incorrect, and your reading comprehension ability is seriously flawed. No offense, but you’re full of shit.

      Posted by Shelly McNeil, MD | August 16, 2016, 12:36 pm
  7. I’m writing a story for REDBOOK about adult vaccines and would like to speak to a woman who chose to get the HPV vaccine after the age of 26. If you or someone you know fits those parameters, please have them contact me ASAP at hollacerschmidt@gmail.com or 440-708-6344. Thank you! Holly Schmidt

    Posted by Hollace Schmidt | July 13, 2016, 4:59 am
  8. Dr. Jen what if someone has been diagnosed w/HPV E6/E7? Would the vaccination still be effective? Would it be as effective to get it now or wait to have a negative test result?

    Posted by Kel | September 8, 2016, 11:35 am
  9. What about HPV vaccinations for men?

    Posted by John | October 26, 2016, 2:34 pm
  10. Hi! I just got the first of the three HPV shots at 32 yrs old. Gonna be protected like whoa from any of the strains I haven’t been exposed to yet. Also, I just got a vaccine against future CANCER how cool is that?

    Posted by Elizabeth Baker | November 6, 2016, 3:06 am
    • Hi Elizabeth,
      Congrats! Where did you meet a doctor who was willing to administer the vaccines to you? I would also like to get the Gardasil 9 shots. thanks. – sarah

      Posted by Sarah | November 4, 2017, 8:30 pm
      • Raleigh Planned Parenthood. So long as you have the cash and acknowledge that the ideal time to administer the vaccine has already passed they’ll go right ahead and get you your cancer vaccine.

        Posted by Elizabeth Baker | November 5, 2017, 6:12 am
  11. i had the injections when i was in school i am now twenty one and have hpv why did it not work

    Posted by sarah | July 7, 2017, 2:59 pm
  12. I am a 47 year old woman in the US who has never had sex. Can I get the vaccine, and shouldn’t insurance pay for it?

    Posted by Julie | August 6, 2017, 4:25 pm
  13. Not sure if this posted or not, since when I logged in it took me back to this page and I didn’t see my comment posted yet. So sorry if this is a repost.

    In Australia the age goes up to 45. Does this mean that Australians conducted studies on this going up to 45 years in age? Why can’t the US use foreign studies for the purposes of verifying a treatment’s effectiveness? It’s not like there’s any reason to expect this will work differently with Australians than with Americans.

    As for the chance of it helping shouldn’t sexual history be taken into account? A virgin at any age can’t have HPV. Someone who is sexually active but with just one partner or not that frequently would also have a better chance of not having HPV or at least not having every strain of it.

    The reason they set the age where they did likely boils down to lack of availability, so they make you pay after age 26. Hence the wealthy get more protection from cancer than the poor. This could be solved by increasing the production of the vaccine. I’m no commie, I think most of the time production decisions should be made by private companies, but in the case of public health the government shouldn’t be shy about stepping in and building the factories and assembly lines themselves to get the job done, and give the private companies a nice eminent domain payment for the intellectual property rights. Sadly they won’t, which is why for example we don’t have a Lyme Disease Vaccine (for humans) in spite of science knowing how to make one. The private sector decided it wasn’t profitable enough, and so they canceled it. Look it up.

    If we had the political will to produce enough we could easily have enough for anyone at any age to get that vaccine and other vaccines.

    Posted by Andrew Miller | October 17, 2017, 12:01 pm
  14. Hello. I am 34, test positive for HPV 16 although I have no symptoms and would never even know I have this virus if it weren’t for the compulsory test I got, have never had Chlamydia or Gonorrhea and have never had an abnormal pap smear. I would like to get the Gardasil 9 vaccine. The question is… how do I convince a doctor to give it to me?? I have asked two of them already and they adamantly say no, and the rationale is always the same and, frankly, not such a good argument: “Your body will clear it, so you don’t need the vaccine. Your body will do it on its own.”

    I have explained that Gardasil 9 prevents against several other dangerous strains of the virus that I do not have, and that it is not dangerous and that I would like to pay for it. To date, two doctors have just shut me down and said no. This is aggravating … I go in with research and a solid explanation, and they withhold it from me.

    Any recommendations?

    Posted by Sarah | November 4, 2017, 8:28 pm
    • My dr is giving me the Gardasil vaccines. I just had the first one a few weeks ago. I am 28 🙂 For whatever reason my previous dr never pushed me to get the vaccine when I was younger but since then I have found an amazing gyno. I had to have a leep procedure done for mild dysplasia, but my dr said it could be beneficial for me to get vaccinated & I would rather not go thru anything like I did this past year. I haven’t had that many partners & I am married but sometimes lady luck is not on your side. I like in SC & go to Lexington Women’s Care in Lexington SC w/ Dr. Brown Price. I hope you find a dr that believes that its never too late to try to prevent something!

      Posted by barbaragrace89 | November 9, 2017, 5:29 am

Trackbacks/Pingbacks

  1. Pingback: Short Answers to Hard Questions About HPV – Credence Nation - April 7, 2017

  2. Pingback: Short Answers to Hard Questions About HPV - Vilvar.Com - April 7, 2017

  3. Pingback: Short Answers to Hard Questions About HPV | 4healthnews.com - April 7, 2017

  4. Pingback: Short Answers to Hard Questions About HPV | GLOBAL JOURNAL - April 7, 2017

  5. Pingback: Short Answers to Hard Questions About HPV – New York Times | | All Breaking News - April 7, 2017

  6. Pingback: Short Answers to Hard Questions About HPV | Flash News Updates - April 8, 2017

  7. Pingback: Short Answers to Hard Questions About HPV – New York Times – News Usa Online - April 8, 2017

  8. Pingback: Short Answers to Hard Questions About HPV – VIPortal Health - April 8, 2017

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

Recent Tweets

%d bloggers like this: