OMA Spotlight on Health

Human Papillomavirus (HPV) and vaccination with Dr. Amanda Selk

October 08, 2020 Ontario Medical Association Season 1 Episode 32
OMA Spotlight on Health
Human Papillomavirus (HPV) and vaccination with Dr. Amanda Selk
Show Notes Transcript

October 5th - 11th marks the fourth annual Human Papillomavirus Prevention Week.

Human Papillomavirus(HPV) is a common sexually transmitted infection. It is estimated that three out of every four sexually active Canadians will contract HPV at some point in their lives.

This episode features Dr. Amanda Selk, an Obstetrician/Gynaecologist and host of the podcast "The Vulva Diaries". List and Subscribe here"

OMA Podcast Episode 32 - Human Papillomavirus (HPV) and vaccination with Dr. Amanda Selk

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Voice-over: In this podcast the Ontario Medical Association looks at current health issues that are on everyone’s mind. Spotlight on Health gives you the straight talk. We’re Ontario’s doctors and your health matters to us.

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Anne Marie Flanagan: I’m Anne Marie Flanagan and I’m the Director of Media Relations and Social Media with the Ontario Medical Association.

Dr. Amanda Selk: I am Dr. Amanda Selk. I'm an obstetrician gynecologist in Toronto, and I run a colposcopy unit.

Flanagan: And we're here today to talk about the human papillomavirus.

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Flanagan: Dr. Selk, what is the human papillomavirus?

Dr. Selk: Human papillomavirus, or HPV, is a whole group of viruses. So, viruses are things like colds that can make you sick. HPV are a group of about 100 different viruses that affect people, and some of them can cause cancer, some of them can cause warts.

There are about 14 cancer-causing strains and a couple of warts strains, and that's in a group of about 100 different HPV viruses. Some of the cancers that they can cause are cervix cancer, vulvar cancer, vaginal and anal cancers, in men penile cancers and then even some head and neck cancers, so a lot of different things.

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Flanagan: Who is most impacted by HPV?

Dr. Selk: Well, it's a very interesting virus because it can actually affect anybody, it can affect both men and women. Men, interestingly, seem to get more head and neck cancers where women tend to get more of the obviously gyne organ cancers. It's super common cause of cancer in the world.

So for example, cervix cancer, in the world, is the number four cancer in women. Whereas in Canada, it's actually a really uncommon cancer, because we have good screening programs and vaccination programs.

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Flanagan: And the vaccine for HPV, that's been a more recent invention, and it seemed to be quite successful. Who should be getting the vaccine?

Dr. Selk: So, we've had it for over 10 years now, so it's not that new anymore. It's approved in Canada for both men and women from the age of nine until the age of 45.

We have school-based vaccination programs. That means that the government pays for students—usually between around grade six to eight, depending which province you live in—and both boys and girls are funded under that program.

It's very encouraged that you get it at school, because your immune system reacts better to it the younger you are. However, it's not like it stops working as you get older. It's strongly recommended if you're under 26, but that doesn't mean it stops working again after that. So, if you're over the age of 26, and you're interested in it, you should still talk to your doctor because you're not actually too old to get it.

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Flanagan: And, has the advice about receiving the vaccine changed with the vaccine's success? Has that meant that it's being offered to a broader range of people than it was initially?

Dr. Selk: Initially in Canada it was first really aimed at girls, because they had looked at what's called "cost effectiveness." So, when the government's paying for a vaccine for everybody, where do they think it helps the most. So, it was always looked at for cervix cancer prevention, and hence, they only started vaccinating girls first.

Other countries, like Australia, vaccinated girls and boys together and they've seen the biggest changes in the whole world first, because they were the first ones to do everybody at school and both boys and girls.

And so, first thing they found was warts pretty much disappeared in people in their 20s. And that costs a lot of visits to the doctor, because nobody's happy about having warts. So, genital warts basically disappeared as a problem in

people who are vaccinated, and now they're starting to see the changes in pre-cancers and things.

Originally in Canada, we were only vaccinating young girls. But now, as we have more experience and we see how well it's working, we're vaccinating both boys and girls, and the age range has increased in who we vaccinate.

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Flanagan: That's an amazing amount of success. I understand that studies have shown that the vaccine could potentially eliminate cervical cancer. How do you think that impacts people?

I know there's a lot of people who are unsure about taking vaccines out there. Do you think these kinds of positive results will help encourage people to get the vaccine?

Dr. Selk: I hope so. It's pretty amazing to have a vaccine that can prevent cancer. We know cancers are one of the biggest killers of people in the world and can affect everybody at any age. And there's a lot of things that we can't do to prevent cancer, and most of the work in cancer world is about trying to pick up cancers early. But here's a way to, actually, we know what causes these cancers, and you can prevent yourself from ever getting the virus that causes them.

And remember, in Canada we're very lucky because we have a public health care system. You can get your pap; you don't have to pay for it. we have all these screening programs. A lot of the world doesn't have that. So, it'll be a long time before we can really eliminate these things from the world.

Also, in Canada, where we have other issues, not just with vaccination, are people who don't get cancer screening. It's more common in new immigrants to the country. We have higher cancer risks in our Aboriginal populations. So, there's a lot of work that we can do to do better still, even in our great system.

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Flanagan: The social determinants of health piece, would you be able to talk to us a little bit more about the impact with cancer and cancer screenings?

