HPV stands for Human Papillomavirus: a virus that can cause cervical cancer. The virus can be transmitted through any sexual contact, and 80 to 90 percent of people get it. Usually, the immune system clears the virus again.
This does not happen in 10 to 20 percent of cases, so there is a chance that the virus will cause cervical cancer. This is especially common among young women. That is why women between the ages of 30 and 60 receive an invitation for a Pap smear every five years. Children and young people between the ages of 10 and 18 receive an invitation for a free vaccination against HPV.
Abnormal cells
But if you want a vaccination as an adult, you will be very expensive, according to Rachel (35) from Utrecht. While her first smear at the age of 30 was still completely correct, it turned out to be wrong with her second smear: abnormal cells were found.
That didn’t mean anything serious yet, but Rachel did need treatment. She underwent a loop excision; a treatment in which a thin metal loop is electrically heated. This removes the abnormal part of the cervix.
All’s well that ends well, you might think, but the treatment might not have been necessary if Rachel had known about HPV vaccines for adults, she says. “I first heard about this from the gynecologist. She told me you can take it when you’re clean.”
No equal opportunities
That vaccination turned out to be very expensive: she had to pay about 450 euros for the total vaccination, which includes three shots. She calls that ‘remarkable’. Especially because this is about the prevention of cancer, and not about a travel vaccination – which is sometimes reimbursed. “I am lucky that I have a piggy bank from which I can pay this, but a lot of people don’t have that. In this way there are no equal opportunities.”
Rachel finds that worrying. “There is now a lot of attention for HPV, but the generation I belong to is at unnecessarily high risk. We are like the generation that cannot participate in the vaccination program. And getting cancer is no fun and unnecessary if you know that it can be prevented with a vaccination.”
More and more adults are buying HPV shots
Outside of the National Immunization Programme, more and more adults in the Netherlands are taking an HPV vaccination on their own initiative, according to figures from the Farmaceutische Kengetallen (SFK) Foundation. The number has been growing steadily for years, and has grown more rapidly in the past two years.
- in 2020 names 5566 people* self-initiated HPV vaccination
- In 2021 names 8213 people* self-initiated HPV vaccination
This mainly concerns women, but more than 1000 men have also taken an HPV vaccination in recent years.
*The figures mainly concern adults, but a few hundred minors have also received an HPV vaccination on their own initiative. Exactly how many there are is not clearly broken down in the figures.
As far as Rachel is concerned, there must be better information about the HPV shot for adults and must be (at least partly) reimbursed.
The fact that this is not yet the case has everything to do with the effectiveness of the vaccine. If you have not yet been infected with HPV, then the effectiveness is greatest, writes the National Institute for Public Health and the Environment.
‘We could have prevented this’
However, adult women can also benefit from a vaccination, says Ruud Bekkers, gynecologist at the Catharina Hospital and professor of Prevention Gynecological Cancer in Maastricht. He treats women with cervical cancer. “I think with every patient: we could have prevented this.”
People sometimes think easily about abnormal cells, he sees. “‘Ah well then you take it away.’ But such an operation on the cervix is simply no fun. And in addition, you have a greater chance of preterm birth afterwards. That chance goes from 6 to 9 percent.”
second smear
Bekkers advocates vaccinating all women who have ever been treated for a preliminary stage of cervical cancer. “But that’s probably not feasible because of the cost.”
That is why he would in any case want to start vaccinating patients at risk. “I’m talking about women who have already had to undergo surgery because of troubled cells. If they have a Pap smear for the second time that shows that they have HPV, then that is actually a sign that the body is not in a good position. It is possible to clear up the virus yourself. That patient group would certainly benefit from an HPV vaccine.”
The advice for such a vaccination is not yet included in the guidelines of the NVOG (Dutch Association for Obstetrics and Gynaecology). Gynecologist Bekkers: “We only discuss the possibility when a woman has to undergo a second treatment. But we cannot give advice, because we cannot put people at risk.”
Research
The NVOG has now launched a study to demonstrate that vaccination of women is useful when they are found to have HPV. “If our study is positive, we will put pressure on it. We want the insurance to reimburse it and then the minister can get the price down.”
So in addition to the women who are diagnosed with HPV for the second time, that is about 5000 to 6000 per year, others may also benefit from a vaccine. “It concerns gay men, people with a kidney or other organ transplant or people who have a low immune system for some other reason.” According to Bekker, this concerns ten to twenty thousand vaccinations per year. “That’s one-tenth the number of HPV vaccinations being done now, and it could save lives.”