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It is amazing to think that the first generation of the human papillomavirus (HPV) vaccine was first approved in 2006. At the time, we had the quadrivalent vaccine, meaning that the vaccine protected against four types of HPV. When it was first approved, it was only for females aged 9 to 26. We have come a long way since 2006. The vaccine is now approved for all genders. We now have the nine-valent vaccine meaning the vaccine protects against nine types of HPV. It is currently approved for individuals up to age 45 years old. According to the CDC, individuals between 27 and 45 can be offered the vaccine using shared clinical decision-making between providers, and previously unvaccinated patients are likely to benefit.

I have always offered women 26 and under the vaccine, but I have recently started to provide women with up to age 45. In 2018, it was approved for age 45, however, not all insurance companies paid for the vaccine. Several studies since 2018 have shown how beneficial the vaccine is in preventing HPV-related cancers.  

We used to think that if you have been exposed to HPV, the vaccine would not help. This is no longer true. The vaccine can prevent further HPV in women who have been exposed to HPV and have been treated for precancerous lesions of the cervix. If you are between 27 and 45 years old, you should consider the HPV vaccine. This is especially true if you have had a procedure like a loop electrosurgical excision procedure (LEEP) or cold knife conization for precancerous cervical lesions (cervical intraepithelial neoplasia( CIN ) 1, 2, or 3).  

Will my insurance cover the vaccine if I am between 27 and 45 years old? My answer is that they should. Studies are available to show that the HPV vaccine is beneficial even if you have been exposed to HPV.

We pay premiums to the insurance company. If the insurance company is unwilling to pay for a medication that is beneficial for your health, it might require a letter from you and your physician. We have to be proactive about our health. Insurance companies get away with not paying for medically necessary procedures because they are not hearing from the people that pay the premiums. If you and your doctor write the letter with available evidence, I do not see it as a problem.

As you can see, I am passionate about the HPV vaccine. We have the potential to eradicate cervical cancer in our lifetime, and the vaccine plays a key role, along with the information below.

1. The pap smear  – If you are 21 years old or older, you must get a pap smear. A pap smear is a screening test for cervical cancer. You do not need to get it every year if it is normal. Between ages 21 – 29, you should get a pap smear at least every three years if the pap smear is normal. This means that you must know your results when you get the pap smear. The majority of women who are diagnosed with cervical cancer are women who have never had a pap smear or women who had an abnormal pap smear result and did not follow up with their health care provider.  
2. The HPV test – If you are 30 years old and above, you should get a pap smear and HPV testing. Not all doctors are doing both. Some might do a pap smear which is an option, but I disagree. If you are 30 years and older, I am asking you to ensure that your doctor obtains a pap smear and HPV testing. Ask for both. The HPV test is very sensitive and does make a difference. If both are negative, you can wait up to 5 years before getting another pap smear and HPV test. Waiting this long depends on your history and your results. Again, you must find out your results.
3. Know your result – Following up on your result is important. Call your provider if you have not heard about your result in 2 weeks. If your results are abnormal, make sure that you understand the next steps. DO NOT IGNORE an abnormal result.
4. You might not need a pap smear if you have had a total hysterectomy (removal of the uterus with the cervix). It will depend on the reason why you had the hysterectomy, your pap smear history, and the pathology of the cervix that was removed. If your health care provider feels that you can stop getting pap smears, ask why and make sure that you get an explanation you understand.
5. You might not need a pap smear when you are over 65 years old. You should know that 20% of cervical cancer cases are diagnosed in women over 65. For you not to need a pap smear after age 65, you must know your pap smear results since you were 55. If you do not know, you must get a pap smear and HPV testing. If your healthcare provider chooses not to obtain a pap smear from you because of your age, you must ask why and ensure you understand why. Make sure your healthcare provider can tell you about all your results since age 55.
6. If you have been treated for pre-cancer or cancer of the cervix, you need to be monitored for at least 25 years very closely.
7. If you have any abnormal uterine bleeding, bleeding with intercourse, or bleeding after menopause, please notify your healthcare provider.
8. If you are immunocompromised, you might need more frequent pap smears. Talk with your healthcare provider.

Lack of insurance should not prevent you from getting a pap smear. You can get a screening pap smear for free or at a low cost with the National Breast and Cervical Cancer Early Detection Program.

I hope that you are up to date with your pap smear. Remember that up-to-date includes knowing your results. The way we are going to eliminate cervical cancer starts with each one of us.