00:00:00:15 - 00:00:07:23 Dr. Winn I'm Dr. Rob Winn and you're listening to Real Cancer Talk from VCU Massey Comprehensive Cancer Center. 00:00:08:00 - 00:00:18:07 Rudene Mercer-Haynes For those of you who don't know me, my name is Rudene Mercer Haynes. Happy to to be facilitating today's conversation. Again, our topic is protecting our health together. 00:00:18:09 - 00:00:20:12 Rudene Mercer-Haynes HPV and cervical cancer. 00:00:20:16 - 00:00:42:13 Rudene Mercer-Haynes So, I had the pleasure of introducing Doctor Tashima Lambert. Giles. She's an assistant professor in obstetrics and gynecology at VCU Health System. She received her undergraduate degree from the UVA, Waahoo Wah, you see on the wall. Completed medical school at Temple University School of Medicine and complete her ObGyn training at Duke University Medical Center. 00:00:42:13 - 00:01:14:16 Rudene Mercer-Haynes I know there's a lot of confusion that she has every like, seek, like, you know, athletic season. She was a National Health Service Corps scholar and repaid these years of service at Unity Health Care and Howard University Hospital in Washington, DC prior to joining staff at VCU. Here at VCU, she serves as a career advisor for medical students interested in surgical specialties and is deeply committed to the service of marginalized patient populations and to training future medical professionals that offer patient centered care. 00:01:14:18 - 00:01:44:21 Rudene Mercer-Haynes You've already heard a little bit from Janice McGirt. We're so happy to have her here. She's a pediatric, a passionate pediatric nurse practitioner and pediatric primary care. She received her bachelor's of science in biology from Elon University and her bachelor's of nursing and master's of pediatric nursing and primary care from Emory University. She spent nearly a decade of work in private practice pediatrics before she transitioned to teaching and working at Walter Reed National Military Medical Center. 00:01:44:23 - 00:02:08:15 Rudene Mercer-Haynes There, she serves as an instructor at the Uniformed Services University, as well as seeing patients in the outpatient pediatric primary care, medical home clinic. She most enjoys partnering with families in their children's health from birth through adolescence, with a particular interest in the preschool and school age groups. That's a precious group to deal with, and you definitely do wash your hands a lot when you're dealing with them. 00:02:08:17 - 00:02:25:21 Rudene Mercer-Haynes Her work with mentoring, medical students, pediatric residents, and the like greatly enhances her clinical skills, but also nurtures our future generation of clinicians. I love that for you. So again, so excited. I'm going to stop talking and let them sort of tell us 00:02:25:23 - 00:02:32:07 Rudene Mercer-Haynes everything we need to know about HPV and cervical cancer. 00:02:32:09 - 00:02:35:06 Dr. Giles I don't know if we're get to everything we need to know, but... 00:02:35:08 - 00:02:36:16 Rudene Mercer-Haynes You have to sell it. 00:02:36:17 - 00:02:39:10 Rudene Mercer-Haynes Go big or go home. We have to sell it. So yes. 00:02:39:10 - 00:02:55:06 Dr. Giles Thank you so much for the introduction. My name is Doctor Lambert Giles. I am an ObGyn here at VCU. So thank you so much for having me, to talk about a topic that I am incredibly passionate about. Just start. I don't have any disclosures. 00:02:55:06 - 00:03:14:00 Dr. Giles Maybe one day I'll make enough money where I can put some kind of disclosure on here. But for now, I've got nothing. Just a quick objectives of what we're going to chat about. I'm hoping that when we finish these ten minutes that you can give me the who, what, when, where, why of cervical cancer, HPV and cervical cancer screening. 00:03:14:02 - 00:03:40:06 Dr. Giles But before we start with the details, I think that everything sticks a little bit better when you have a personal connection to that thing. And I wanted to show you guys why I am so passionate about this. When I left residency, as we mentioned, I did residency at Duke University. And when I left residency, I paid back my years at Unity Healthcare in Washington, D.C. this is a federally qualified health center. 00:03:40:08 - 00:04:07:01 Dr. Giles And in this job, I had the opportunity to serve patients. That was east of the Anacostia River. My patients are historically socio economically disadvantaged groups. And through working with this group, which was somewhat different than my population at Duke, I really was able to grow a passion for cervical cancer screening because I was able to witness how much this disease was really one of disparities. 