A conversation about HPV vaccines and cervical cancer screenings

A conversation about HPV vaccines and cervical cancer screenings

Patricia Geraghty, MSN, FNP-BC, WHNP did the medical review of this document.

Designed by Elizabeth Gething

Tip: Click on the three vertical dots to view in full screen.

a photo novella

The HCP office. Liliana (40-45 year old female, darker skin) is sitting on a patient table (I don’t know their names, Maricela is on the chair, HCP is talking next to Liliana).

Liliana is accompanied by her 12-year-old daughter, Maricela. (It is common for Latino patients to be accompanied by their children in case they need help with translation)

Dr. Sharp: Hi Ms. Arias, how are you?

Lilian and Marciela are watching Dr. Sharp; Dr. Sharp is leafing through papers on a clipboard, looking down.

Dr. Sharp: I was going through your chart and I see the last time you had a Pap smear was five years ago. Do you know if he also did the HPV test?

Thought bubble: what is an HPV test? Isn’t that the same as a Pap smear?

Liliana (looks confused as she nods slowly). Mmm yes?

Dr. Sharp: Well, Liliana, let me explain what HPV is and why its testing is important.

Dr. Sharp takes a plastic model of a woman’s reproductive system

Close-up of the reproductive model with Dr Sharp’s hand Dr Sharp points to the cervix area and other places on the plastic model

Dr. Sharp: The acronym HPV is used to refer to the human papilloma virus. It is the most common sexually transmitted infection. HPV can go away on its own, but sometimes some types can cause cancer or genital warts.

Liliana looks puzzled, a little

embarrassed, and remains silent.

Thought bubble:

Hmm…it’s not possible for me to have it. I only had intercourse with my husband.

Liliana: *nods*

Dr. Sharp: Well, that doesn’t mean someone with HPV has had relationships with many people. Most people who have sex get HPV at some point.

There is no need to feel ashamed or uncomfortable about this. But I wanted to mention this because HPV can cause various types of cancer especially cervical cancer.

This is why tests are so important for preventing cancer.

Liliana: Ah, I get it. How can I get tested for HPV?

Dr. Sharp: We can do that today when we do your Pap smear. If your HPV test is positive, we may need to do follow-up tests.

Remember that having HPV does not mean that you will definitely get cervical cancer. It could simply imply that you have the virus and that your cells have changes. If the test results are negative, it means that Pap smears can be done less frequently.

Liliana seems a little nervous and resistant

Liliana: *nods*

Dr. Sharp: How do you feel now about the information I just gave you?

Liliana: A little nervous.

Dr. Sharp: I know this can be a little scary, but you shouldn’t worry. We will do tests to make sure everything is ok.

Liliana: Ok, will the test be painful?

Dr. Sharp: No, it won’t be painful, but it might be a little uncomfortable. It is the same procedure as the Pap smear. I will take a sample of cells from your cervix using a soft brush and run both tests on that sample.

Dr. Sharp: Have you been vaccinated against HPV?

Liliana: No, I didn’t get that vaccine before, so I don’t think I need it now.

Dr. Sharp: I understand why you feel this way. A few years ago, the HPV vaccine wasn’t available to everyone.

But now it is, and it’s a great tool for preventing cervical cancer. On a scale of 1 to 10, how important is preventing cancer to you?

Liliana: I would say 10.

Dr. Sharp: It’s wonderful! The HPV vaccine is most effective when given at an early age and before adolescents are sexually active. But it would still be nice if he had it now.

Dr. Sharp: I’m so glad we’re focusing on taking care of you, Ms. Arias, which means you’ll also be able to take care of your family. I was wondering, what do you think about your daughter getting vaccinated too?

Liliana: I think I’d rather talk to my husband before deciding.

Thought bubble:

How should I discuss this with my husband?

Dr. Sharp: I understand. If you find it helpful, you can tell him that this is a very safe and effective vaccine to prevent cancer.

It wasn’t available when we were kids. But we now know that the best age to vaccinate children is 11 or 12, when they are most likely not sexually active.

We are also available to answer any questions you may have.

Liliana: It’s okay, thanks. If we decide that Marisela is vaccinated, where can we do it?

Dr. Sharp: You can take it here or to your pediatrician’s office. Do you have any other questions before having the Pap test and HPV?

Liliana: If I don’t have a Pap smear next year, should I still have an appointment with you?

Dr. Sharp: Great question! Yes, I still want you to come in for a consultation next year to discuss your general medical concerns or have any other tests done. Please ask reception to make an appointment before you leave.

Liliana: All right. Thank you!

Please. I will keep you posted on the results of the Pap smear and HPV test and see you in a year!

Bullets

Some information on the HPV vaccine

The first HPV vaccine was introduced in 2006. The vaccine offers protection against the types of human papillomavirus (HPV) that cause cervical cancer.

Since the introduction of the HPV vaccine, the incidence of cervical precancers caused by HPV has been reduced by 40% for vaccinated women.

It is best to give the HPV vaccine to children of both sexes at age 11 or 12 (although they can be vaccinated as early as 9). The vaccine can also be given to adults and is approved for people up to 45 years of age.

The benefits of the HPV vaccine include protection against nine types of HPV. Seven of them are high-risk HPV types that can cause cancer. The other two are low-risk types that can cause genital warts.

In addition to cervical cancer, the HPV vaccine is also helpful in preventing other types of cancer, including throat and anus cancer, vulvar and vaginal cancer for women, and penile cancer for men.

The HPV vaccine is given as 2-3 injections over 6-12 months. Possible side effects include reddish skin or swelling of the arm at the injection site, nausea, and headache.

Worried about the cost? The Vaccines for Children (VFC) program provides free vaccinations for children under 18 years of age.

It’s important to note that vaccines don’t protect against all types of HPV that cause cervical cancer, so vaccinated people who have a cervix should be tested regularly for cervical cancer.

A very special thanks to

Patricia Geraghty, MSN, FNPBC, WHNP

Cathy Maslen and Absolute Care of Baltimore

This resource has been prepared with support from Merck.

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