The human papillomavirus (HPV) vaccine is an important public health intervention aimed at cervical cancer prevention. The FDA approved this vaccine in 2006 for use in female patients 9 to 26 years of age. Vaccination is most effective in childhood or early adolescence, prior to the initiation of sexual activity and exposure to HPV. However, older adolescents may also benefit from the vaccine.
Adolescent infections on the rise
Data show that adolescents represent a growing segment of the population infected with HPV. Of the 6.2 million men and women infected with HPV in this decade, 4.6 million were between the ages of 15 and 24. It is clear that vaccinating this group would benefit individual and public health by preventing HPV transmission.
Adolescents have a distinct set of healthcare needs that presents providers with unique challenges. One of the greatest needs is to balance a respect for their developing sense of independence with preservation of the parents' role in medical decision making.
Viewed as ‘part of the package'
It is not unusual for adolescent women to assume increasing responsibility for healthcare, particularly for their reproductive and sexual health. Adolescents may perceive HPV vaccination as one part of the whole reproductive healthcare package. Thus, they may expect the same degree of confidentiality that is afforded to them for healthcare specific to sexually transmitted infections (STIs) and safe sex practices.
As the law presently stands, minors cannot consent for the majority of their medical care, including HPV vaccination. While minors should be included in discussions about healthcare, parents ultimately must authorize vaccination. This may come as a surprise to patients under age 18, who can independently authorize STI treatment without parents' knowledge.
Studies demonstrate that adolescents are less likely to present for appropriate and timely medical care when they are required by law to notify their parents about reproductive issues or to obtain their consent before treatment. Under these conditions, there is serious concern about teens' willingness to be honest with their parents about sexual activity and the need for STI testing, treatment or prophylaxis, and particularly, the need for HPV vaccination.
By working as a team with patients and parents, physicians may help to ensure that the opportunity for prevention is not lost.
By Ruth Farrell, M.D., M.A.
Dr. Farrell is a member of Cleveland Clinic's departments of Obstetrics and Gynecology, and Bioethics. She specializes in the bioethics of women's health, health policy for women and adolescent health. She also runs a colposcopy clinic for adolescents at Hillcrest Hospital.