00:04:07:03 - 00:04:28:20 Dr. Giles So I wanted to tell you guys a little bit about Anna. Anna, I met her in 2019, and at the time she was in her mid 30s, she actually came to me for Hope of fertility. She was in the hospitality industry, but unfortunately, immediately on examining her, I knew that what I was going to tell Anna was going to change her life forever. 00:04:28:22 - 00:04:53:17 Dr. Giles And ultimately it did. She went on to be diagnosed with stage three cervical cancer. She received chemo and radiation. Ultimately, Anna lost her fertility to treatment induced menopause. And this news article was actually written in celebration of her being the first patient to receive treatment at what had just been the newly expanded Hopkins Cancer Center in Washington, DC. 00:04:53:19 - 00:05:20:23 Dr. Giles And it's stories like Anna that really inspire me to, as a general ObGyn, to really focus on prevention, and to really focus on things that we can do before it gets too late. So, Anna is my why. But let's talk a little bit about what exactly cervical cancer is, why we care about HPV. So just so that everybody kind of are on the same page, the cervix, it is basically this really small organ right at the bottom of the uterus. 00:05:20:23 - 00:05:42:23 Dr. Giles It connects the uterus to the outside vagina. They are two parts of the cervix. There is an inside lining to the cervix. And that's called endocervix. And there's an outside part of the cervix that's called the ectocervix. Because there's two different parts, there's two different cells that grow on each part, and each of these different parts can create a different type of cervical cancer. 00:05:43:00 - 00:06:13:06 Dr. Giles 90% of cervical cancers are actually forms from the outside part of the cervix. And those are called squamous cell carcinoma. But within the cervix, those are more glandular cells. And those cancers are called adenocarcinomas. So who gets cervical cancer? Cervical cancer disproportionately affects patients with decreased access to care. It disproportionately affects patients who under utilize screening and vaccination. 00:06:13:08 - 00:06:36:14 Dr. Giles And it disproportionately affects those who have inadequate treatments for pre-cancer lesions. Worldwide, cervical cancer is the fourth most common cancer in terms of both incidence and mortality. And that's in women. But it is the number one cause of death of cancer in 37 countries for women. And of those 37 countries, they are all low or middle income countries. 00:06:36:16 - 00:07:01:12 Dr. Giles And you might say, you know, we are talking about different countries that you can see the United States kind of list here is one of the lowest countries. But ultimately, the reason we're talking about this is because despite how preventable cervical cancer is, they are still more than 13,000 new cases of cervical cancer that's diagnosed annually. And more than 4000 women die of this disease each year. 00:07:01:14 - 00:07:26:24 Dr. Giles So the point of why we're here, what puts patients at risk and not others? And I think number the 12:00 on here is exactly why we are here to chat. Human papillomavirus, also called HPV virus, is one of the biggest risk factors for patients developing cervical cancer. In fact, over 90% of cervical cancers are caused by prolonged infections with HPV. 00:07:27:01 - 00:07:54:01 Dr. Giles So what is HPV? HPV is a thing that gets the bad rap. Yes, technically HPV is a sexually transmitted disease. The truth is over 90% of patients that have ever had intercourse will come in contact with some version of HPV. And because of that, we really want to demystify that. We really want to make sure that people don't feel, ashamed of talking about HPV or saying the word HPV. 00:07:54:05 - 00:08:20:24 Dr. Giles There's over 200 types of HPV. And so people get in contact with it. Your body sees it just like it sees the flu. It creates a response against the flu. And most people are better in 7 to 10 days with HPV. It sees this virus. It creates an immune response against this virus, but it takes about 1 to 2 years for most patients to actually get rid of an HPV virus. 