From the Guidelines
No, a 32-year-old female with HPV and ASCUS should not get the HPV vaccine as the current evidence suggests that the vaccine's effectiveness in preventing precancerous lesions is reduced in women over 26 years old, and the potential benefit may not outweigh the risks or costs. According to the American Cancer Society guideline update in 2016 1, the evidence for vaccine efficacy in preventing precancerous lesions is based primarily on data from RCTs that included women ages 15 to 26 years who had a limited number of lifetime sexual partners. The guideline update also states that the "real-world" effectiveness of HPV vaccination in women (and men) older than age 21 years is likely to be lower than that in younger populations.
The 2016 guideline update 1 also mentions that ecological studies examining trends in disease outcomes since the introduction of vaccination show either significantly reduced effectiveness or no effectiveness in older age groups. Additionally, two studies published after the completion of the supplemental evidence review provide individual-level data on outcomes by age, showing that the odds of testing positive for HPV16 or HPV18 were higher for women vaccinated at older ages compared to younger ages.
While the HPV vaccine (Gardasil 9) is approved for use in individuals up to age 45, the evidence suggests that the benefits of vaccination are reduced at older ages, and the vaccine may not provide significant protection against HPV-related cancers or precancers in women over 26 years old. The 2007 American Cancer Society guideline 1 also states that there are currently insufficient data to recommend for or against universal vaccination of females aged 19 to 26 years in the general population, and a decision about whether a woman in this age group should receive the vaccine should be based on an informed discussion between the woman and her healthcare provider regarding her risk of previous HPV exposure and potential benefit from vaccination.
In this case, since the woman is 32 years old, which is above the age range where the vaccine's effectiveness is significantly reduced, the potential risks or costs of vaccination may outweigh the potential benefits, and alternative methods of prevention and screening, such as regular Pap testing and colposcopy, may be more effective in preventing cervical cancer and other HPV-related cancers. It's essential to note that she should continue with recommended follow-up for her current ASCUS finding, which typically includes repeat Pap testing or colposcopy depending on her specific HPV type and clinical history.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
HPV Vaccination for a 32-Year-Old Female with HPV and ASCUS
- The patient is 32 years old, which is above the recommended age for routine HPV vaccination, but the vaccine is now licensed in the United States for women and men through age 45 years 2, 3.
- For some women aged 27-45 years who are previously unvaccinated, obstetrician-gynecologists and other health care professionals may use shared clinical decision making regarding HPV vaccination, considering the patient's risk for acquisition of a new HPV infection and whether the HPV vaccine may provide benefit 2, 3.
- The HPV vaccine is most effective when administered before exposure to HPV through sexual activity, and it does not treat pre-existing HPV infections 4, 5.
- The patient has already been exposed to HPV, as indicated by the presence of HPV and ASCUS, so the vaccine may not provide the same level of benefit as it would for someone who has not been exposed 4, 5.
- However, the vaccine may still provide some benefit by protecting against other types of HPV that the patient has not been exposed to, and it may also prevent other HPV-related sequelae, such as cervical intraepithelial neoplasia grade 2 or 3 (CIN2/3) 2, 3, 5, 6.