Ask the doctor: Why vaccinate girls when cervical cancer occurs in older women?

Dear Dr Ombeva,

I have heard that the government wants to start cervical cancer vaccination for all girls. But I hear the cancer occurs in older women. Why not vaccinate older women instead? Some people say the vaccine is to make the girls not give birth in future, as a means to family planning. What is your take on this?

Response:

Cervical cancer is the second most common cancer in women after breast cancer. The Kenya Cancer Registry reports about 5,000 cases annually with about 3,000 deaths.

Unlike breast cancer, cervical cancer has an effective prevention through vaccination. Human Papilloma Virus, also called HPV, is the virus that causes cervical cancer. It is sexually transmitted.

HPV can be contracted after one exposure with an infected person. This means any prevention must be done before one is exposed to the virus, meaning preferably before first sexual exposure, hence the goal to vaccinate girls not yet sexually active.

Usually, infection is silent but, in some instances, it may have long term consequences like warts and cancer of the anus, throat and genitalia in males and females. There is no way of predicting who among those infected will progress to cancer.

Screening (Pap smear) only detects already transformed cells on their way to becoming cancerous. There are several HPV serotypes, but 70 per cent of cervical cancer follows types 16 and 18, and these are the target of the vaccine, though now the vaccines have been improved to cover warts, anal and penile and vulvo-vaginal cancers.

HPV vaccines have been found in long term follow up studies from the countries that introduced it into their schedules to prevent infection with HPV and associated warts and cancers. The safety profile of the vaccine is good, they are safe.

Reports of fainting after vaccine are anxiety related and are also known to occur in older children and adolescents receiving other vaccination or other medical treatments. The widely circulated claims by anti-vaccination campaign groups of the vaccine causing harm, infertility, sterility, impotence and death are false and have no causal effect from receiving the vaccine.

The Ministry of Health (MoH) is introducing Gardasil 4 vaccine into the routine schedule from July 2019. The vaccine is not new in Kenya and has been available in private hospitals and clinics since its introduction by the World Health Organisation.

The MoH will offer it initially to girls from 10 years of age. Please take all your girls for vaccination, and encourage your friends to do so.

Women up to 45 years of age can benefit from the vaccine as well, and those above 14 years of age can purchase the vaccine from private facilities, because the free government vaccine will target girls 10-14 years of age. 

Dr Ombeva Malande is a specialist paediatrician. You can reach him on [email protected]