00:08:20:24 - 00:08:48:15 Dr. Giles There are, despite the over 200 types of HPV virus, there's two in particular HPV 16 and 18 that cause greater than 70% of the cervical cancers that we see. And the other types we have kind of grouped them under high risk HPV because, as we noted, over 90% of HPV, 9% of cervical cancers are due to HPV. So not everyone that gets HPV will go on to have abnormal cells and will go on to have cancer. 00:08:48:17 - 00:09:10:06 Dr. Giles There are still other factors that please some patients that risks, while others might have less of that risk. Some of those factors are things that yes, expose us to more versions of HPV. So we talk about multiple sexual partners. We talk about having intercourse without condoms. Those things are going to put us at more exposure of a HPV virus. 00:09:10:08 - 00:09:43:22 Dr. Giles But even when patients have had one sexual partner their entire life, there are some things that about that patient that might actually put them at a higher risk for continuing to have an HPV infection without being able to clear that some of those things are things like smoking, things like a weakened immune system. When we say weakened immune systems, we think of things like people that are on immunosuppressants, maybe because they had a kidney transplant, a liver transplant, a heart transplant, or they're on other medications because they have things like lupus, you know, these are things or end stage renal disease. 00:09:44:01 - 00:10:17:07 Dr. Giles These things actually put them at a really weakened immune system, similar to pregnancy, where you get a lot sicker, a lot faster than the other folks because your body cannot mount the same immune response. When you think of how some communities might be at higher risk for continuing these infections, a lot of it comes down to not being able to actually have adequate diet to actually have the antioxidants that they need from fruits and vegetables to be able to mount an appropriate response to improve their immune system, to get rid of things like HPV. 00:10:17:09 - 00:10:40:10 Dr. Giles And then I think the last one that becomes a little controversial, is the long term use of contraceptive pills. And as a gynecologist, I am pro people planning their pregnancies. So I definitely don't want anyone to take away. If you're on birth control, you're at a higher risk for HPV. What is considered long term use of contraceptive pills, or the use of over for five over five years. 00:10:40:12 - 00:11:04:19 Dr. Giles And this data is actually specific to birth control pills and not the other types of, contraception. And there is the thought that somehow the long term use of contraceptive pills might actually change how your body fights certain DNA changes. And this is still data that's been flushed out, but it's been flushed out enough that we think that it is one of the risk factors for prolonged use. 00:11:04:21 - 00:11:29:00 Dr. Giles So now that we know most people will get HPV, most people will clear HPV. For those that haven't, there is ways for us to prevent them from becoming cancer before it's there. For everyone that's at risk, they do not develop cervical cancer. This is a great graph that I think helps us to explain some of the wins that we've gained in the cervical cancer world. 00:11:29:02 - 00:11:52:03 Dr. Giles So in the 1940s is when the use of pap smears was actually invented, and it became clinically useful in the 1950s. As a result of that, cervical cancer rates have decreased by more than half from the 1970s all the way to the mid 2000s. And that is just secondary to use in pap smears that can actually find precancerous cells prior to that. 00:11:52:05 - 00:12:15:10 Dr. Giles So who gets a Pap smear? Our goal is really making sure that people are paying attention to their health and paying attention to things that are preventable. Everyone. We recommend a pap smear in patients age 21 to age 65. If patients started having intercourse before that, it still doesn't change our recommendation. The recommendation still is that they start having cervical cancer screening at age 21. 00:12:15:12 - 00:12:38:22 Dr. Giles And I think this is a good graph that summarizes when we think of the average patient, not the patient that we talked about that has multiple organ transplants or the patient we talk about that has immunosuppression like HIV or any of those things. For a normal typical patient, we recommend that they get screened every three years with a pap test between age 21 and age 30. 