To wonder why older women are not offered the HPV vaccine

[DangerNoodles]

When gay and bisexual men are.

I recently found out that smear tests only check to see if you have HPV. I already knew about the vaccine offered to girls at school but looking into it, it seems it is effective for women up to the age of 45 (but most effective before 26). Gay and bisexual men are offered the vaccine up to 45 on the NHS so why aren't women? I can't afford the £500+ it costs to get the vaccine privately so I can't help but feel a little bit pissed off about it. I honestly thought smears were actually checking for cancer, not just for a preventable virus.

I'm guessing it's a cost cutting measure.

I'd wondered this too. If you're HPV negative then surely the vaccine would still be an effective way to avoid the risk.

I guess statistics maybe show that less older women have unprotected and/or casual sex with multiple partners so the stats don't line up with the cost? Total guess though.

JCVI / NICE decision making is based on risk profile and statistically men who have sex with men are at a greater risk of being diagnosed at a much later stage with HPV-related cancers because they don’t have the same protocol for HPV / abnormal cell testing as women do e.g. cervical smears. The age limits for both sexes is based on mathematical modelling to decide at what age the vaccine stops being cost-effective and beneficial and actuarially this is just where it lands.

I read rhat it was because if you’ve already had HPV then it isn’t as effective and something like 80% of people have by their mid twenties or so. So I guess yes they have to manage cost against what’s effective

It's not just middle-aged women. They don't offer it to straight men at all, so any heterosexual boy older than 14 won't have it, despite the risks of oral/throat cancers.
I paid for my own vaccine a few years ago.

It's based on risk/cost profile and is a bit crap. Still a fairly new vaccine. Now more evidence is emerging of its role in reducing a number of cancers, perhaps the groups will be expanded to include older woman and straight men

I'm no expert but I thought the thing was that it was most effective if you had not come into contact with HPV e.g. were not sexually active and that's why they targeted young teens?

So it is down to cost. So what is the point of smears then if you have HPV? How do they tell if you are at risk of cancer if 80% of smear tests come up with a positive result? I'm sorry if I sound ignorant, I thought smears were to check for pre cancerous cells. I hate smear tests and I just don't see the point of them now. I am HPV negative and have no intention of changing partners anytime soon.

There's a move towards less frequent smears for those who test negative for hpv so you likely won't have many more tests

@DangerNoodles I didn't think 80% were positive for HPV? But if the smear is positive then it goes for further testing under a microscope, same as how it used to be done prior to the HPV check.

I tested positive for HPV a few years ago having had the same partner for nearly 20 years and never having tested positive before. Turns out that I might not have had a new partner - but my (now ex) husband had. I had no idea.

There are over 100 strains of HPV (some strains cause warts). Just because 80% roughly will have had one or more strains in their lifetime doesn’t mean they will have had a high risk strain or that they will receive an abnormal smear result. The body typically rids itself of the virus after a few years with most never knowing they had it but some of the high risk types linger for longer and can cause Changes to the cells in the cervix. It’s these potentially pre-cancerous cell changes that the smear is looking for. Yes HPV is the main cause for these changes it isn’t the only one which is why they aren’t proposing completely eliminating smear tests for those who had the vaccine (which focuses on only a few of the highest risk strains).

This has been really informative, thanks everyone.

@Peoniesandpeaches according to the NHS website, the cells are only sent for further testing if you are HPV positive. So given that I have tested negative for HPV, my cells won't be sent for further testing so if I had cancer caused by something other than HPV or HPV no longer showing in my system I would be none the wiser until I got symptoms.

A smear doesn't just check for HPV. Cervical cancer is very very rare without active HPV. Therefore the sample is checked for HPV first, which is the quickest, most cost effective test. If that is positive then the sample is rescreened for pre-cancerous cells. If those are found you get a colposcopy and if required, treatment.

I would prefer to have the vaccine and my cells looked at regardless of whether or not I have HPV. But I guess the funding just isn't there.

