January is cervical cancer awareness month. While the number of TDAP and meningococcal vaccinations have increased in recent years due to schools requiring children to get them before enrollment, the number of HPV vaccines is still low. Children are not getting their HPV vaccines. This year, state and national health care leaders are implementing new screening methods to increase the number of children vaccinated for HPV. One such leader, ImmunizeAR has worked to encourage providers to promote the HPV vaccine. Heather Mercer, the Executive Director of ImmunizeAR, knows first-hand the importance of this vaccine in preventing cervical cancer.
The Advisory Committee on Immunization Practices (ACIP), the organization that advises the Centers for Disease Control and Prevention (CDC) on all vaccine information, recommends that children receive their HPV vaccine at age 11 or 12. “We are trying to initiate a new strategy,” Heather says, “to start vaccinating children at age 9.” ImmunizeAR has tried to advise providers to bundle the HPV vaccine with the TDAP and meningococcal vaccines required for schools due to such a low HPV vaccination rate. “Currently, some providers are saying, ‘your child is due for these two required vaccines, and there is also this other one that is not required that your child is due for.’” A strong recommendation from providers encourages parents to get the HPV vaccine. Heather hopes that initiating the HPV vaccine at age 9, before they receive the other two vaccines for school, will help solve this issue.
“There are no school-required vaccines at age 9,” Heather says. “You’re also not getting as many vaccines in one visit.” Parents may be more incentivized by one vaccination instead of three or four. Parents may also think that if their child gets the HPV vaccine at age 11 or 12, it may open the door for uncomfortable conversations about sex. “Some parents are afraid that, if their child gets the HPV vaccine, it will give their child permission to have sex, or that their child may begin having sex.” Moving the age of vaccination to age 9 takes that conversation off the table.
Just as critical as vaccinations are regular screenings via pap test. However, some women may feel that, because their test results always come back normal, they are completely healthy and do not need to keep getting screened. It is important that providers let patients know that, just because one screening came back normal does not mean that all of them will. “There are many strains of HPV, and not all of them cause cancer, but there are seven that do,” Heather says. “[a patient] may be negative for HPV at one visit but positive at another visit.” This is why providers should prioritize ensuring that patients get regular pap tests. “Researchers are not sure why HPV causes cancer in some women but not others,” Heather adds, “so there is no way to know which people may get cancer and which will not.” Providers must make their patients aware of this so that they can understand the importance of regular screenings.
How do HPV and cervical cancer affect males?
While providers typically encourage women to get the HPV vaccine, men should also get vaccinated. According to the Centers for Disease Control and Prevention (CDC), among 15- to 59-year-olds, 2 in 5 (40%) people will have HPV. Though most men do not have symptoms of HPV, they can still spread it to someone else through vaginal, anal, or oral sex. It also spreads through close skin-to-skin contact. HPV infections in men usually go away by themselves. If they don’t, they can cause cervical cancer in women, penile cancer in men, anal cancer in men and women, and oropharyngeal cancer (cancer in the back of the throat) for both men and women. Oropharyngeal HPV is transmitted to the mouth through oral sex. “In 2015, the number of oropharyngeal cancer cases actually surpassed the number of cervical cancer cases caused by HPV and has stayed higher since then,” Heather says. For more information on the effects of HPV on men, check out the CDC’s HPV and Men Fact Sheet.
Staying Ahead of the Virus with Vaccines and Awareness Campaigns
Heather says, “Cancers can show up much later, so if we can vaccinate children when they’re younger, we can prevent people from developing cancer in their 30s and up.” When a person’s body is exposed to HPV via a vaccine, the body can prepare to defend itself against the HPV virus. Since the ImmunizeAR team is proposing to administer the HPV vaccine at 9, a child’s body would be ready to fight HPV well before the age they begin having sex.
According to cancer.net, there are over 150 strains of HPV. Most HPV infections to not show symptoms, so patients may not know if they have been infected with the virus. Some types of HPV, however, cause cancer or abnormal growths that can lead to cancer. In fact, HPV strains 16 and 18 lead to the majority of cancer cases. HPV vaccines (and especially those that protect against strains 16 and 18) can prevent cancers caused by HPV; yet, despite this fact, many people are afraid to talk to their providers about cervical cancer or HPV vaccinations. “There are many stigmas associated with cervical cancer,” Heather explains. HPV causes cancers that people may feel embarrassed to talk about, such as anal cancer, penile cancer, and cervical cancer. “We need to remove the stigma surrounding HPV because providers don’t care how patients got cancer; they want to help treat it.” There are many resources out there for providers to use to help lessen stigmas surrounding HPV and promote acceptance of the HPV vaccine. ImmunizeAR is doing their part to help raise awareness.
“We have an annual HPV summit (this year, it’s on May 5) for nurses, pharmacists, physicians, and even dental professionals (due to the prevalence of oropharyngeal cancer),” Heather says. “We have an HPV prevention workgroup that meets the third Thursday of odd months where we hear information and education from different groups like St. Jude, the American Cancer Society, and other partner groups to raise awareness of HPV and stress the importance of the HPV vaccine.” The HPV vaccine is recommended by the Advisory Committee on Immunization Practices (ACIP), an advisory group to the CDC who develops recommendations on how to use vaccines. The HPV vaccine has been recommended for patients since its inception in 2006. “Many people think it’s a newer vaccine,” Heather adds, “but it’s been on the market since 2006 so it’s not so new anymore.”
Other countries outside of the U.S. have implemented a school requirement for the HPV vaccine. “Australia administers the HPV vaccine as part of their school program,” Heather says. “They have seen a decrease in cancer and mortality rates across the nation over the past 10 years.” You can read more about the impact of HPV vaccination in Australia here. Many parents only get the vaccines required by their child’s school, or they get the vaccines that their providers recommend. If more providers recommend the HPV vaccine, more parents are likely to have their children get it. Unfortunately, providers are not recommending the HPV vaccine as frequently as they should. “We hear from a lot of patients that say their provider never recommended the HPV vaccine,” Heather says.
Provider Incentives
To promote more widespread acceptance and recommendation of the HPV vaccine, insurance companies have begun implementing incentives for providers who administer the HPV vaccine. “Some insurance companies like Blue Cross and Blue Shield give quality metric incentives [to providers] if they complete the vaccine series by age 13,” Heather states. “By administering the vaccine starting at age 9, providers have plenty of time to complete the series before age 13.” If a patient receives their HPV vaccine before age 15, they only need two doses of the vaccine. If the patient is over 15, they need three doses. If parents wait until after their child is 15 to have them get the vaccine, the child’s immune system won’t have as robust of an immune response as it would if they were younger, so three vaccinations are recommended.
What can health care professionals do to start the conversation or ease patients into being okay with talking about cervical cancer?
ImmunizeAR Resources
The ImmunizeAR website includes a specific tab on HPV information for health care professionals, pharmacists, and parents/families. Health care professionals and pharmacists can also earn one hour of continuing education (CE) credit by attending a webinar titled “HPV Vaccination is Cancer Prevention.”
Visit the ImmunizeAR website for more resources on vaccinations, including HPV vaccines and providers' roles in increasing vaccination rates and uptake.
