EXECUTIVE SUMMARY

Results of a new analysis led by researchers at The University of Texas Health Science Center at Houston indicate that more than 70% of U.S. adults do not know that human papillomavirus (HPV) causes anal, penile, and oral cancers.

• HPV infection is the most common sexually transmitted infection in the United States. Research indicates that 79 million people in the U.S. are infected, with approximately half of new infections occurring before age 24.

• It is estimated that more than 9,000 cases of HPV-related cancers occur in men on an annual basis, with HPV responsible for 63% of penile, 91% of anal, and 72% of oropharyngeal cancers.


When it comes to human papillomavirus (HPV), many patients are unaware of the link between HPV and anal, penile, and oral cancers. Results of a new analysis led by researchers at The University of Texas Health Science Center at Houston indicate that more than 70% of U.S. adults do not know that HPV causes such cancers.1

HPV is the most common sexually transmitted infection in the United States.2-5 Research indicates that 79 million people in the U.S. are infected, with approximately half of new infections occurring before age 24.6 It is estimated that more than 9,000 cases of HPV-related cancers occur in men on an annual basis, with HPV responsible for 63% of penile, 91% of anal, and 72% of oropharyngeal cancers.7

In an analysis of responses from 2,564 men and 3,697 women who participated in the Health Information National Trends Survey, researchers found that two-thirds of men and one-third of women ages 18-26 were unaware that HPV causes cervical cancer. More than 80% of men and 75% of women in the same age group did not know that HPV can cause oral, anal, and penile cancers.1

Recommendations from the CDC call for boys and girls ages 9-14 to receive the two-dose HPV immunization. A three-dose schedule is recommended if the first dose was given on or after the 15th birthday.8 Recent recommendations also advise that adults ages 27-45 may receive the HPV vaccine, based on discussion with their clinician.9

Findings from a recent CDC study indicate that 51% of all teens ages 13-17 have received all recommended doses of the HPV vaccine.10 The lack of knowledge about the link between HPV infection and anal, penile, and oral cancers may have contributed to low vaccination rates, said Ashish Deshmukh, PhD, MPH, assistant professor at The University of Texas Health Science Center at Houston.

“HPV vaccination campaigns have focused heavily on cervical cancer prevention in women,” Deshmukh noted in a statement. “Our findings demonstrate a need to educate both sexes regarding HPV and HPV vaccination.”11

Use Strong Recommendations

When discussing the HPV vaccine, are clinicians using their strongest, most persuasive recommendation? In a recent survey of national physician networks, researchers found that only 65% of pediatricians and 42% of family practitioners used the presumptive style of discussion, leading off with “we have three vaccines for today.” About 24% of family practitioners and 16% of pediatricians used a more conversational style, which is less effective.12

HPV vaccination rates are higher in teens whose parents reported receiving a recommendation from their child’s healthcare professional.10 Research indicates that healthcare providers play a key role in educating parents and are the most trusted source of information for parents of preteens eligible for vaccination.13,14 Clinicians can avoid missed opportunities by strongly recommending the HPV vaccine to parents of children ages 11-12 on the same day and in the same way that Tdap and meningococcal vaccines are recommended.

REFERENCES

  1. Suk R, Montealegre JR, Nemutlu GS, et al. Public knowledge of human papillomavirus and receipt of vaccination recommendations. JAMA Pediatr 2019;doi:10.1001/jamapediatrics.2019.3105.
  2. Clifford GM, Smith JS, Plummer M, et al. Human papillomavirus types in invasive cervical cancer worldwide: A meta-analysis. Br J Cancer 2003;88:63-73.
  3. Chaturvedi AK, Engels EA, Pfeiffer RM, et al. Human papillomavirus and rising oropharyngeal cancer incidence in the United States. J Clin Oncol 2011;29:4294-4301.
  4. Jemal A, Simard EP, Dorell C, et al. Annual Report to the Nation on the Status of Cancer, 1975-2009, featuring the burden and trends in human papillomavirus (HPV)-associated cancers and HPV vaccination coverage levels. J Natl Cancer Inst 2013;105:175-201.
  5. Khan MJ, Castle PE, Lorincz AT, et al. The elevated 10-year risk of cervical precancer and cancer in women with human papillomavirus (HPV) type 16 or 18 and the possible utility of type-specific HPV testing in clinical practice. J Natl Cancer Inst 2005;97:1072-1079.
  6. Satterwhite CL, Torrone E, Meites E, et al. Sexually transmitted infections among U.S. women and men: Prevalence and incidence estimates, 2008. Sex Transm Dis 2013;40:187-193.
  7. Juckett G, Hartman-Adams H. Human papillomavirus: Clinical manifestations and prevention. Am Fam Physician 2010;82:1209-1213.
  8. Meites E, Kempe A, Markowitz LE. Use of a 2-dose schedule for human papillomavirus vaccination — updated recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep 2016;65:1405-1408.
  9. Meites E, Szilagyi PG, Chesson HW, et al. Human papillomavirus vaccination for adults: Updated recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep 2019;68:698-702.
  10. Walker TY, Elam-Evans LD, Yankey D, et al. National, regional, state, and selected local area vaccination coverage among adolescents aged 13-17 years — United States, 2018. MMWR Morb Mortal Wkly Rep 2019;68:718-723.
  11. University of Texas Health Science Center at Houston. Most American adults do not know that HPV causes oral, anal, and penile cancers. Sept. 16, 2019. Available at: https://bit.ly/2PiXma5.
  12. Kempe A, O’Leary ST, Markowitz LE, et al. HPV vaccine delivery practices by primary care physicians. Pediatrics 2019;doi:10.1542/peds.2019-1475.
  13. Gilkey MB, Moss JL, McRee A-L, et al. Do correlates of HPV vaccine initiation differ between adolescent boys and girls? Vaccine 2012;30:5928-5934.
  14. Stokley S, Jeyarajah J, Yankey D, et al. Human papillomavirus vaccination coverage among adolescents, 2007-2013, and postlicensure vaccine safety monitoring, 2006-2014 — United States. MMWR Morb Mortal Wkly Rep 2014;63:620-624.