HPV Vaccine for Women over age 45 years

Women over 45 years old, especially those with new sexual partners, should strongly consider getting vaccinated against Human Papillomavirus (HPV), a virus that causes cancer and genital warts. Unfortunately, the vaccine is rarely offered.

Nora, whom I profiled in the previous post, had had one lifetime partner by the time of her divorce at age 50. In her late 50’s, after only two new partners, her PAP smear tested positive for high-risk HPV.[1] Like many women her age, she had little awareness of the risk of HPV. Should Nora have been offered the HPV vaccine by a healthcare provider before she was exposed through new partners?

The Gardasil9 vaccine targets nine strains of HPV inclusive of those that cause 85% of cervical cancers. The vaccine also targets strains of HPV responsible for the majority of vaginal, labial, penile, anal and oropharyngeal cancers, as well as genital warts. In total, HPV is responsible for an estimated 5% of all cancers worldwide, most of which are preventable with recommended vaccination. When given to young women with no previous exposure to HPV, the vaccine is nearly 100% effective against the targeted strains.

Currently, in the United States, the CDC recommends the HPV vaccine for persons of all genders aged 9-26 years. With shared clinical decision-making, it may also be given to persons aged 27 through 45 years. The vaccine is even recommended for persons with a history of HPV-related infection or cancer. In these individuals, vaccination may decrease the risk of recurrence and will protect against strains to which an individual has not yet been exposed. The vaccine is not FDA-approved for use over age 45.

For women over age 45, the HPV vaccine can be given off-label. However, most older women do not know about its availability or benefits. The link between HPV and cervical cancer was not known until the 1980’s. Therefore, older women did not come of age with the knowledge of HPV as a risk to their health. And women born before 1980 have little to no chance of having received the vaccine, which was first licensed in 2006.

Yet, sexually active Gen-X and Boomer women with new sexual partners (or with partners who have other partners) are at risk of HPV infection. And like Nora, they may not list HPV among the myriad challenges of dating as a mid-life woman.

Even older women not experiencing new partners may be at increased risk of HPV infection. With aging, the immune system becomes less robust causing previously dormant or latent HPV to evoke new or recurrent infection in an individual. Indeed, there is a second peak in cervical cancer among older women. And labial cancers are mostly diagnosed in women in their 60’s, 70’s and 80’s.

·  Can women over 45 years old receive the HPV vaccine? Yes, they can receive the vaccine off-label.  

·  Is the vaccine as effective in older women as in younger women? It has not been studied in older women.

·  Will insurance pay for the HPV vaccine in persons older than 45 years?  Unfortunately, no. Even with a GoodRx coupon, the cost is over $240 per dose. Full coverage consists of three doses over six months.

·  Should older women be given the choice to receive the HPV vaccine? Absolutely yes!! Especially older women with new sexual partners.

Brown, Vivien. Immunization for midlife women. Menopause 29(10):p 1204-1209, October 2022.

Khadraoui, Hanaa; Thappa, Sarah; Smith, Marianne; Davidov, Adi; Castellanos, Mario R. Age-associated trends of vulvar cancer in the US. Menopause 28(2):p 119-125, February 2021.

PharmacoEconomics & Outcomes News 723, p20 - 14 Mar 2015

Yousefi Z, Aria H, Ghaedrahmati F, Bakhtiari T, Azizi M, Bastan R, Hosseini R, Eskandari N. An Update on Human Papilloma Virus Vaccines: History, Types, Protection, and Efficacy. Front Immunol. 2022 Jan 27;12:805695.

[1] As you may recall from the story, her husband had been having an affair prior to their divorce. His new partner offered another possible route of HPV infection for Nora.