Thank you for this! I'm 48 and though I have a stable partner, new (extra!) partners are a possibility. I've had abnormal PAPs in the past. I'm booking my appointment for the vaccine!
Jul 11, 2023·edited Jul 11, 2023Liked by Dr. Jen Gunter
Thank you Dr.Gunter.I was at at talk you gave in Kingston a few years ago and asked why the upper age limit was only 45.You shared with the audience that you had the vaccine at 52.I believe you hinted that the age cap could be related to misogny.:)I appreciate that you share personal information.It seals the deal for me when a trusted source,like yourself,demonstrates their belief in something!
The ASCCP also recommends vaccination for healthcare workers who may be routinely exposed to HPV, regardless of age. So if you're doing or involved in LEEP procedures, cones, cryoablation, etc. you'd be a candidate as well.
Thank you. This confirms what I was thinking, that the upper age limit had been set owing to biases and assumptions that did not fit me. I wanted the vaccine following divorce from my ex at age 48, but was told no... At 52, and with a new partner, I tested positive for HPV for the first time. I was grateful that my daughters were vaccinated but very frustrated when practitioners said no to me owing to the upper age limit of 45. Now they tell me, "HPV is very slow."
Sorry that happened to you. Typically, it's about 20 years from HPV infection to invasive cancer (assuming someone goes unscreened and un treated). Screening is excellent at picking up people who need treatment and preventing cancer.
Great post! I am 54 years old with a new partner after losing my husband in 2019. Pap was normal but positive for high risk HPV, not subtyped, in 2021. Pap one later was normal with no HPV. Will have my next pap in a month. I will check with my insurance company to see if the vaccine is covered.
This is a very interesting article - thank you. I had genital warts when I was 19 - in 1983. I was treated successfully and they never came back. My PAP smears have always been normal. I'm 58 now. Is there anything else I should do - anything to bring to my doctor in terms of prevention? I am currently in a monogamous relationship with my husband of 9 years. Thank you.
Great post, something I have wondered about after having an abnormal PAP at 52. Typed, not 16 or 18 but took two years to “clear”. Would rather not do that again.
I would like to take a step back and simply appreciate that we have a vaccine that prevents cancer. I mean (singing from the rooftop) PREVENTS CANCER!! But curious, does the vaccine change the schedule for the Pap smear? I’m borderline too old to get any benefit from it (60) but dang would love to never have a pap again.
if a person had hpv as a teenager what is the likelihood of cervical cancer? is there anything i cand o at 50 to avoid it? should i trust that doctors are screening my paps for it properly? thanks.
I frequently offer it to patients "off-label" that are over 45, but most decline since insurance won't pay for it. There's a study out there that supports giving it to any patient diagnosed with CIN2 or above at the time of treatment.
I’m 54 yo and had persistent HPV 16 and HPV other than 16/18 infections for 5+ years. A few months ago my tests came back negative, which was approximately 16 months after my 3rd vaccine dose. My insurance didn’t cover the vaccine which was incredibly offensive to me. Apparently they would rather continue to pay for yearly Paps and colposcopies. Fortunately, I could afford the vaccine but I’m sure many people cannot. Truly grateful to my doctor for strongly encouraging me to get the vaccine.
Finally got around to reading this. Work has been intense this summer. I think you definitely made the right call!
I've been thinking about getting the HPV vaccine myself. I'm 48, male, married to an Ob-Gyn spouse, and both of us I assume are committed and way too tired to mess around. Nonetheless my wife is involved in lots of deliveries/CSx and could theoretically pick up HPV from occupational exposures, careful as she is.
She got the HPV vaccine recently as some of her colleagues were also thinking this way... and like you said it's an insurance policy for lots of unknowns.
I'm not an expert on the HPV vaccine literature, but it would make intuitive sense that boosting the immune system against latent virus would potentially help years later, even in older people who have been exposed to HPV already. This is how Shingrix works against latent VZV.
A best friend's Dad recently died of oral cancer, so that got me thinking, too. Alcohol probably played a role but I digress.
