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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

12 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

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