To answer the question, I have to explain how cervical cancer forms and how does HPV gets involved.
Let's imagine a scenario, where a young girl is exposed to one of the HPV viruses. The virus will attack the cervix and cause some low grade inflammation, and during this time, if this lady goes on to get herself a Pap smear, it will come back as inflammatory yield.
The doctor will ask the patient to return 6 months later for repeat smear, and sure enough many times her body's immunity will fight the virus and the inflammation will resolve.
A small percentage of the case, the inflammation persists and the repeat smear will still come back positive, and this goes on for the subsequent few years, until one day the smear comes back as CIN (or cervical insitu neoplasm).
This will be the time where the patient is referred to a Gynecologist, who will examine the cervix with a microscope and will either cut away the high risk inflammed areas with a laser or with surgery.
But if this lady did not even seek medical attention, or did not go for her routinr pap smear, the CIN continues to progress to cervical cancer. This whole process takes years.
From this story, we understand that:
Regular pap smears will detect early cancers and save lives.
If we can prevent the HPV from attacking the cervix in the first place, there will not be inflammation to deal with, and no cancers in the end.
Scientists have identified many HPV subtypes, many of them do not cause cancer, but some of them do.
The most common subtypes that causes cervical cancers are types 16 and 18 (these 2 accounts for 70% of all cervical cancers), but these are also known to cause cancers : 58, 33, 52, 45 and 31.
Currently, the recommendations is for young ladies to get themselves vaccinated before they had their first sexual contact, and hence the national immunisation program vaccinates all 14 year old school girls.
After the vaccination, when they have immunity against the HPV virus subtypes, the immune system will destroy the virus when the girl is infected, and we are preventing a future cancer.
But what about the other ladies who have already had their first sexual encounter, or already caught a HPV virus?
Here are some important points:
The official indication of the vaccine in Singapore is not for these type of patients, so the official answer is no.
You also have to understand that the vaccine can only help by PREVENTING future HPV infections, it does not help to clear up existing infections. So you will still need to go for routine pap smears to take care of your HPV 52 infection.
Even though you already have HPV 52 infection, I will still think it will be useful to vaccinate you against all the other subtypes of the cancer causing HPV viruses.
Some GPs do give the Gardasil-9 vaccine to such patients, even though this is against the official guidelines. We call this "off-label use". The only issue is that in these cases, the vaccination will have to be self-funded.
I will still recommend that you get your Gardasil-9 vaccination, but you will have to end up paying for the vaccine yourself.
Talk to your GP about "off label use" and see if he is comfortable with it. Some are, others, not so much. Even though you already have HPV52 infection,
you will still get protection against the other HPV subtypes if you get vaccinated
you will still need to go for your routine PAP smears to follow up on your HPV52 infection
Hope this helps for you to make a decision. Cheers!
Dr Seah Heap Yong