00:12:38:24 - 00:13:08:21 Dr. Giles At age 30 to age 65, we can continue pap test every three years, but the preferred method is actually with HPV specific testing for those actual viruses that we know can cause the cervix to become a cancer up until 65. And then after age 65. That is the conversation that patients should have with their providers. We don't recommend routine screening if patients have tested negative for the 25 years prior to that, or if they don't have any additional risk factors. 00:13:08:23 - 00:13:33:11 Dr. Giles I think we talked about where does screening happen, and this is definitely one of the things that I try to demystify in my clients. And I think this is a good example. It's a really short clip. And I'm going to hit play here. Many of you are female in nature and you have been to the gynecologist, and you understand what it means to get a pap test. 00:13:33:13 - 00:13:54:17 Dr. Giles While many of you on this call might not understand what it means to get a practice and why people are not necessarily lining up at my door to get a pap smear. I think this is a great in the ways of social media. This piece to this person depicted what most people face when they think of having a pap smear. 00:13:54:19 - 00:14:16:03 Dr. Giles Most people think we are literally using wine bottle openers, something that is so sharp, something that is so fearful. And because of this perception, it is something that is really difficult when we're having conversations with teenagers or with people in their young 20s, we say, hey, we really should start doing your pap smears. And they're like, you know, everybody tells me it hurts so much and it's so terrible. 00:14:16:08 - 00:14:37:23 Dr. Giles I think this is a great example as to why people think that. The truth is, that is not actually what we're doing. The truth is we actually use a speculum which looks inside of the vagina because the vagina is really a tunnel, and we are visualizing the cervix at the end of that tunnel. And we use a brush to collect cells from that cervix. 00:14:38:00 - 00:15:03:21 Dr. Giles It is a fast and simple test. As technology is advancing, we do have FDA approval in 2024 for cervical cancer screening that does not include placement of the speculum. And that is not approved everywhere as yet. And every facility might not actually have the ability to do that. But we do think that in the near future, we might not have to use this actual speculum to do cervical cancer screening. 00:15:04:00 - 00:15:28:16 Dr. Giles But regardless, the test is easy, it's simple, and it is a huge part of us preventing cervical cancer. So the reason why this is important is because cervical cancer is the most preventable, and it is the most treatable form of cancer. So despite it only having 4000 people to die a year in this country, from that, we actually can get that to way, way less. 00:15:28:18 - 00:15:49:08 Dr. Giles And that's the reason why we're having this conversation, to make sure we're answering questions that we're taking away any myths about HPV, about cervical cancer, so that patients don't stop coming to the gynecologist or their primary care doctor or whoever, they need to actually get the screening that they need. So and McGirt is going to chat with us a little bit about how we can do prevention. 00:15:49:10 - 00:16:08:07 Janice McGirt Yes. Hi there. Janice McGirt again. Thank you. I love all of that information. The video was spot on. I've seen it before and it's so funny because I think for women we all can very much identify with the like kind of silly nature of it, but almost like what it feels like. And for men, it's just they have no idea. 00:16:08:11 - 00:16:35:00 Janice McGirt So I love that. From a pediatric standpoint. Again, my population that I serve is from birth up until 21. So I see newborns, all the way up to adolescents and young adults. And really from a prevention standpoint, it's giving the HPV vaccine, which is the Gardasil vaccine, previously and initially when it first came out, the HPV vaccine was quadrivalent, which means it protected against four types of HPV. 00:16:35:05 - 00:16:58:07 Janice McGirt Specifically speaking to what Doctor Giles had mentioned, types 16 and 18, which were the forms that we know cause the majority of cervical cancer that is, from HPV and then also type six and 11. But then we got an updated version of the vaccine in 2016. So they added several more viral strains of HPV that were known to cause cervical cancer. 