Do women who have been vaccinated still need to have Pap tests?

Yes. Because these vaccines do not protect against all HPV types that can cause cancer, Pap tests continue to be essential to detect cervical cancers and precancerous changes. In addition, Pap tests are critically important for women who have not been vaccinated or who are already infected with HPV. There could be future changes in screening recommendations for vaccinated women.

How much do these vaccines cost, and will insurance pay for it?

The retail price of the HPV vaccines is approximately $130 per dose.18 However, the actual cost for vaccination may be determined by the clinic that provides the service. Clinics may charge for staff time and the vaccination equipment, for example, or they may have sliding-scale fees that set the cost according to a person’s level of income or insurance coverage.

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The best way to know how much vaccination will cost is to contact the insurance plan or the clinic. Individual or group insurance plans are subject to state laws. These laws generally establish whether insurers should cover the cost of vaccination based on recommendations from the ACIP.

Medicaid covers HPV vaccination in accordance with the ACIP recommendations, and immunizations are a mandatory service under Medicaid for eligible individuals under age 21. Medicaid also includes the Vaccines for Children Program, which provides immunization services for children 18 and under who are Medicaid eligible, uninsured, underinsured, receiving immunizations through a Federally Qualified Health Center or Rural Health Clinic, or are Native American or Alaska Native.

The vaccine manufacturers also offer help for people who cannot afford HPV vaccination. GSK has the Vaccines Access Program Exit Disclaimer, which provides Cervarix free of charge to women who do not have insurance and who have a low income, and who are ages 19 to 25 and therefore too old for the Medicaid Vaccines for Children Program. More information is available by telephone at 1–877–822–2911.

Merck offers the Merck Vaccine Patient Assistance Program Exit Disclaimer, which provides Gardasil for free to people over the age of 19 who do not have health insurance or cannot afford to pay for the vaccine. More information is available by telephone at 1–800–293–3881.

What research is being done on HPV?

Researchers at NCI and elsewhere are studying how high-risk HPV types cause precancerous changes in normal cells and how these changes can be prevented or managed most efficiently. Most of this research has focused on cervical cells in women, but researchers are now investigating these questions in other tissues in which HPV may cause cancer, such as the oropharynx and anus.

NCI is conducting a community-based clinical trial of Cervarix in Costa Rica, where cervical cancer rates are high. This study is designed to obtain information about the vaccine’s longer-term safety, the extent and duration of protection, the immune mechanisms of protection, and the natural history of infection with HPV types other than the types included in the vaccine.

NCI is also collaborating with other researchers on second-generation preventive vaccines and on therapeutic HPV vaccines, which would prevent the development of cancer among women previously infected with HPV. The ideal vaccine strategy would combine a preventive and therapeutic vaccine.

Another prevention strategy that is being explored is topical microbicides. Carrageenan, a compound that is extracted from a type of seaweed and used widely in foods and other products, has been found to inhibit HPV infection in laboratory studies. Clinical trials are under way to test whether a topical microbicide that contains carrageenan can prevent genital HPV infection.

Laboratory research has indicated that HPVs produce proteins known as E5, E6, and E7. These proteins interfere with the cell functions that normally prevent excessive growth. A better understanding of how these proteins interact may help researchers develop ways to interrupt the process by which HPV infection can lead to the growth of abnormal cells.

The FDA-approved tests for HPV infection in women detect viral DNA in cervical cells that are collected during a Pap test. Researchers are trying to find other ways to test for HPV infection that may be faster, more accurate, and less expensive. These new tests may be especially useful in developing countries and medically underserved populations.

Researchers at NCI and elsewhere are also studying what people know and understand about HPV and cancer, the best way to communicate to the public the latest research results, and how doctors are talking with their patients about HPV. This research will help to ensure that the public receives accurate information about HPV that is easily understood and will help people get access to the appropriate tests.

How can people learn more about HPV infection?

