Slow on the Uptake
We have a safe, effective vaccine that prevents cervical cancer – let’s use it!
BY ELECTRA PASKETT, PHD, MSPH
With 12,900 new cases of cervical cancer expected in the United States in 2015, and a projected 4,100 deaths from the malignancy, cervical cancer remains a serious problem in the nation.
Virtually all cervical cancers are caused by HPV infection, mainly HPV-16 and HPV-18. These viruses also can cause vaginal and vulvar cancers in women, penile cancer in men, and anal cancer and oropharyngeal cancer in women and men.
The HPV vaccine, approved in 2006, has proven safe and able to prevent cervical cancer. Approval was extended to boys in 2011. People should be lined up around the block to get the vaccine. But uptake remains low.
Girls and boys should receive three doses of the vaccine before they become sexually active, ideally at ages 11 to 12, though the vaccine can be given up to age 26 in girls and 24 in boys.
The Centers for Disease Control and Prevention (CDC) found that, while HPV vaccination rates improved in 2014, the gap in coverage between one dose of HPV vaccine and one dose of tetanus, diphtheria and pertussis (Tdap) vaccine is large. Only 40 percent of girls and 22 percent of boys had completed the three-shot series in 2014.
By comparison, HPV vaccination rates in Australia, Canada and United Kingdom are approaching 70 percent, and virtually all countries that have widely adopted the vaccine are beginning to see decreases in markers of HPV infection.
And while we won’t see changes in cancer incidence for several years, we are seeing trends that are clearly positive.
A study in the March 2016 issue of the journal Pediatrics analyzed cervical and vaginal specimens from females ages 14 to 34 gathered by the National Health and Nutrition Examination Survey (NHANES) from 2003-2006 (pre-vaccine era) and from 2009-2012 (vaccine era). The quadrivalent HPV vaccine protects against HPV- 6, -11, -16 and -18.
The study found that, since vaccine approval, the prevalence of the four HPV types declined to 4.3 percent from 11.5 percent among females aged 14-19 years, and to 12.1 percent from 18.5 percent among females aged 20 to 24 years.
Among sexually active females aged 14-24 during the vaccine era, prevalence of the four HPV types was lower in vaccinated (one or more doses) compared with unvaccinated females: 2.1 percent vs. 16.9 percent.
The study found that just six years after vaccine approval, the prevalence of four cancer-related HPV types dropped 64 percent among females aged 14 to 19 years and 34 percent among females aged 20 to 24 years.
This evidence extends earlier findings showing decreases in markers such as HPV titre levels, decreasing incidence of genital warts and of pre-invasive cervical-cancer abnormalities.
What can we do to bring U.S. HPV vaccine rates on par with those of meningococcal conjugate and Tdap?
One key reason for low vaccination rates is parents who decide they don’t want the vaccine for their children. Common reasons include:
- Concern with safety and side effects. FACT: Seven years of safety studies and distribution of about 57 million vaccine doses in the United States have identified no serious safety concerns with the HPV vaccine;
- A belief that the vaccine is not needed. FACT: HPV infection is the most common sexually transmitted infection among adults. Vaccination of 80 percent of adolescents and young adults could eliminate this infection;
- The young person is not sexually active. FACT: Girls and boys need three doses of vaccine when young so they can build an immune response before they become sexually active;
- This vaccine gives the child permission to have sex. FACT: Multiple studies show that HPV-vaccinated preteens and teens have sex no sooner than their unvaccinated peers.
Parents need to hear these messages from the physician. Unfortunately, many doctors don’t recommend HPV vaccination. A study in the February issue of examined perspectives of HPV vaccine from 364 pediatricians and 218 family physicians nationally.
Nearly one-third of the pediatricians and almost half of the family physicians reported discussing HPV vaccination only occasionally or rarely during 11-to 12-year-old visits. The most common reasons were:
- The patient is not sexually active;
- The patient is too young;
- The patient is getting other vaccines during the visit;
- The parents will refuse;
- Family physicians noted that they didn’t have time to discuss the vaccine.
The CDC recommends that physicians present the topic to parents by confidently saying, “Today your child needs three vaccines. These vaccines prevent HPV cancers, meningitis, diphtheria, tetanus and whooping cough.”
Sometimes, parents may just want reassurance from the physician that the vaccine is important for the child. Physicians can do this by saying that they would want their own children, grandchildren or close family members to be protected against HPV cancers by being vaccinated.