Have smears always been just to look for HPV or did they previously check everyone for cell changes? I'm sure I once had a letter back saying there were no abnormal changes in my cervix.

I wish I had looked at the NHS site before, I had no idea that I was basically just going for an invasive STI check.

The move from 3 year smears to 5 year smears is due to the change in how smears work and evidence that HPV free cervical cancer is very rare and the tests are now more effective.

As for the vaccine, unless you can guarantee you've never contracted HPV its pretty useless. Most women have had it if they are sexually active with someone who was not a virgin before they got with them. HPV can be fought effectively by the body (I was HPV positive for the cancer strain in my early 20s but not anymore).

The smear test does check for cancer, but only of you are HPV positive. It is essentially a two-step process using one sample:

• First, test for HPV status
• • If negative, do nothing
• • If positive, test for (pre-)cancerous cells
• • • If negative, do nothing
• • • Of positive, send for additional investigation.

As the vaccine becomes more widely available the rate of HPV positivity will come down, and so the frequency of screening is likely to be reduced, too.

They used to just check for cell changes. Then the research showed that HPV is present in most cases - I was part of that trial. Its a much more effective way of doing it both in cost and results.

I’m pretty sure my 14 year old ds has been routinely vaccinated against HPV at school as part of the school immunisation programme.

Yes, it's new for boys his age and younger.

Happy for you.

There is no catch up programme for older boys or young men. They just get to risk oral cancers in later life instead.

It changed to 'HPV primary' testing around 3/4 years ago. So yes, only samples with HPV are now checked for precancerous changes. There are usually many years between HPV infection and progression to cervical cancer as it first causes precancerous changes (CIN 1 up to CIN 3), so checking for HPV first does make sense as it's really only when the HPV hangs around too long that it causes problems.
The 80% figure is how many of us get HPV over our lifetime, most of us clear it within a year or two without it doing any damage. If HPV is found, cells will be checked and if normal the smear will be repeated a year later to see if the HPV has gone. This approach has been supported by research. In future, it is likely that smears will only be done on those who have HPV and it would be a simple swab test (London trial currently of self swabbing for HPV) first of all.

Mine was too, but my 15 year old wasn't. Year 10 now are the first cohort of boys to have had it. They initially thought it was enough to vaccinate girls only, but of course some men get HPV related cancers and many men have sex with men so the herd immunity from girls vaccination wouldn't apply.

I agree they should be offered to women under 45.
And all boys at the same time girls are vaccinated.
On another note I am seriously not impressed that smears only now test for HPV virus. Just 3-4 years ago after a history
of regular clear smear tests and just 2 years after having a clear test I started to have bleeding in between periods and after sex and was diagnosed CIN3 and high grade dyskaryosis BUT HPV NEGATIVE.
I had a lletz procedure to remove part of my cervix but f it happened now I would have never known that l had CIN3 etc as HPV would have come back negative.
I just can't get my head round this, is CIN3 a cancer risk or not? Clearly you can get CIN3 pre cancerous cells without HPV so will cervical cancers now be missed ?
To me it sounds like a downgraded service to save money that could cost lives

You don't have to change partners or for either of you to cheat for you to suddenly go from a negative hpv result to a positive
Pregnancy caused my latest hpv flare up , women married 20 - 30 years have found they are positive . It can lie dormant for decades undetectable

Jesus Christ @Runnerduck34 I am so glad you had a proper smear test when you did.

I wonder how many women, like me, have gone along for thier smears thinking that they are having an abnormal cell check when really thier sample gets discarded due to their HPV status.

fedup078 that's good to know in case a future smear comes up positive!

@Cleothecat75

Boys born after 1st September 2006 are allowed it. Any older aren't.

Has anyone ever used the home HPV testing kits? It looks like they test for more HPV variants than a smear test but I don't know how easy it would be to test at home. I'm tempted to buy those in future and only go for an NHS one if I get a positive result. Even after going through childbirth I find smear tests embarrassing and uncomfortable. Plus I always have to be quite firm with the nurse about having a small speculum, they always try and go for the big one just because I've had babies and it hurts!