The following federal agencies can provide more information about HPV infection:

National Institute of Allergy and Infectious Diseases
Office of Communications and Government Relations
6610 Rockledge Drive, MSC 6612
Bethesda, MD 20892–6612
301–496–5717
1–866–284–4107
1–800–877–8339 (TTY)
http://www.niaid.nih.gov

Centers for Disease Control and Prevention
1600 Clifton Road
Atlanta, GA 30333
1–800–CDC–INFO (1–800–232–4636)
8:00 a.m. to 8:00 p.m. Eastern Time, Monday to Friday
1–888–232–6348 (TTY)
http://www.cdc.gov/std
http://www.cdc.gov/hpv/
[email protected]ov

Source: National Cancer Institute

Selected References

  1. American Cancer Society (2011). Cancer Facts and Figures 2011 Exit Disclaimer. Atlanta, GA: American Cancer Society. Retrieved December 27, 2011.
  2. D’Souza G, Kreimer AR, Viscidi R, et al. Case-control study of human papillomavirus and oropharyngeal cancer. New England Journal of Medicine 2007; 356(19):1944–1956. [PubMed Abstract]
  3. Stanley M. Pathology and epidemiology of HPV infection in females. Gynecologic Oncology 2010; 117(2 Suppl):S5–10. [PubMed Abstract]
  4. Division of STD Prevention (1999). Prevention of genital HPV infection and sequelae: report of an external consultants’ meeting. Atlanta, GA: Centers for Disease Control and Prevention. Retrieved December 27, 2011.
  5. Winer RL, Hughes JP, Feng Q, et al. Condom use and the risk of genital human papillomavirus infection in young women. New England Journal of Medicine 2006; 354(25):2645–2654. [PubMed Abstract]
  6. Koutsky LA, Ault KA, Wheeler CM, et al. A controlled trial of a human papillomavirus type 16 vaccine. New England Journal of Medicine 2002; 347(21):1645–1651. [PubMed Abstract]
  7. Romanowski B. Long term protection against cervical infection with the human papillomavirus: review of currently available vaccines. Human Vaccines 2011; 7(2):161–169. [PubMed Abstract]
  8. Garland SM, Hernandez-Avila M, Wheeler CM, et al. Quadrivalent vaccine against human papillomavirus to prevent anogenital diseases. New England Journal of Medicine 2007; 356(19):1928–1943. [PubMed Abstract]
  9. The Future II Study Group. Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions. New England Journal of Medicine 2007; 356(19):1915–1927. [PubMed Abstract]
  10. Paavonen J, Naud P, Salmerón J, et al. Efficacy of human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine against cervical infection and precancer caused by oncogenic HPV types (PATRICIA): final analysis of a double-blind, randomised study in young women. Lancet 2009; 374(9686):301–314. [PubMed Abstract]
  11. Kreimer AR, Gonzalez P, Katki H, et al. Efficacy of a bivalent HPV 16/18 vaccine against anal HPV 16/18 infection among young women: a nested analysis within the Costa Rica Vaccine Trial. Lancet Oncology 2011; 12(9):862–870. [PubMed Abstract]
  12. Kreimer AR, Rodriguez AC, Hildesheim A, et al. Proof-of-principle evaluation of the efficacy of fewer than three doses of a bivalent HPV 16/18 vaccine. Journal of the National Cancer Institute 2011; published online September 9, 2011.
  13. Steinbrook R. The potential of human papillomavirus vaccines. New England Journal of Medicine 2006; 354(11):1109–1112. [PubMed Abstract]
  14. Slade BA, Leidel L, Vellozzi C, et al. Postlicensure safety surveillance for quadrivalent human papillomavirus recombinant vaccine. JAMA 2009; 302(7):750–757. [PubMed Abstract]
  15. Centers for Disease Control and Prevention. FDA Licensure of Bivalent Human Papillomavirus Vaccine (HPV2, Cervarix) for Use in Females and Updated HPV Vaccination Recommendations from the Advisory Committee on Immunization Practices (ACIP). MMWR 2010; 59(20):626–629. Retrieved December 27, 2011.
  16. Centers for Disease Control and Prevention. Recommendations on the Use of Quadrivalent Human Papillomavirus Vaccine in Males—Advisory Committee on Immunization Practices (ACIP), 2011. MMWR 2011; 60(50):1705-1708. Retrieved December 27, 2011.
  17. Hildesheim A, Herrero R, Wacholder S, et al. Effect of human papillomavirus 16/18 L1 viruslike particle vaccine among young women with preexisting infection: a randomized trial. JAMA 2007; 298(7):743–753. [PubMed Abstract]
  18. American Cancer Society (2010). Human Papilloma Virus (HPV), Cancer, and HPV Vaccines―Frequently Asked Questions: How much does the HPV vaccine cost? Is it covered by health insurance plans? Exit Disclaimer Atlanta, GA: American Cancer Society. Retrieved December 27, 2011.

Topics:

Cervical Cancer Gynecologic Cancers Human Papillomavirus