00:16:58:12 - 00:17:15:24 Janice McGirt And so now that is a nine strain, Gardasil that we now give to patients. You can give it as young as nine. And then all the way up to all of my patients who are 21, but now it's approved up to age 45. Doctor Giles, you can correct me if I'm wrong, but I believe that that's the age window. 00:17:16:01 - 00:17:41:16 Janice McGirt So the majority or I would say like half of my patients being nine and above can obviously get it. This discussion happens with families and children at well visits. So, you know, if you remember when your children were young or if you've got nieces and nephews and things like that, we recommend once you're over the age of three, coming in just annually, usually once kids are past the age 4 to 6, they've gotten all of their big childhood routine vaccines. 00:17:41:18 - 00:18:18:16 Janice McGirt But then there's this nice lull between 6 and 11 when they're not getting any mandatory vaccines, just your flu and your COVID's that we recommend during the cold and the winter season. But part of what my practice has been is that while we're having those like easy years per se, where they're not necessarily getting a lot of vaccines, I like to discuss and just start bringing up what is coming on the horizon at ages 11 and beyond, so that the HPV discussion isn't necessarily foreign to families, but also that we normalize the fact that many people at some point will contract HPV with or without their awareness. 00:18:18:19 - 00:18:37:11 Janice McGirt And this is just a simple measure to protect against cancer. The interesting thing, and when we talk about it initially, and I think I see this a lot when I, counsel and discuss different families, is that people always think that it's just for the girls. So they're like, oh, I'll only give it to my daughters, but I have sons and it's just not necessary. 00:18:37:13 - 00:18:59:09 Janice McGirt And that I like to dispel because I say, well, yes, your son doesn't have a cervix, your daughter does, but males can pass it to female partners. Again, many for many people unknowingly. But HPV also can cause head and neck cancers, oral cancers and genital warts for females and males. So this is not one that specific to any gender. 00:18:59:09 - 00:19:32:17 Janice McGirt And so again, I am a proponent of vaccines and preventative health. I work in private, primary care because I'd like to be reactive and not, or proactive, rather, and not reactive. And so the prevention is just discussing HPV, answering people's questions and then recommending that they get the vaccines. The beauty of the current vaccines and young bodies is that actually, if you initiate the vaccine series under the age of 15, you only need two, two shots, 6 to 12 months apart, and then you're done. 00:19:32:19 - 00:20:04:14 Janice McGirt If you're 15 years of age and older, then you'll need three doses because the older bodies just don't mount the same, immune response and protection. So it's also a caveat to say, hey, like if you don't want as many shots like do it sooner and just be done with it. And I also like to encourage parents and children to get it before any of those thoughts in terms of how we contract HPV are on the horizon, because when I speak with my patients privately, they'll often disclose that they're engaged or, you know, have experimented with certain activities that their parents may not be privy to. 00:20:04:16 - 00:20:23:05 Janice McGirt And so the point is to get it when they're young. And that's not anything that they're considered and they're protected. And so that moving forward as they move into adolescents and young adulthood, if these are experiences that they're having, we've made sure that we've done the best that we can to prevent them, from HPV and other pathogens. 00:20:23:07 - 00:20:26:01 Janice McGirt Hopefully that gave you the information you wanted. I speak very quickly. 00:20:26:01 - 00:20:46:16 Rudene Mercer-Haynes So no no no no no no no no no....So I appreciate that and I think I'm going to start from...there are questions in the chat. So I'll address those first. But I have a ton. So one of our listeners, indicated that her daughters had had the HPV vaccine some years and years ago. 00:20:46:16 - 00:20:55:06 Rudene Mercer-Haynes They're now in their mid 30s. Should they repeat the vaccination? We've been talking about repeating the flu vaccination, Covid vaccination. Does it work like that for HPV? 00:20:55:08 - 00:21:06:08 Dr. Giles Yeah. So it's definitely a conversation I have very frequently with patients. The initial vaccine came out in 2006. And with the nine valent, that only came out in 2014. 