By Rebecca Bowers

EXECUTIVE SUMMARY

The 67 National Cancer Institute-designated cancer centers and a host of other cancer organizations now are fully endorsing the goal of eliminating cancers caused by human papillomavirus (HPV) through gender-neutral HPV vaccination and evidence-based cancer screening.

  • The call to action seeks vaccination of more than 80% of males and females ages 13-15 by 2020, screening of 93% of age-eligible females for cervical cancer by 2020, and provision of prompt follow-up and proper treatment of females who screen positive for high-grade cervical pre-cancerous lesions.
  • Results of a 2014 study indicated that more than 90% of sexually active women and 80% of sexually active men will be infected with at least one type of HPV at some point in their lives. Data indicate about one-half of these infections were with a high-risk HPV type.

The 67 National Cancer Institute designated cancer centers and a host of other cancer organizations now are fully endorsing the goal of eliminating cancers caused by human papillomavirus (HPV) through gender-neutral HPV vaccination and evidence-based cancer screening.

A call to action has been issued, which falls in line with the nation’s Healthy People 2020 goals:

  • Vaccination of more than 80% of males and females ages 13-15 by 2020;
  • Screening of 93% of age-eligible females for cervical cancer by 2020; and
  • Providing prompt follow-up and proper treatment of females who screen positive for high-grade cervical pre-cancerous lesions.

In a similar move, the American Cancer Society has launched “Mission: HPV Cancer Free,” a public health campaign to eliminate vaccine-preventable HPV cancers, starting with cervical cancer.

“If we can achieve sustained 80% HPV vaccination in pre-teen boys and girls, combined with continued screening and treatment for cervical pre-cancers, we could see the elimination of cervical cancer in the U.S. within 40 years,” said Richard Wender, MD, chief cancer control officer for the American Cancer Society, in announcing the new campaign. “No cancer has been eliminated yet, but we believe if these conditions are met, the elimination of cervical cancer is a very real possibility.”

About 26,000 new cancers attributable to HPV occur each year, including 18,000 among females and 8,000 among males.1 A 2014 study by the Centers for Disease Control and Prevention (CDC) estimated that more than 90% of sexually active women and 80% of sexually active men will be infected with at least one type of HPV at some point in their lives.2 Data indicated about one-half of these infections were with a high-risk HPV type.3

All girls and boys who are 11 or 12 years of age should receive two shots of HPV vaccine six to 12 months apart.4 While HPV vaccination prevents an estimated 90% of HPV cancers when given at the recommended age, cancer protection decreases as age at vaccination increases.5

“The American Cancer Society is determined to protect the future of every boy and girl by preventing six types of cancer with the HPV vaccine,” notes Debbie Saslow, PhD, senior director of HPV related and women’s cancers for the American Cancer Society. “We have a historic opportunity and all we have to do is make sure the children in our lives are vaccinated and the women in our lives are screened.”

To help improve vaccination rates, the CDC notes that receiving a provider’s recommendation for a vaccine is an important reason parents decide to vaccinate their children. Clinicians can take the opportunity to strongly recommend the HPV vaccine to parents of children ages 11-12 at the same time that they recommend the Tdap and meningococcal vaccines.

Overcome Vaccine Challenges

New research from the University of North Carolina at Chapel Hill indicates that follow-through on the HPV vaccine the percentage of those who complete the series within a year of receiving their first dose is low and has declined over time.6

The analysis used data from insurance claims for more than 1.3 million privately insured individuals in the United States, ages 9 to 26 years, who initiated the HPV vaccine series between 2006 and 2014. Researchers reported the vaccination follow-through for females fell from 67% in 2006 to 38% in 2014, and dropped from 36% in 2011 to 33% in 2014 for males. This means that only one-third of males and one-third of females received all recommended doses of the HPV vaccine.

The study findings indicate that follow-through was highest among patients initiating HPV vaccine through an obstetrician/gynecologist and lowest among those initiating the series with a physician’s assistant or nurse practitioner. Patients with HMO insurance plans also had lower follow-through than those with other insurance plan types, researchers reported.6

“We’ve focused a lot on ways to increase initiation of the vaccine, but this work really shows that’s only part of the story,” states Jennifer Spencer, MSPH, lead author and health policy and management doctoral student at the University of North Carolina Gillings School of Global Public Health. “We need to make sure patients and providers understand the importance of completing the full series.”

Data Underscore Safety, Efficacy

Results of a new comprehensive review of the most recent clinical data on the subject show that HPV vaccines can help prevent cervical cancer without producing any serious side effects.7

The review summarizes 26 studies that involved 73,428 women and that were conducted across the globe during the past eight years. Most women in the studies were younger than 26 years of age; three trials recruited women between 25 and 45 years of age. All studies in the review randomized women to receive either an HPV vaccine or a placebo. Two types of vaccine were included in the review: the bivalent vaccine, which targets HPV 16 and 18, and the quadrivalent vaccine, which guards against HPV 16/18 and two other HPV types of low risk that cause genital warts. Researchers did not include the newest vaccine, Gardasil 9, in the review because it has not been compared to a placebo in a randomized controlled trial. Gardasil 9 is designed to target four HPV types (16, 18, 6, and 11), as well as five more HPV types that are associated with cervical cancer (HPV 31, 33, 45, 52, and 58). Research indicates that the vaccine can reduce 90% of cervical cancers throughout the world.8

The review focused on women who did not have high-risk HPV at the time of vaccination, and all women regardless of HPV status at vaccination. The researchers measured the effects of the vaccine according to precancer related to HPV 16/18 and precancer no matter the type of HPV. The data were from 10 trials with information about cervical lesions from three and a half years to eight years after vaccination.7

The researchers found that among young women who did not have HPV, the risk of developing precancer was decreased. About 164 per 10,000 women who received the placebo and two per 10,000 women who received the HPV vaccine later developed cervical precancer.7

REFERENCES

  1. Centers for Disease Control and Prevention (CDC). Human papillomavirus-associated cancers — United States, 2004-2008. MMWR Morb Mortal Wkly Rep 2012;61:258-261.
  2. Chesson HW, Dunne EF, Hariri S, Markowitz LW. The estimated lifetime probability of acquiring human papillomavirus in the United States. Sex Transm Dis 2014;41:660-664.
  3. Hariri S, Unger ER, Sternberg M, et al. Prevalence of genital human papillomavirus among females in the United States, the National Health and Nutrition Examination Survey, 2003–2006. J Infect Dis 2011;204:566-573.
  4. Centers for Disease Control and Prevention (CDC). HPV Vaccines: Vaccinating Your Preteen or Teen. Available at: https://bit.ly/2gChcrK. Accessed June 21, 2018.
  5. Giuliano AR, Palefsky JM, Goldstone S, et al. Efficacy of quadrivalent HPV vaccine against HPV infection and disease in males. N Engl J Med 2011;364:401-411.
  6. Spencer JC, Brewer NT, Trogdon JG, Predictors of human papillomavirus vaccine follow-through among privately insured US patients. Am J Public Health 2018;108:946-950.
  7. Arbyn M, Xu L, Simoens C, Martin-Hirsch PP. Prophylactic vaccination against human papillomaviruses to prevent cervical cancer and its precursors. Cochrane Database Syst Rev 2018;5:CD009069.
  8. Huh WK, Joura EA, Giuliano AR, et al. Final efficacy, immunogenicity, and safety analyses of a nine-valent human papillomavirus vaccine in women aged 16-26 years: A randomised, double-blind trial. Lancet 2017;390:2143-2159.