Opinion: such a programme would reduce HPV-associated cancers and help teenagers protect their future health

By Terri FloodUlster University

As a population, we are generally aware of the strong association between Human Papillomavirus (HPV) and cervical cancer, but did you know that HPV causes up to 70% of oropharyngeal cancers in developed countries? Remarkably, these cancers, which occur in the throat, are increasing rapidly in western countries and occur mostly in men rather than women. HPV is also strongly associated with various other cancers including cancers of the mouth, vagina, vulva, anus and penis. 

For the first time in Ireland, HPV vaccines were offered in 2019 to both all girls and boys in the first year of secondary school. The HPV vaccine currently used in Ireland, Gardasil 9, protects against a number of specific high-risk types of HPV, including HPV 16 and 18, with the HSE directing readers to over 90 pieces of research supporting the vaccine's effectiveness and safety. 

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From RTÉ 2fm's Jennifer Zamparelli, Dr Dominic Rowley on the HPV vaccine

So what do teenagers understand about the HPV vaccination itself? Very little it seems. Numerous global studies have shown that teenagers' knowledge of the HPV vaccine, and what it protects against, is very poor. This occurs even where uptake of the vaccine is high.

Education around the vaccine generally involves 11 to 13 year old students taking home a leaflet and consent form to their guardians to sign so that they can stand in line at school and receive the vaccine. A recent study questioned 100 women in an Irish hospital (the majority of whom were 25-39 years old) about their opinion of HPV vaccinations. Despite the majority listing the 'news' as their primary source of information, the survey found only 40% of participants believed boys should receive the HPV vaccine, with the majority (50%), indicating that they didn’t know.

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From RTÉ Radio 1's Today with Miriam O'Callaghan, former Minister for Health Dr James Reilly and Dr Yvonne Williams from Shannon Medical Centre on the take-up rate for the HPV vaccine

What impact does this lack of knowledge have on the future health of our teenagers? In 2016/2017, uptake rates of the vaccination programme in Ireland fell from over 80% to just over 50% over a two year period. This fall in uptake was attributed to public concern about the vaccine, mainly because of misinformation being broadcast to parents through social media outlets such as Facebook, a clear example of how social media can directly impact our collective health. Ireland was not alone in experiencing this trend with France and Denmark facing similar challenges.

Although there has been a significant recovery in vaccination numbers since 2017, 50% of 15 to 17 year old girls and all teenage boys currently living in Ireland have no protection against HPV. With more teenagers in Ireland becoming sexually active between the ages of 15 and 17, there is a clear need to provide education for this age group who are likely to be unaware of the risk of HPV acquirement through both sexual intercourse and oral sex, which teenagers often initiate at an even younger age.

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From RTÉ Radio 1's Morning Ireland, Stephanie O'Keefe from the HSE on the death of HPV vaccine campaigner Laura Brennan at the age of 26

With young people aged 15 to 19 years acquiring an estimated 50% of all sexually transmitted diseases, there is a need to act fast to address this gap in education and protect their future health. Information about HPV and the HPV vaccine is likely to be much more relevant to teenagers at this older age. Education at this age would also provide an opportunity for teenagers to self-consent to the vaccine and take control of their own future health as their health decisions may no longer align with that of their guardians. 

This education is also necessary to reiterate the importance of cervical screening as peak incidences of cervical cancer occur in young women aged 25 to 39 years old. Approximately 30% of cervical cancer cases are caused by HPV subtypes, which the vaccine does not protect against. However, young women may incorrectly think that receiving the HPV vaccine negates the need to attend cervical screening. 

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From RTÉ 2fm's Louise McSharry show, Adam Shanley from MPOWER on the effect of Covid lockdowns on sexual health

As a researcher, I feel that it is important that we engage with our teenagers, their teachers and the school vaccination nurses to ensure that we develop an educational programme for 15 to 17 year old teenagers that is relevant and engaging. This needs to be effective in reducing the incidence of HPV-associated cancers, which could reduce future pressure on the healthcare system to meet the physical and psychosocial challenges associated with a variety of HPV-associated cancers. 

It's worth noting that social media has the potential to cause fluctuations in HPV vaccine uptake. But by taking this step in schools, we are providing our teenagers with a second chance to make their own decisions about an important aspect of their sexual health and helping to safeguard their future health.

Terri Flood is a Lecturer in Radiotherapy & Oncology at the School of Health Sciences at Ulster University


The views expressed here are those of the author and do not represent or reflect the views of RTÉ