Cervical cancer vaccination

The Standing Vaccination Commission (STIKO) at the Robert Koch Institute in Berlin recommends the vaccination against human papillomavirus (HPV) as a standard vaccine for girls and young women aged 9 to 14 years. Each year, more than 4, 700 women are diagnosed with cervical cancer (cervical cancer) and about 1, 500 women die of it. HPV vaccination reduces the risk of developing cervical cancer in women. Also for boys the vaccination is recommended recently.

Worth knowing about the cervical cancer vaccine

The vaccine is approved for the prevention of cervical carcinoma and its precursors, as well as for vulvar and genital warts (genital warts). The two-time vaccination should ideally be given to girls between the ages of 9 and 14, 5 months apart, and completed before the first sexual intercourse. Complete protection exists only after administration of both doses. The vaccine does not work against existing HPV infections or existing genital warts.

However, this reference does not mean that girls are excluded from the vaccine or a reimbursement of health insurance could become obsolete if sexual intercourse already took place. It is also unlikely that even the first sexual intercourse leads to an infection with the four key virus types.

Missed vaccinations should be made up to the age of 18, ie until the day before the 18th birthday. In the case of vaccination after the age of 14 years or less than 5 months between the first and second dose, a third dose of vaccine is required.

The vaccination may be performed by gynecologists, family doctors or pediatricians.

HPV vaccine also recommended for boys

For boys, the STIKO also recommends that the HPV vaccination be carried out at the age of 9 to 14 years - re-vaccinations are also advisable until the age of 17 years. The reason for the recommendation is not only that the virus is also spread by men. The vaccine also serves to protect the men themselves, because they can contract as a result of the same types of HPV, for example, oropharyngeal cancer, penile or anal cancer.

No age limit for the vaccine

The STIKO explicitly points out that women outside the age range of 9 to 14 also benefit from a vaccine. It is the responsibility of the gynecologist to refer the patients to the vaccine and to offer the vaccine according to the approval of the vaccine currently on the market.

The STIKO leaves no doubt that a cervical cancer vaccine does not replace the recommended screening tests. Vaccination and screening together form the supporting pillars of effective prevention of cervical cancer.

Cervical Cancer Vaccination: What to Consider?

Since August 2017, only the vaccines Cervarix and Gardasil 9 have been approved in Germany:

  • Cervarix works exclusively against HPV 16 and 18, which accounts for approximately 60 to 70 percent of all cervical cancers. The active ingredient does not protect against genital warts.
  • Gardasil 9 protects against 9 HP viruses that cause about 75 to 90 percent of all cervical cancer. Gardasil 9 also protects against genital warts.

According to current findings, it is still unclear whether the vaccine protection persists permanently or whether a booster vaccination is necessary. Although previous studies indicate that the vaccine has a lasting effect. Cervical cancer, however, usually develops over many years, so further investigation is necessary.

Since the vaccine against HPV viruses does not cover all oncogenic HP types, the STIKO explicitly points out that the cervical cancer screening needs to be maintained.

Cervical cancer vaccine in pregnancy?

Because of the insufficient data, however, should be dispensed with vaccinations during pregnancy. Breastfeeding is - as with all other vaccinations too - no contraindication. If a woman becomes pregnant during the vaccination program, the missing second or third vaccination can be made up after the delivery. Individual cases in which the vaccine was accidentally carried out during pregnancy did not prove to be harmful to the baby.

HPV-related diseases

Cervical cancer is exclusively caused by human papillomaviruses and the main transmission path is sexual intercourse. The association between HPV infection and cervical cancer is even more pronounced than that between smoking and lung cancer, according to the experts.

Human papillomaviruses are widespread. An estimated 80% of sexually active girls and women come into contact with the virus at some point in their lives (often as adolescents or young adults). It is believed that in Europe overall for HPV-related diseases

  • 75% of all cases of cervical cancer
  • 95% of vulvar and vaginal cancers
  • 70% of the precancerous and 50% of the potentially precancerous cervical lesions
  • 80% of pre-cancerous vulvar and vaginal lesions
  • 90% of genital warts

caused by the virus types 6, 11, 16 and 18.

Vaccinated individuals should be advised by the physician that the vaccine protects only against the vaccine-containing types HPV 6, 11, 16 and 18, with 16 and 18 responsible for the prevention of cervical cancer, while 6 and 11 are primarily responsible for education to prevent genital warts. The latter are not considered malignant, but they are physically and psychologically extremely distressing.

Frequency of genital warts is increasing

The mean age of onset of cervical cancer is 53 years. While cervical cancer death rates have been significantly reduced as a result of screening tests, the frequency of genital warts has increased dramatically, from about 10 per 100, 000 women in 1970 to 200 today per 100, 000. Therefore, physicians advocate a generous approach to the cervical cancer vaccine, even if women outside the recommended age limit, the vaccine must pay well in the future itself.

Patients with recurring genital warts may also benefit from the vaccine and the use of condoms reduces the risk of long-term infections. The fact that the mortality rate from cervical cancer has almost halved in recent decades, is due to the cytological examination, which takes place during the check-up at the gynecologist.

More education about HPV

A survey showed a sobering result: Only 3.2% of German women know the virus and bring its potential danger directly linked to cervical cancer. Consequently, awareness of the need for a cervical cancer vaccine as an effective preventive measure must be aroused and sustainably strengthened.

The willingness of the doctors for this vaccination is great, especially among the gynecologists who have always been considered as prevention doctors of women. The task of the media is to build trust in vaccination through broad information and education in broad circles of the population and especially among the young people.

Update vaccination protection regularly

The STIKO and the Professional Association of Gynecologists point out that the vaccine against HPV should also be used as an opportunity to complete other recommended - especially for adolescents - recommended vaccinations. Only 25% of adolescents have full immunization coverage.

Full vaccination includes vaccinations against:

  • Measles, mumps, rubella (if there are not already two MMR vaccinations, the gaps should be closed at the latest in adolescence).
  • Hepatitis B (basic immunization recommended if not already vaccinated in infancy).
  • Chickenpox (who has not had the varicella or is not vaccinated, receives one or two vaccinations - depending on age).
  • Diphtheria, tetanus, poliomyelitis and whooping cough: a booster dose is recommended for all adolescents.
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