Dr. Selk: We're trying to target in—in screening programs in Canada, those are the groups—that under screened and never screened—are the groups that really are where we see the most cervix cancer. That's where a lot of work is being done on how can we target those populations.

Nobody likes having a pap done. Maybe self-screening, where you take a swab yourself for HPV, will be the future. That's being looked at. Finding ways to educate in different languages, to teach that you may have come from a country where they didn't have screenings, so that we, “Here's a cancer, this is how we can prevent it,” that sort of thing.

The other thing, as you mentioned earlier, is all these fear-based things in vaccination programs. And you know, again, that's very interesting. It depends where you live.

In Newfoundland, they have really good coverage, like more than 90 per cent of kids get vaccinated. Some of the other provinces it's a lot lower—you know, the 60 to 70 per cent range. So, we don't totally understand why that is.

And I think doctors can do a lot of work to say, “We think it's safe, we get our kids vaccinated, we get ourselves vaccinated.” I always tell other parents that as a parent that I vaccinate my kids for HPV. I want them to get it. I got it myself, 'cause I think it's safe and it's done a lot of good in the world.

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Flanagan: Initially, I think people might have been reticent to it because they thought about it as—as a vaccine to prevent sexually transmitted infection of some sort, but really, it's a cancer vaccine.

Dr. Selk: That's the way to think about it.

I mean, hepatitis B is also a cancer vaccine, and it's also often transmitted sexually, but it doesn't have the same stigma attached to it. You don't hear people being worried about getting the hepatitis B vaccine.

So, some of this was how it was marketed at the beginning, which is just disappointing. And I think people really need to think of it as: it's safe, it's been given over 120 million times in the world, it's been given all over the world, it's well tested, and it's working.

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Flanagan: And the rates of HPV pre-vaccine were quite high, weren't they?

Dr. Selk: Yeah, 75 to 80 per cent of people in Canada and in the world will pick up an HPV strain over their lifetime. And most of them don't know until they have a problem from it.

Colposcopy is the procedure where, if you have an abnormal pap and you're sent to a specialist to look at your cervix under a microscope, that's what colposcopy is. And I do a lot of that. So actually, I'm decreasing my work if people don't come, but that would be amazing.

We've seen a big draw, while people get vaccinated, in the younger population. So, it's really, really neat. And I find that most people who come in with an abnormal pap, they have no idea that these are caused by the HPV virus. They didn't realize that most people get HPV. They don't have these conversations.

So, we can really do a better job at educating the public that it's a common thing. And, really, the best thing you can do for yourself is get vaccinated and then to continue to have your pap screening when recommended by your province.

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Flanagan: People really need to be able to have an open conversation with their families, with their doctors, with their health care providers. Would you agree?

Dr. Selk: A hundred per cent. It's always important to have these conversations.

People are often worried about talking about things related to sexual activity, and their bodies, and their body organs, and other things. But your doctors are there for you. They're happy to talk to you, most of the time. And it's good to have these open conversations to help you help yourself.

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Flanagan: I wanted to talk a little bit about our current situation in the pandemic. And, of course because of that, people's vaccination schedules have been potentially impacted or delayed. Kids that might have received vaccinations through schools, they might have missed those programs. What advice do you have for patients and for their parents on making sure that they stay up to date, and how important is that?

Dr. Selk: It's such a hard question, because COVID has just affected everything; people's surgeries are cancelled, people's wait times for specialists are cancelled, the whole world is cancelled. I think it's important for people to know that there is some data for the HPV vaccine that it —it still works quite well, even if your series was delayed.

So, say you got your first needle, but your second one wasn't exactly when it should be. That you still develop quite a good immune response to it. So, it's not a waste, it's not that it's not going to work, and that you just have to get it when you can get it.

So, the vaccine programs that were on hold with the schools, they're all run by public health, who are the same people who are busy-busy dealing with COVID and other issues.

However, I've noticed that they, like, I looked today and one of the big health units in the province, Toronto, has plans for people to come in by appointment to get the doses that they missed.

So, it's going to be more work for parents, and I know parents are all tired with home schooling and trying to help their kids and all these other things. But I think people forget sometimes about the preventative things, you know?

When you have your little baby, and, you know, they have their two months, four months, six months visits, parents are on it. But these vaccines that are newer, that they didn't have when they were kids, are not always easier for them to remember. The schools will probably send letters home, so hopefully people stay on it.

No one wants their kids to get cancer. So, try to take some time out of your day, if you can, to get them these appointments. That'll be a bit more work if they're not done at school.

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Dr. Selk: HPV is super contagious. Think of it like a cold. You can get it from any skin to skin contact. So, that doesn't mean that you have to have penetrative intercourse—you can just be sexual touching, oral sex—all kinds of things spread HPV. Condoms do not prevent the spread of HPV.

So, people don't realize that “Oh, people are not going to have sex till they're a lot older, we don't need to worry about these 10-year-old kids.” But your immune system reacts much better to the vaccines the younger you are. You build a better response.

So, you don't want to wait until people are meeting people and checking them out at parties and other things. You want them years before to have it, and they're not thinking about it, and their immune system reacts well. Long before anyone's thinking about any other activity.

It's common, it's contagious, and let's try to get it before you ever get it.

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Voice-over: This podcast is brought to you by the Ontario Medical Association. It is produced and edited by Jodi Crawford Productions. This podcast is not intended to provide medical advice for specific situations and is for general educational purposes only. Please consult your doctor if you have symptoms or questions about your health.

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