00:21:06:10 - 00:21:26:23 Dr. Giles So for patients that are unsure on whether or not they were vaccinated before that period, they definitely can repeat it to get, protection against the other five valents. There is a lot of what we call shared decision making there. At some point, the reason why we stop screening this frequently is because people's exposure tends to go down. 00:21:27:00 - 00:21:45:03 Dr. Giles We kind of assume that once people start engaging in sexual activity, that it tends to rise in their teenage years and in their 20s. And then after their 30s, they tend to have less exposure. But the other conversation is that the thought is that they might have already been exposed to all of these other viral strains. 00:21:45:05 - 00:21:58:09 Dr. Giles Because we don't know that, I definitely tell patients that are interested in getting repeat vaccination, and they know that they've been vaccinated prior to 2014. I will definitely give them another series that they desire. 00:21:58:11 - 00:22:16:00 Rudene Mercer-Haynes Well, this might be a variation of a variant of the same question. For those who have actually been diagnosed with HPV and they've cleared it and whatnot, does it make sense for those folks to go and get an HPV vaccine, or does that does it make any sense after you've had it? 00:22:16:00 - 00:22:38:08 Dr. Giles Yeah. So again, we can only see or test for those very specific forms. So sometimes the patient might come in and they knew that they had this clearance. They had HPV 18 and it got cleared. I don't know whether or not they actually had been vaccinated or exposed to HPV 45 or any of those other things. So if a patient desires vaccination, we still do offer it and give it. 00:22:38:10 - 00:23:03:02 Rudene Mercer-Haynes Well, I still remember when the HPV vaccine came out and I was so excited because I'm like, yeah, my son's going to get it. And then my daughter, when she's of age. And I remember going to the hair salon because I spent some time in hair salons at time. And I remember this conversation happening around me where these people were saying, under no set of circumstances would they give their children that HPV vaccine, because that's just opening the door. 00:23:03:04 - 00:23:17:23 Rudene Mercer-Haynes That's saying that you condone them engaging in sexual activity. And I, I kind of lost it and was like, this is insane because one of you provide a statistic that said 80% like there's a very high number. 00:23:17:23 - 00:23:24:16 Dr. Giles 90% of people that will ever have intercourse will actually be exposed to one strain of HPV or not. 00:23:24:18 - 00:23:29:08 Rudene Mercer-Haynes And look at all these boxes where, I mean, how is the world get populated, right? 00:23:29:08 - 00:23:48:01 Rudene Mercer-Haynes So to think that, oh my goodness, by telling them about this vaccine, you know, it's possible they're just going to like lose their minds. So I was upset and hopefully you know Janice and Doctor Giles, you're not hearing that same kind of tomfoolery come out of the mouth. 00:23:48:01 - 00:23:52:15 Dr. Giles So we still hear it. Oh, we hear it. Yeah. 00:23:52:15 - 00:24:11:17 Janice McGirt And I think, you know, because this is my population, right? I think for Doctor Giles, she has the fortune of having adults where, you know, they're one on one. So there's not an individual who's there, a proxy like their parent who's there, and bringing them to their visits. But it's definitely a conversation that I continue to have with families, and I'm transparent about that. 00:24:11:17 - 00:24:37:05 Janice McGirt I say this is not permission to have intercourse, and certainly we're not promoting promiscuity, because I think that's what people are worried about. And certainly from a cultural standpoint and religious standpoint, there are families that are very strict in what they expect of their children. But the point here is prevention, right? And I mentioned, I think prior that we don't have expectations all the time when kids will have their sexual debut. 