Here's a quick paragraph from Pub Med to chew on:
Data from men and women with a history of HPV-related diseases further support the potential for HPV vaccination to protect adults.6–9 In a retrospective analysis of data from two qHPV vaccine efficacy studies in young women who underwent cervical surgery or were diagnosed with genital warts or vulvar/vaginal disease related to infection present before vaccination (Figure 1), prior qHPV vaccination was associated with a significant reduction (46.2−64.9% for those who underwent cervical surgery; 35.2% for those diagnosed with infection-related disease) in any subsequent HPV-related disease, including high-grade disease.6 Other studies demonstrated that HPV vaccination before and after surgical treatment for cervical lesions reduced the risk of subsequent cervical intraepithelial neoplasia (CIN) grade 2 or higher, related to HPV16/18 (88.2% efficacy 60 days or more post-surgery),8 and the risk of recurrent CIN 2–3 post-surgery was higher in qHPV vaccine non-recipients compared with recipients (hazard ratio [HR] 2.840).9 In a nonconcurrent cohort study of young men who have sex with men (MSM) with a history of anal high-grade squamous intraepithelial lesions (HSIL), a positive oncogenic HPV test was associated with an increased risk of recurrent anal HSIL, while qHPV vaccination was associated with a significant reduction in anal HSIL recurrence within 2 years post-treatment (HR 0.47) when compared with unvaccinated MSM.7
I'm 56 and my female partner of 8 years has HPV, I don't think I ever had it. Should I get vaccinated? Wish a provider had brought this to my attention.
I am 52, I got mine two years ago at 50- same reasoning, I’m divorced, not dead and why wouldn’t I just get it in the event that it worked! I told my doctor you give it to younger women you can give it to me. I told my doctor you give it to younger women you can give it to me
I didn't look up the data for men. For the cervix it takes about 20 years from exposure to invasive cancer, so I wouldn't have bothered getting vaccinated if I were over 70. However, men are at higher risk of mouth and throat cancer, and I don't know the incubation. Also, there is no effective screening. I think you would have to ask someone who is an expert in head and neck cancer.
The info on a potential resurgence during/post menopause pinged my radar. I had genital warts in my early 20s, was treated and they cleared. I have not had a recurrence but do periodically have an abnormal pap that always comes back negative for 16 and 18. I just turned 54 and I have officially hit menopause. Though I have been in a monogamous relationship for the past 17 years and don't foresee any new partners in my future, I am wondering if it's worth considering not only getting the vaccine myself, but having my husband get it?
Thank you for this! I'm 48 and though I have a stable partner, new (extra!) partners are a possibility. I've had abnormal PAPs in the past. I'm booking my appointment for the vaccine!
Let me know if you were able to get an appt. I can’t seem to get a doctor to give it to me.
Thank you Dr.Gunter.I was at at talk you gave in Kingston a few years ago and asked why the upper age limit was only 45.You shared with the audience that you had the vaccine at 52.I believe you hinted that the age cap could be related to misogny.:)I appreciate that you share personal information.It seals the deal for me when a trusted source,like yourself,demonstrates their belief in something!
Hope to make back on book tour in 2024!
The ASCCP also recommends vaccination for healthcare workers who may be routinely exposed to HPV, regardless of age. So if you're doing or involved in LEEP procedures, cones, cryoablation, etc. you'd be a candidate as well.
Yes, that is also true. I had stopped doing those procedures when that recommendation came around.
Thank you. This confirms what I was thinking, that the upper age limit had been set owing to biases and assumptions that did not fit me. I wanted the vaccine following divorce from my ex at age 48, but was told no... At 52, and with a new partner, I tested positive for HPV for the first time. I was grateful that my daughters were vaccinated but very frustrated when practitioners said no to me owing to the upper age limit of 45. Now they tell me, "HPV is very slow."
Sorry that happened to you. Typically, it's about 20 years from HPV infection to invasive cancer (assuming someone goes unscreened and un treated). Screening is excellent at picking up people who need treatment and preventing cancer.
Great post! I am 54 years old with a new partner after losing my husband in 2019. Pap was normal but positive for high risk HPV, not subtyped, in 2021. Pap one later was normal with no HPV. Will have my next pap in a month. I will check with my insurance company to see if the vaccine is covered.
This is a very interesting article - thank you. I had genital warts when I was 19 - in 1983. I was treated successfully and they never came back. My PAP smears have always been normal. I'm 58 now. Is there anything else I should do - anything to bring to my doctor in terms of prevention? I am currently in a monogamous relationship with my husband of 9 years. Thank you.
Great post, something I have wondered about after having an abnormal PAP at 52. Typed, not 16 or 18 but took two years to “clear”. Would rather not do that again.
My same exact experience
I would like to take a step back and simply appreciate that we have a vaccine that prevents cancer. I mean (singing from the rooftop) PREVENTS CANCER!! But curious, does the vaccine change the schedule for the Pap smear? I’m borderline too old to get any benefit from it (60) but dang would love to never have a pap again.
if a person had hpv as a teenager what is the likelihood of cervical cancer? is there anything i cand o at 50 to avoid it? should i trust that doctors are screening my paps for it properly? thanks.
