When the Centers for Disease Control and Prevention recommended a half-dozen years ago that preteen girls be vaccinated against human papillomavirus, two things happened.
A lot of parents and some conservative groups were jarred by the idea of immunizing young girls against a sexually transmitted virus. And uptake of the vaccine has been poor — only about a third of 13- to 17-year-old girls have gotten the full three-shot series.
Now, in the wake of a CDC expert panel's recommendation to extend vaccination to 11- and 12-year-old boys, there's reason to think things might be different this time.
"There's been a surprisingly muted reaction," says Dr. Don Dizon, a Brown University oncologist. "We tend to believe that girls are chaste and are going to 'save themselves for marriage.' But, you know, sexual activity is something that's almost expected of boys."
Seventeen-year-old Connor Perruccello-McClellan agrees. The idea that teenage girls might have sex is "just a touchy issue, a taboo, I guess," he says. "It's just not as accepted for girls."
Perruccello-McClellan, a senior at Providence Country Day School in Rhode Island, is among the 1 percent of U.S. males who have already been vaccinated against HPV. That's because Rhode Island has one of the nation's most aggressive campaigns to vaccinate schoolchildren against nine different infections, including HPV.
Still, like most people, he thought HPV vaccine protects only against cervical cancer — a notion that may have abetted the double standard associated with it.
Cervical cancer is why the vaccine originally got approved. But that's not the whole story. HPV causes a half-dozen different kinds of cancer, and some are gender-neutral.
Some of these malignancies are sex-specific: cancers of the cervix, vagina and vulva in females; penile cancer in boys; both get HPV-associated genital warts.
But both sexes get anal cancer linked to HPV — sometimes without ever having had anal sex. That's because the virus can migrate from the genitalia. And even though anal cancer is thought to be mainly a risk among men who have sex with men, more women get it than men.
But Dizon worries most about cancers of the head and neck — devastating, often disfiguring and hard-to-treat malignancies that used to be strongly linked to smoking and alcohol abuse.
"There's an epidemic of head and neck cancers, and we are seeing this increase in ... nonsmokers," he says. "And it's being tied to HPV."
The fact that HPV is linked to a variety of cancers has important implications for vaccination strategy. For one thing, it's clear that HPV is not just transmitted through sexual intercourse.
"Diseases like HPV or herpes are skin-to-skin transmitted," says Dr. Michelle Forcier, a specialist in adolescent medicine at Hasbro Children's Hospital in Providence. "So while condoms are very effective in preventing transmission, it's not 100 percent."
There's a whole range of sexual behaviors that can transmit HPV, many of them the kinds of things teenagers experiment with. That makes it tricky to wait until kids are just about to have sex before vaccinating them. To be protected, they need three shots of HPV vaccine over a six-month period.
"But teens don't plan when they have sex," Forcier says. "They don't go to their mom and dad and say, 'Oh, I'm 16 now and I think I'm going to have sex in the next six months, so I'd better get vaccinated.' "
That's why the experts are saying to parents of both sons and daughters that it's better to get ahead of the game.
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STEVE INSKEEP, HOST:
Now we'll get a look at a medicine that experts agree on, a vaccine that protects against a sexually transmitted virus called HPV. An advisory panel of the Centers for Disease Control and Prevention recently recommended that 11 and 12-year-old boys get the vaccine. The CDC has recommended it for preteen girls for six years. That's been controversial. But NPR's Richard Knox says it may be a different story when it comes to boys.
RICHARD KNOX, BYLINE: In Rhode Island, the Health Department's been recommending that boys get the HPV vaccine for a couple of years now. And it's routinely given out in high schools throughout the state.
CONNOR PERRUCCELLO-MCCLELLAN: I am Connor Perruccello-McClellan. I am a senior at the Providence Country Day School.
KNOX: I asked Connor if he's heard of HPV.
PERRUCCELLO-MCCLELLAN: I have. I have.
KNOX: What does it stand for?
PERRUCCELLO-MCCLELLAN: Human papillomavirus.
KNOX: Have you been vaccinated against it?
PERRUCCELLO-MCCLELLAN: I have. Last year, when I was 16.
KNOX: So, what does HPV cause?
PERRUCCELLO-MCCLELLAN: I know in girls, it causes cervical cancer. I don't know what for boys.
KNOX: A lot of people don't know why boys should get this vaccine. One reason is so they don't pass the virus on to girls. Another is it causes a half-dozen different kinds of cancer, including cancer of the penis and other female genital cancers. Both sexes can get anal cancer linked to HPV, even without ever having anal sex. But cancer specialist Don Dizon of Brown University worries most about cancers of the head and neck. Those used to be strongly linked to smoking.
DON DIZON: But we are seeing this increase in the numbers that are developing head and neck cancers in non-smokers, and it's being tied to HPV.
KNOX: Dizon says these are devastating cancers, disfiguring and hard to treat. The key to preventing all these cancers is to vaccinate early.
KENNETH DION: My name's Kenneth Dion. I'm 12 years old, and I go to Delsesto Middle School in Providence.
KNOX: Kenny Dion is in for a routine checkup at Hasbro Children's Hospital in Providence.
KATHLEEN WICKS: Okay, Kenny. We haven't met. I'm Dr. Wicks.
MARGARET DION: That's your new doctor.
WICKS: Very nice to meet you.
KNOX: Kathleen Wicks tells Kenny he has to get three vaccines, and one of them is for HPV.
WICKS: We start at 11 and 12. Okay?
DION: All right.
WICKS: So we give it early, when kids are young, so that it can work into their body and it can have the effect that we want when they're older.
KNOX: Preteens have a stronger immune response to the vaccine than older kids. But the most important reason for giving it at this age is to protect kids before they start having sex. Michelle Forcier says talking to parents about this vaccine can be tricky. She's a Rhode Island specialist in adolescent medicine.
MICHELLE FORCIER: Most parents don't want to think about their 12-year-olds being sexually active. No parent wants to think about their 12-year-old being sexually active.
KNOX: But the fact is, half of all teenagers will start having sex while they're in high school. And most of the time, they'll get infected with HPV within two years. To be protected, kids need three shots of HPV vaccine over a six-month period.
FORCIER: Teens don't plan when they have sex. They don't go to their mom and dad and say, oh, I'm 16 now, and I think I'm going to have sex in the next six months. So I'd better get vaccinated.
KNOX: And HPV is not just transmitted by sexual intercourse.
FORCIER: Diseases like HPV or herpes are skin-to-skin transmitted. So while condoms are very, very effective in preventing transmission, it's not 100 percent.
KNOX: Does that come as a surprise to a lot of people, you think?
FORCIER: Yeah. Definitely. Definitely.
KNOX: So there's a whole range of sexual behaviors that can transmit HPV, including touching down there and oral sex. So experts now recommend routine vaccination for both girls and boys before high school. That makes a lot of parents of preteen girls pretty uncomfortable. But so far, there hasn't been the same kind of reaction about vaccinating boys.
FORCIER: Our culture is a little bit more tolerant of early or premarital sexual activity among males than it is females.
KNOX: Connor Perruccello-McClellan, the 17-year-old we met at the top of this story, agrees.
PERRUCCELLO-MCCLELLAN: It's just a touchy issue, a taboo, almost. It's not as accepted, I guess.
KNOX: For girls.
PERRUCCELLO-MCCLELLAN: Yeah. For girls.
KNOX: Doctors like Forcier hope vaccinating boys will defuse that taboo and make this vaccine just a normal part of growing up. Richard Knox, NPR News.
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INSKEEP: It's MORNING EDITION, from NPR News. Transcript provided by NPR, Copyright NPR.