00:24:37:11 - 00:25:02:23 Janice McGirt And there are, times where kids experiment or do things either by force, because it happens to them or just because they're trying to please someone or it's just what they want to try. And so the point is that you want to protect them before that happens and before exposure even occurs. And so I do just say upfront like this is I am not giving them, you know, the go ahead to, to be engaged in sexual activity. 00:25:02:23 - 00:25:09:05 Janice McGirt But if they're going to be at some point in their life, we'd like to take this, you know, take care of this and be done with it. 00:25:09:07 - 00:25:23:21 Dr. Giles I also think, nuance that I have with patients all the time, too, is that, yes, we consider it a sexually transmitted. But the truth is this is skin to skin. And the definition of intercourse for some patients are vastly different. 00:25:23:23 - 00:25:43:06 Dr. Giles And you will particularly find that in a, in a population that are teens and adolescents, I've never had intercourse, but they've actually done a lot of other things that are considered oral intercourse or, you know, other things. And it is skin to skin contact, even if they've never had penetration. That is something that puts them at risk for this. 00:25:43:08 - 00:26:11:10 Dr. Giles So we definitely want to make sure that we're taking that away. And from a male perspective, I think I saw someone mention it in the chat like HPV, although over 90% of cervical cancer is secondary to HPV, the reason why the vaccine was actually progressed to age 45 is because of the rise of oropharyngeal cancer. And that is again, skin to skin mucosa, interaction from oral intercourse and people that might never have had penetration. 00:26:11:12 - 00:26:32:24 Dr. Giles In our male to male patients anal intercourse HPV also causes things like vaginal vaginal cancer as well as vulvar cancer. So we definitely want to make sure that we're protecting them against all of the different cancers that can come from HPV. And that's why we actually recommend it even up to age 45. 00:26:33:01 - 00:26:50:16 Rudene Mercer-Haynes So I see you have a question, but I wanted to make sure that people understand what the vaccination is. So Doctor Ross asks, what's actually entailed with boys or men getting vaccinated? Because I think there's this confusion that, hey, it's just a shot. It's a shot for everyone, right? 00:26:50:18 - 00:27:00:01 Janice McGirt Right. It's just a shot. And again, it's age specific. So for my population, if they're under 15 traditionally it's approved down to age nine. 00:27:00:01 - 00:27:20:05 Janice McGirt But we start traditionally giving it at age 11. That's the AAP recommendation, the CDC recommendation before these recent changes with the current administration. So I talk about it, you know, usually at the nine and ten year visit and then at 11, we're giving it. But I have some parents who come in at nine and they're like begging for it. 00:27:20:05 - 00:27:41:13 Janice McGirt And I'm like, sure happy to give it. So again, it's a two dose series, 6 to 12 months apart. And then if they are 15 and older when we're initiating the HPV series, then it's a three dose series and still all done within a year. And so part of what I impress upon parents as well is that if you miss that time frame, because sometimes they come in, let's say you get it January 1st. 00:27:41:13 - 00:27:57:04 Janice McGirt So you'd be due again June 6th. They worry like, oh, I didn't get back into you till July or August. Do I need to restart the series? And the answer is no. We just pick you up where you left off and we finish there. So it's rather straightforward. It's simple, like getting a flu shot or anything else that you would get. 00:27:57:10 - 00:28:08:21 Janice McGirt But, my favorite thing is just to counsel about it and answer questions so that we demystify about who needs it, why do they need it? And like, what is the sequence look like? 00:28:08:23 - 00:28:17:23 Dr. Giles And I just want to find a follow up question there because I think they were they wanted to know exactly what the vaccine does. I think it's similar to some other vaccines. 