From the Guidelines
HPV vaccination is not recommended for a 45-year-old as a standard practice, but rather as a shared clinical decision-making process with their healthcare provider, considering the individual's risk factors and potential benefits. The American Cancer Society does not endorse the recommendation for shared clinical decision making for vaccination at ages 27 to 45 years due to the low effectiveness and low cancer prevention potential of vaccination in this age group 1. However, the CDC and other organizations suggest that vaccination may still be beneficial for some individuals in this age group who are at high risk of new HPV infections, such as those with a new sex partner or those who have not been previously vaccinated 1.
The vaccine (Gardasil 9) is given as a three-dose series over 6 months if started after age 15, and while it provides the greatest benefit before exposure to HPV through sexual activity, even adults with previous sexual experience may benefit from protection against HPV types they haven't yet encountered 1. The vaccine helps prevent HPV infections that can lead to cervical, anal, penile, vaginal, vulvar, and oropharyngeal cancers, as well as genital warts.
Some key points to consider when making a decision about HPV vaccination at age 45 include:
- The vaccine's effectiveness decreases with age due to likely prior HPV exposure, which is why the strongest recommendations target adolescents 1
- Side effects are generally mild and may include pain at the injection site, headache, or fatigue 1
- The individual's risk factors, such as a new sex partner or a history of HPV-related diseases, should be taken into account when making a decision about vaccination 1
- The American Cancer Society recommends routine HPV vaccination between ages 9 and 12 years to achieve higher on-time vaccination rates, which will lead to increased numbers of cancers prevented 1.
Ultimately, the decision to vaccinate against HPV at age 45 should be made on a case-by-case basis, taking into account the individual's unique circumstances and risk factors, and in consultation with a healthcare provider 1.
From the Research
HPV Vaccination for 45-Year-Olds
- The Human Papillomavirus (HPV) vaccine is primarily recommended for pre-adolescent females and "catch-up" vaccination for females aged 13 to 26 years 2.
- However, vaccination can still benefit females over the age of 26 years who have not been previously exposed to HPV 6,11,16, or 18 and those who may have new sexual partners in the future 2.
- Women up to 45 years of age have been shown to exhibit strong immune responses to the bivalent HPV vaccine, which might be expected to reduce the risk of HPV re-infection and address the second peak of HPV-related malignancy in later life 3.
- A study found that early data from randomized trials testing the quadrivalent HPV vaccine in women over 25 years suggested high vaccine efficacy comparable to younger women 3.
- For adults aged 27-45 years, shared clinical decision-making with a healthcare provider is recommended for HPV vaccination 4.
- A patient decision aid tool, HPV DECIDE, has been developed to support the implementation of this mid-adult HPV vaccination guideline and has shown promise in reducing decisional conflict and improving knowledge, intentions, and self-efficacy about the HPV vaccine 4.
- Awareness and knowledge of HPV and HPV vaccination among adults ages 27-45 years are crucial for cancer prevention, with most respondents aware of HPV (72.9%) and HPV vaccination (67.1%) 5.
- However, there are opportunities to improve awareness and knowledge, particularly related to non-cervical cancers, as these are critical first steps toward shared decision-making for HPV vaccination in mid-adulthood 5.
Key Considerations
- The effectiveness of HPV vaccination in preventing HPV-related disease in adults over 45 years old is still being studied 2, 3.
- The decision to vaccinate against HPV at 45 years old should be made in consultation with a healthcare provider, taking into account individual circumstances and risk factors 6, 4.
- Patient-centered interventions are needed to engage adults in shared decision-making regarding HPV vaccination 6.