Human papillomavirus (HPV) is the most common sexually transmitted infection (STI) in Canada and worldwide. Health Canada estimates that up to 75% of unvaccinated sexually active individuals will contract at least one HPV infection in their lifetime.¹ Despite its prevalence, most cases are asymptomatic and apart from genital warts, there are often no visible signs or symptoms that a person has contracted an HPV infection.
Although most cases are benign, individuals infected with high-risk strains of HPV have an increased risk of certain types of cancers. Sexually transmitted HPV infections are responsible for nearly 3,800 new cancer cases annually in Canada, including:¹
- Cervical cancer (~ 100% of cases)¹
- Head and neck cancers (~ 60 to 70% of cases)¹
- Anal cancers (~ 80–90% of cases)¹
- Vulvar, vaginal, and penile cancers (~ 40–50% of cases)¹
Fortunately, HPV is largely preventable through vaccination. For optimal protection, the HPV vaccine should ideally be administered before an individual becomes sexually active. In Ontario, students from grades 7 to 12 can receive the publicly funded vaccine for free through provincial immunization programs. However, immunization coverage among adolescents and young adults varies across Canada and remains below the national target of 90%.¹ Ontario pharmacists play a vital role in educating patients and parents about HPV vaccines and the risks of HPV-related cancers and diseases.
Overview of HPV Vaccine Recommendations
In Canada, two vaccines are available to protect against high-risk strains of human papillomavirus (HPV):
- Gardasil® 9 (9vHPV)
- Cervarix® (2vHPV)
The National Advisory Committee on Immunization (NACI) strongly recommends HPV vaccination for all individuals aged 9 to 26, regardless of gender. For those aged 27 and older, the decision to vaccinate should be made in consultation with a healthcare provider based on the individual risks and benefits. Although both vaccine products are authorized for use in Canada, NACI recommends vaccination with Gardasil® 9 due to its broader protection against multiple HPV types and associated diseases.
While the HPV vaccine is most effective when administered at a younger age—before the onset of sexual activity—it can still benefit adults who have not been previously vaccinated and remain at risk of infection. Even if someone has been exposed to one type of HPV, the vaccine can protect against other strains they have not yet encountered. However, it is important to note that the vaccine does not treat existing infections or provide protection against HPV types a person has already been exposed to.
Preventing Head and Neck Cancers
While smoking and alcohol have historically been the leading risk factors for head and neck cancers, the patient demographics are shifting. The incidence of HPV-related oropharyngeal cancers is rising, particularly among younger adults in their 40s and 50s who have little or no history of smoking.²
The Canadian Cancer Society estimates that in 2024:
- 8,100 Canadians will be diagnosed with head and neck cancer.³
- 2,100 Canadians will die from head and neck cancer.³
- 5,800 men will be diagnosed with head and neck cancer and 1,550 will die from it.³
- 2,300 women will be diagnosed with head and neck cancer and 590 will die from it.³
With the incidence rates of HPV-associated head and neck cancers increasing in Canada, vaccination remains a critical preventive measure.⁴ In response to this growing public health need, Health Canada has issued a Notice of Compliance, accelerating the approval of Gardasil®9 for use in individuals 9 through 45 years to help prevent HPV-related oropharyngeal and head and neck cancers.⁵
Pharmacists have a critical role in ensuring that patients and caregivers are aware that both males and females benefit from HPV immunization, particularly given the increased risk of head and neck cancers among males.
Actionable Strategies for Pharmacists
Pharmacists can take an active role in increasing HPV vaccination uptake by integrating immunization discussions into routine pharmacy practice. Here are some practical strategies:
- Identify opportunities for proactive discussions: Patients using contraceptives, acne medications (e.g., isotretinoin), or treatments for STIs may benefit from discussing the benefits and risks of receiving an HPV vaccine. Identifying patients who are candidates for HPV vaccinations during patient consultations is one way to incorporate immunization discussions into the pharmacy workflow.
- Concurrent Administration of Vaccinations: When administering other vaccines (e.g., flu, COVID-19, hepatitis B), pharmacists can assess whether patients are up to date on their HPV vaccinations and recommend it as part of routine immunizations. Patients should be advised that HPV vaccines may be administered concomitantly with other age-appropriate vaccines at different injection sites, using separate needles and syringes.⁴
- Leveraging Technology: Pharmacies can use pharmacy management systems to flag eligible patients and attach materials to prescription bags to facilitate conversations during pickup or annual medication reviews.
Pharmacists can refer to OPA’s A Pharmacist’s Guide to Initiating Discussions about HPV Prevention Against Head and Neck Cancers for additional practical strategies. The guide includes a sample counselling script, tips on how to identify eligible patients, and answers to commonly asked patient questions.
Conclusion
HPV is a prevalent sexually transmitted infection that poses serious health risks, including several types of cancer. A vital component of HPV vaccinations is educating the public about the dangers of HPV-related cancers, and the benefits of vaccination. As accessible healthcare providers, pharmacists are essential in initiating proactive conversations, identifying vaccine-eligible patients, and integrating HPV immunization into routine pharmacy practice to improve vaccination rates and reduce the burden of HPV-related diseases.
Disclaimer: This blog post was developed by the Ontario Pharmacists Association (OPA) with an educational grant provided by Merck. The information provided in the blog is intended to provide pharmacists with general information and is not intended to provide or take the place of medical advice, diagnosis or treatment, or professional judgement. It is intended to supplement materials provided by regulatory authorities, and should there be any discrepancies, municipal, provincial, and federal laws, policies, and guidelines shall prevail. The information provided in this document are current at the time of publication. The decision for use and application of this document is the responsibility of the user. OPA expressly disclaims responsibility, and shall have no liability for any damages, loss, injury, or liability whatsoever suffered as a result of reliance on the information contained in this resource.
References
- Government of Canada. An Advisory Committee Statement (ACS). National Advisory Committee on Immunization (NACI). Updated Recommendations on Human Papillomavirus (HPV) Vaccines. July 24th, 2024. https://www.canada.ca/content/dam/phac-aspc/documents/services/publications/vaccines-immunization/national-advisory-committee-immunization-updated-recommendations-hpv-vaccines/naci-statement-2024-07-24.pdf
- Young, D., Xiao, C. C., Murphy, B., Moore, M., Fakhry, C., & Day, T. A. (2015). Increase in head and neck cancer in younger patients due to human papillomavirus (HPV). Oral oncology, 51(8), 727–730. https://doi.org/10.1016/j.oraloncology.2015.03.015
- Canadian Cancer Society. Canadian Cancer Statistics 2024. 2024. https://cancer.ca/en/research/cancer-statistics.
- Public Health Agency of Canada. Human papillomavirus (HPV) vaccines: Canadian Immunization Guide. Ottawa (ON): Government of Canada; July 2024. https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-4-active-vaccines/page-9-human-papillomavirus-vaccine.html
- CPS online. Gardasil-9. Canadian Pharmacists Association; 2020. Available from: cps.pharmacists.ca.