00:28:18:01 - 00:28:47:09 Dr. Giles This is not a live vaccine. So we're not actually given HPV so that you mount a response. It's a recombinant vaccine. So they have created something that looks like HPV in the lab. And that vaccine now is given to you where your body creates an immune response to things that look like HPV. So it is not live, unlike some of the other things that we might get of and because of that, it means a response that you can now, that you can actually attack actual HPV viruses that look like that. 00:28:47:11 - 00:29:08:08 Janice McGirt You know, the only live vaccines that we currently carry in the States are your MMR, your measles, mumps, rubella, your varicella, which is chickenpox, rotavirus, which is something that we give to infants. And then the flu vaccine, which is intranasal, the attenuated one is the one that gets, your shot like injection in your arm. But yeah, it's not live as Doctor Giles mentioned. 00:29:08:10 - 00:29:16:05 Janice McGirt Can I make sure that last question from doctor Ross, it's not a mandatory vaccine, so it's recommended, but not mandatory. You won't be kept out of school for it. 00:29:16:05 - 00:29:33:07 Janice McGirt So totally up to families. But I will say that for seventh graders in my region, I'm in, Maryland and Montgomery County, Maryland, you get a little nasty gram, I call it, from the school health nurse. If you're entering seventh grade and you haven't gotten it as a friendly reminder for the T-Dap in the meningitis, but not for HPV. 00:29:33:07 - 00:29:37:16 Rudene Mercer-Haynes Perfect, Miss Naavaal, you're trying to shine. 00:29:37:18 - 00:29:57:09 Dr. Naavaal Yeah. Hi. My name is, Dr. Naavaal I'm a professor at the School of Dentistry at VCU and do a lot of HPV research, so thank you guys for I've sharing all the things. And I kind of wanted to emphasize the need for it, especially for the boys. My work is heavily with the oropharyngeal kind of side of it. 00:29:57:11 - 00:30:21:09 Dr. Naavaal So boys definitely need it because again, it's a cancer prevention vaccine. Thinking about what will happen because at some point in life you will get engaged into sexual activity. But I think why we get a vaccine sooner is because that's the time when your immunity is highest. That's the time when you take the vaccine and you can get protected for a long period of time. 00:30:21:11 - 00:30:43:14 Dr. Naavaal It just often cause two cancers. But as folks have kind of labeled other one, it causes six different types of cancers. And oropharyngeal cancers and cervical cancers are the most common one. We have done a lot of work in Virginia area two and kind of you can see vaccine rate low, cancer rates high. That's kind of like the combination. 00:30:43:14 - 00:31:09:16 Dr. Naavaal You will see so many places. So again I want to emphasize that it is really, important. And again, think about it as a cancer prevention vaccine because that's what it is doing. Because you're taking that vaccine even though you are right now sexually active or not active. The reason being that your body is really, going to produce a better immune response to it, and then it will long for a much last. 00:31:09:18 - 00:31:31:11 Dr. Naavaal And I'd like the questions were asked about, should you take again or not again, after 26 years of age, that all conversation becomes a lot of shared decision making in terms of what has happened, what has not happened, but most of the times, if you are not exposed to one of those nine, then you'll still be able to kind of get the benefit out of it. 00:31:31:13 - 00:31:53:09 Dr. Naavaal So, and then about the mandatory piece of it, I kind of wanted to clarify. So at the school in Virginia, Virginia is one of the states where it is a school required vaccine, so it is a mandatory vaccine. However, the mandate is not enforced, which means you can say no to it. And you will be okay. 00:31:53:13 - 00:32:14:10 Dr. Naavaal So so it is mandated, but it is not mandatory in that way. The Virginia schools like the way the law is written. There's it easy out from it. So at the school level now boys are required to that their girls were required to get it from a long time. But but yeah, there are laws the way it is written. 00:32:14:12 - 00:32:36:15 Dr. Naavaal But again, I, highly encourage and kind of, definitely if you guys have any question, you have both experience, but if you have any other questions related to other things, I do a lot of AP research and other things to it. I'm happy to kind of provide more resources as well. But you guys got yeah, a lot of good information today. 00:32:36:17 - 00:32:48:23 Rudene Mercer-Haynes Dr. Naavaal, thank you for underscoring the fact that we were fed today. On this topic, really, really timely information. So thank you Janice, as well as Doctor Giles.