The way to avoid cervical cancer is regular cervical cancer screening so you catch it very early before it's cancer and can have treatment.
I frequently offer it to patients "off-label" that are over 45, but most decline since insurance won't pay for it. There's a study out there that supports giving it to any patient diagnosed with CIN2 or above at the time of treatment.
Yes, I reference the data. I think it si very valid to offer at the same time as treatment.
I’m 54 yo and had persistent HPV 16 and HPV other than 16/18 infections for 5+ years. A few months ago my tests came back negative, which was approximately 16 months after my 3rd vaccine dose. My insurance didn’t cover the vaccine which was incredibly offensive to me. Apparently they would rather continue to pay for yearly Paps and colposcopies. Fortunately, I could afford the vaccine but I’m sure many people cannot. Truly grateful to my doctor for strongly encouraging me to get the vaccine.
Finally got around to reading this. Work has been intense this summer. I think you definitely made the right call!
I've been thinking about getting the HPV vaccine myself. I'm 48, male, married to an Ob-Gyn spouse, and both of us I assume are committed and way too tired to mess around. Nonetheless my wife is involved in lots of deliveries/CSx and could theoretically pick up HPV from occupational exposures, careful as she is.
She got the HPV vaccine recently as some of her colleagues were also thinking this way... and like you said it's an insurance policy for lots of unknowns.
I'm not an expert on the HPV vaccine literature, but it would make intuitive sense that boosting the immune system against latent virus would potentially help years later, even in older people who have been exposed to HPV already. This is how Shingrix works against latent VZV.
A best friend's Dad recently died of oral cancer, so that got me thinking, too. Alcohol probably played a role but I digress.
Here's a quick paragraph from Pub Med to chew on:
Data from men and women with a history of HPV-related diseases further support the potential for HPV vaccination to protect adults.6–9 In a retrospective analysis of data from two qHPV vaccine efficacy studies in young women who underwent cervical surgery or were diagnosed with genital warts or vulvar/vaginal disease related to infection present before vaccination (Figure 1), prior qHPV vaccination was associated with a significant reduction (46.2−64.9% for those who underwent cervical surgery; 35.2% for those diagnosed with infection-related disease) in any subsequent HPV-related disease, including high-grade disease.6 Other studies demonstrated that HPV vaccination before and after surgical treatment for cervical lesions reduced the risk of subsequent cervical intraepithelial neoplasia (CIN) grade 2 or higher, related to HPV16/18 (88.2% efficacy 60 days or more post-surgery),8 and the risk of recurrent CIN 2–3 post-surgery was higher in qHPV vaccine non-recipients compared with recipients (hazard ratio [HR] 2.840).9 In a nonconcurrent cohort study of young men who have sex with men (MSM) with a history of anal high-grade squamous intraepithelial lesions (HSIL), a positive oncogenic HPV test was associated with an increased risk of recurrent anal HSIL, while qHPV vaccination was associated with a significant reduction in anal HSIL recurrence within 2 years post-treatment (HR 0.47) when compared with unvaccinated MSM.7
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10038021/
Think I'm foolish? Ain't nobody messin' around, promise.
Thanks Ryan you’re confirming her reasoning with this research.
I'm 56 and my female partner of 8 years has HPV, I don't think I ever had it. Should I get vaccinated? Wish a provider had brought this to my attention.
I am 52, I got mine two years ago at 50- same reasoning, I’m divorced, not dead and why wouldn’t I just get it in the event that it worked! I told my doctor you give it to younger women you can give it to me. I told my doctor you give it to younger women you can give it to me
Any suggestions or references for men over 70 never vaxed for HPV?
Thank you.
Ed
I didn't look up the data for men. For the cervix it takes about 20 years from exposure to invasive cancer, so I wouldn't have bothered getting vaccinated if I were over 70. However, men are at higher risk of mouth and throat cancer, and I don't know the incubation. Also, there is no effective screening. I think you would have to ask someone who is an expert in head and neck cancer.
The info on a potential resurgence during/post menopause pinged my radar. I had genital warts in my early 20s, was treated and they cleared. I have not had a recurrence but do periodically have an abnormal pap that always comes back negative for 16 and 18. I just turned 54 and I have officially hit menopause. Though I have been in a monogamous relationship for the past 17 years and don't foresee any new partners in my future, I am wondering if it's worth considering not only getting the vaccine myself, but having my husband get it?