EXECUTIVE SUMMARY
Top U.S. cancer centers have joined to emphasize the importance of human papillomavirus (HPV) vaccination for the prevention of cancer.
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Despite the availability of three HPV vaccines, vaccination rates lag far behind those of other routine adolescent vaccines. Only 60% of females and 42% of males received one dose of an HPV vaccine series in 2014, and 40% of females and 22% of males received the complete three-dose series.
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HPV vaccines should be given routinely for females and males at ages 11 or 12, though it can be given as early as age 9. Vaccination for females ages 13-26 and males ages 13-21 also are recommended if they have not completed the three-dose series. Vaccination is recommended up to age 26 for men who have sex with men, as well as for immunocompromised males.
Sixty-nine of the top cancer centers in the United States have joined to emphasize the importance of human papillomavirus (HPV) vaccination for the prevention of cancer. Despite the availability of three HPV vaccines, vaccination rates lag far behind those of other routine adolescent vaccines.
In 2014, 87.6% of adolescents ages 13-17 were vaccinated with tetanus, diphtheria, and acellular pertussis, and 79.3% were vaccinated with meningococcal conjugate. In contrast, only 60% of females and 42% of males received one dose of an HPV vaccine series, and just 40% of females and 22% of males received the complete three-dose series.1 (Contraceptive Technology Update reported on the vaccination research in the story “HPV vaccination: Many teens still not receiving the shot,” October 2015, available at http://bit.ly/1SFFBgQ.)
While the cancer centers designated by the National Cancer Institute (NCI) are at the forefront of cancer research, care, and prevention, they rarely have come together in concerted action, said Ernest Hawk, MD, vice president and division head of the Houston-based University of Texas MD Anderson Cancer Center’s Cancer Prevention and Population Sciences. “These centers care for patients daily with HPV-related cancers, and there is no greater motivation for prevention than that experience,” said Hawk in a statement accompanying the joint message. “Therefore, they have bonded together in the hope that their collective action will catch the public’s attention to highlight the tremendous opportunity we have to prevent these cancers.”
MD Anderson Cancer Center hosted a November 2015 national summit that included experts from the NCI, the Centers for Disease Control and Prevention, the American Cancer Society, and more than half of the NCI-designated cancer centers to share findings from 18 NCI-funded detailed regional assessments, which sought to identify barriers to increasing immunization rates in pediatric settings across the country.
For its part, MD Anderson Cancer Center has launched its HPV Moon Shot. The program is taking three approaches to defeat HPV-related cancers:
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prevention and screening, including projects to dramatically increase HPV vaccination rates through education and policy and to increase access to early diagnosis through screening outreach and new screening clinical trials;
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discovery, which will identify new targets for therapy through an integrated genomics effort across disease sites, drug screening, and preclinical models;
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immunotherapy and novel trials, which will advance ways to influence the immune system to fight cancer and include preclinical studies and future clinical trials.
Lois Ramondetta, MD, professor of gynecologic oncology and reproductive medicine and co-leader of the project, said, “MD Anderson has made a commitment to ending HPV-related cancers with the recently unveiled HPV-related Cancers Moon Shot. One of our goals is to inspire policy and education to increase HPV adolescent vaccination rates to 80% to prevent several cancers.”
This effort falls in line with the February 2016 White House announcement of a $1 billion National Cancer Moonshot initiative to eliminate cancer as we know it.
CURRENT RECOMMENDATIONS
The current recommendation from the Advisory Committee on Immunization Practices is that HPV vaccines should be given routinely for females and males at ages 11 or 12, though it can be given as early as age 9.
Vaccination for females ages 13-26 and males ages 13-21 also is recommended if they have not completed the three-dose series. Also, vaccination is recommended up to age 26 for men who have sex with men, as well as for immunocompromised males.2
Despite this guidance, results of a 2014 survey show that many providers fail to give a strong recommendation for vaccination.3 A sizeable minority of physicians reported that they do not strongly endorse HPV vaccine (27%) or deliver timely recommendations for girls (26%) or boys (39%). Many physicians (59%) used a risk-based approach to recommending HPV vaccine, and only half (51%) usually recommended same-day vaccination.3
THE POWER OF A PROVIDER
A provider’s recommendation is the main factor that motivates parents to get HPV vaccination for their children, notes Noel Brewer, PhD, a University of North Carolina (UNC) Lineberger Cancer Center member and associate professor in the UNC Gillings School of Global Public Health, both in Chapel Hill.
“However, low-quality communication about HPV vaccination is common,” noted Brewer, the study’s senior author, in a press statement accompanying the research. “Many physicians recommend HPV vaccine hesitantly, or late, or not at all.”
How can you help increase HPV vaccination rates? Look to resources provided by the Centers for Disease Control and Prevention (CDC) at http://1.usa.gov/1KDz3wB. Get information on how to answer questions from parents, speak with colleagues about the importance of vaccination recommendation, and link information from the CDC to your practice’s web site.
Parents who discourage their daughters and sons from getting HPV vaccination due to opposition to vaccinations of any kind or concern that HPV vaccination will make their child more promiscuous sexually are doing a grave disservice to their children by increasing their risk of one of the most common forms of cancer in women and several types of cancer in men, suggests Robert Hatcher, MD, MPH, professor emeritus of gynecology and obstetrics at Emory University School of Medicine, Atlanta.
REFERENCES
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Reagan-Steiner S, Yankey D, Jeyarajah J, et al. National, regional, state and selected local area vaccination coverage among adolescents aged 13-17 years — United States, 2014. Morb Mortal Wkly Report 2015; 64:784-792.
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Markowitz LE, Dunne EF, Saraiya M, et al. Centers for Disease Control and Prevention (CDC). Human papillomavirus vaccination: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2014; 63(No. RR-05):1-30.
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Gilkey MB, Malo TL, Shah PD, et al Quality of physician communication about human papillomavirus vaccine: Findings from a national survey. Cancer Epidemiol Biomarkers Prev 2015; 24(11):1673-1679.
