The HPV vaccine — it’s cancer prevention in the hands of physicians and parents

As a gynecologic oncology fellow, I have the privilege of caring for women with gynecologic cancers in their greatest time of need. However, one of the most troubling experiences is caring for women whose disease could have potentially been prevented, such as those cancers associated with the human papillomavirus (HPV).

HPV is known to cause a variety of cancers, including cancer of the vulva and vagina, penis, throat and, most commonly, the cervix. Approximately 38,000 HPV-attributable cancers are diagnosed each year in the U.S. — 60 percent in women and 40 percent in men — with hundreds of thousands of HPV-associated pre-cancers also diagnosed annually.

{mosads}In fact, HPV is known to cause more than 99 percent of all cervical cancers, and nearly all American men and women will become infected with this virus at some point in their lifetimes. While HPV is sexually transmitted, condoms do not provide complete protection, and the virus can be transferred with skin-to-skin genital contact.

Most infections will be controlled by the immune system and will not go on to cause a cervical cancer. However, when the infection does progress to cancer, it can be devastating and deadly. Most cervical cancer cases are diagnosed in middle aged and older women; however, many patients I have cared for have been diagnosed in their third or fourth decades of life, including young mothers.  

I will always remember the first patient with cervical cancer I cared for as a medical student; she had missed her regular Pap screening as a busy single working mother of two. By the time she presented to our hospital, her cancer was so advanced that we could only offer her a palliative surgery to provide some comfort in the last months of her life. Her four- and six-year-old children were orphaned, even though her cancer could have potentially been prevented. Sadly, I have experienced this same story time and time again, caring for countless women with cervical cancer.

While Pap smear screening and HPV testing are methods of identifying cervical cancer precursors, with the goal of treating them before they become malignant, we now have the ability to prevent precancerous lesions from developing at all. The first HPV vaccine was approved for use by the FDA in 2006, and it represents the first time we have the real possibility of preventing a cancer with a vaccine. We have more than a decade of data to suggest it is both effective and safe. In late 2014, an updated vaccine was approved which prevents infection from nine HPV subtypes, with the potential to prevent up to 90 percent of cervical cancers.

The HPV vaccine is recommended for boys and girls as young as age nine because the vaccine is most effective when given before any exposure to HPV through sexual contact. Unfortunately, American girls and boys are being vaccinated at suboptimal rates. There are several factors that contribute to the low vaccination rates in the U.S.; however, physician enthusiasm for vaccination can help to improve immunization rates. Studies show that some physicians are hesitant to discuss the vaccine with parents because they feel the need to also discuss sexual activity at the same time.

Lead researcher, Anne Rositch, PhD, MsPH, as well as Melinda Krakow, PhD, MPH, Kimberly Levinson, MD, MPH, and I initiated a study to examine the reasons for persistent low vaccination rates in the US. We utilized data from the National Immunization Survey-Teen (the same survey the CDC uses to track vaccination rates) to evaluate if parents’ concerns have changed over a 5-year period.

From 2010-2014, the top two reasons why parents do not intend to vaccinate their adolescent girls stayed the same: they were concerned about safety or side effects, and they felt that the vaccine was not necessary. In 2010, approximately 18 percent of parents were also concerned that their child had not yet initiated sexual activity; however, in 2014 this was reported by just 9 percent of parents.

It fell from the third most common reason for not initiating vaccination to the fifth most common reason. Lack of physician recommendation was the fourth most common reason in 2014, up from the fifth most common in 2010. Fewer than two percent of parents were worried the vaccine would increase their child’s sexual activity.

Pediatricians, family physicians, and obstetrician gynecologists are at the frontline in recommending this vaccine. Our data demonstrate that parents are less concerned about the vaccine’s relation to sexual activity, and need to hear more about its safety and necessity. Educating parents on the importance of cancer prevention should be an easy and achievable goal of healthcare providers.

Our data support discussing the vaccine with parents of children before sexual activity is initiated, and physicians should not be reluctant to discuss and recommend the vaccine simply because they do not want to discuss sexual activity.

We now have the potential to prevent almost 90 percent of cervical cancers, a remarkable public health opportunity and feat of science and medicine, which will be wasted if we fail to vaccinate current and future generations. The potential impact of HPV immunization is dependent on strong physician engagement in educating parents of young children, as well as young adults, regarding the importance of this cancer prevention vaccine.

As a physician who cares for women diagnosed with pre-cancers and cancers caused by HPV, I urge physicians who provide preventive care to our current generation of girls and boys to strongly recommend the HPV vaccine. Physician discussion about the vaccine, its safety and side effects, and a robust recommendation could contribute significantly to beginning to eradicate the cancers caused by this preventable viral infection.

Anna Beavis, MD, MPH is a clinical gynecologic oncology fellow with The Kelly Gynecologic Oncology Service at Johns Hopkins Hospital. Her work was performed with the guidance of Anne Rositch, PhD, MSPH from the Johns Hopkins Bloomberg School of Public Health, and Kimberly Levinson, MD, MPH from the Kelly Gynecologic Oncology Service.

The views expressed by contributors are their own and are not the views of The Hill.