ASCO Calls for Increased HPV Vaccination Efforts

The American Society of Clinical Oncology (ASCO) released a statement calling for the rapid expansion of use of the human papillomavirus (HPV) vaccine to help protect thousands of people from HPV-associated cancers.

“With safe and effective vaccines readily available, no young person today should have to face the devastating diagnosis of a preventable cancer like cervical cancer. But unless we rapidly increase vaccination rates for boys and girls, many of them will,” said ASCO President Julie M. Vose, MD, MBA, in a press release. “As oncologists, we see the terrible effects of these cancers first hand, and we have to contribute to improving today’s alarmingly low vaccination rates.”

The statement, published in the Journal of Clinical Oncology, outlines current barriers to HPV vaccination and provides recommendations to promote the uptake of these vaccines.

The Centers for Disease Control and Prevention (CDC) currently recommends that all boys and girls aged 11 to 12, men aged to 21, and women aged to 26, be vaccinated against HPV. In addition, the CDC recommends vaccination in everyone with compromised immune systems up to age 26 and in gay and bisexual men up to age 26.

Despite that, the 2011 National Immunization Survey found that only about 36% of girls and 14% of boys have received all three doses of HPV vaccines needed to provide protection, according to the ASCO press release. In addition, a recent study by Jonathan K. Kish, PhD, MPH, of the National Cancer Institute, and colleagues found that decreases in the incidence of HPV seen from 1995 to 1999 and 2000 to 2004 slowed from 2005 to 2009.

“A possible explanation for the slowing of the decreasing trend is that women with access to health care are benefiting from preventive services such as Pap screening and HPV testing, to a greater extent than are women in medically underserved groups,” Kish and colleagues wrote in the Journal of Global Oncology. “These underserved women, who experience a higher burden of cervical cancer, include ethnic minorities, women from low socioeconomic backgrounds, and women living in impoverished geographic areas. Future progress to reduce the burden of cervical cancer depends on access to vaccination, screening, and treatment of these hard-to-reach groups.”

The researchers used data from the Cancer in North America data set provided by the North American Association of Central Cancer Registries to examine incidence trends from 1995 to 2009 for the entire United States. The data revealed a higher incidence of HPV in rural areas within Appalachia, Texas, the lower Mississippi Valley, and the southeastern United States. Ten out of 17 states or districts with a high incidence of cervical cancer were also found to have low rates of Pap screening, HPV vaccine coverage, or both.

“Provisions of the Affordable Care Act, which require most health insurance plans to cover cervical cancer screening and HPV vaccination with no cost sharing, could improve cervical cancer prevention among low-income women,” the researchers wrote.

The study also showed that Hispanic and black women had higher rates of cervical cancer compared with white and Asian/Pacific Islander women during each of the time periods in the study.

“This study identified populations that would benefit from cervical cancer outreach by ethnicity, geography, and access to screening and HPV vaccination,” the researchers wrote. “Although progress has been made in reducing the incidence of cervical cancer, outreach is needed in low-socioeconomic areas of the United States.”

ASCO Recommendations

In order to increase uptake of HPV vaccination among these populations, ASCO made several recommendations in its policy statement, including:

•  Education and awareness among healthcare professionals, policy makers, patients and the public, including ways to improve delivery in doctor’s offices with the use of electronic health record systems.

•  Coverage and access for routine vaccination, including consideration of school-based HPV vaccination programs, which have been successful in other countries.

•  Addressing critical knowledge gaps through research on effective ways of increasing routine vaccine use.

In its statement, ASCO also discussed the important role of oncologists in increasing the use of HPV vaccines.

“Although most oncologists will not be direct providers of these preventive measures, this does not abrogate us from contributing to this process. Our unassailable role in the mission to lessen the burden of cancer for our patients, their families, and our communities places us in a position of influence,” the statement said.

The statement recommended that oncologists use interactions with health care systems, and primary care providers, specifically, to discuss the important role of HPV vaccination in preventing HPV-related cancers.