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February 24, 2014

HPV Vaccination: A Significant Opportunity for Cancer Prevention

February 24, 2014

Dr. Susan FlockeThe following piece was written by Dr. Susan A. Flocke, Director of the Behavioral Measurement Core Facility and co-Leader of the Cancer Prevention, Control and Population Research Program of the Case Comprehensive Cancer Center. She is also Associate Professor of Family Medicine and Epidemiology & Biostatistics at CWRU.

The President's Cancer Panel monitors progress of the National Cancer Program, identifies topics of high importance to the nation, and recommends action to address identified issues. Earlier this month, the Panel highlighted human papillomavirus (HPV) vaccines as an effective but under-used intervention to prevent cancers1.

Letters from the Panel were sent to multiple stakeholder organizations and to the President of the United States urging action to increase the uptake of HPV vaccination, especially in adolescents. The primary message of the calls to action is that HPV vaccination is cancer prevention and that the HPV vaccination is safe, effective, and especially important given the high prevalence of HPV.

In the United States, about 79 million people are currently infected with HPV and about 14 million become newly infected each year. More than 26,000 cancers each year are attributed to HPV, with cervical cancer in women accounting for most of these cases (10,300), followed by oropharyngeal cancer in men (6,700)2.

Currently, the Centers for Disease Control and Prevention (CDC) recommends HPV vaccination for girls and boys at ages 11 and 12. For those who were not vaccinated at age 11-12, HPV vaccination is recommended for females ages 13 through 26 and males ages 13 through 21.

Cervarix and Gardasil are two HPV vaccines that are available for girls to protect against the HPV types that cause most cervical and anal cancers. Gardasil also protects against the HPV types that cause most genital warts; Gardasil is the only vaccine approved for boys. Both brands of HPV vaccine are given in three doses over six months.

Currently, only about 33% of US adolescent girls complete HPV vaccination3. Completion rates among boys is even lower at 7%. Unlike other types of vaccinations like Tdap (tetanus toxoid, reduced diphtheria toxoid and acellular pertussis) and MenACWY (meningococcal conjugate) that have improved in coverage since 2006, HPV uptake has been poor with coverage rates dropping from 2011 to 20123.

Factors associated with lack of uptake include lack of provider recommendation4,5 and parental concerns about side effects or potential harm to the child from the vaccine4.

Specific suggestions from the President's Cancer Panel1 for accelerating HPV vaccine uptake include:

  • Developing and implementing integrated and comprehensive communication strategies directed at parents and adolescents to raise awareness of the importance and addressing misconceptions about the vaccine
  • Improving clinician preparedness to talk with parents about the vaccine and to make a strong recommendation
  • Recommending HPV vaccination of age eligible individuals whenever other vaccines are administered

Clinicians can immediately act by providing a consistent and focused message about HPV vaccination to age-eligible patients and parents. The American Academy of Family Physicians recently summarized what clinicians can tell parents when they express concerns about the vaccine for their child:

  1. The vaccine is important. HPV vaccines prevent cancer. In girls it represents the single best defense against cervical cancer. It is a key tool in preventing anal and oropharyngeal cancers in both males and females.
  2. The vaccine is effective. Clinical trials have shown HPV vaccines to be extremely effective in both boys and girls. Studies in the United States and other countries where the vaccine is used demonstrate significant reductions in the incidence of infections caused by the HPV types targeted by the vaccine.
  3. The vaccine is safe. The vaccine has been carefully studied in both girls and boys and it has not been associated with any long-term side effects. If they do occur, most side effects are mild, consisting mainly of soreness or redness in the arm in which the vaccine is given.
  4. The vaccine consists of three doses in six months and it is important to get all three. The vaccine should be given to 11-12 year old girls and boys. As with other vaccines, it is critical that the child receive the vaccine well before he or she is likely to be exposed to HPV.

Increasing HPV vaccine uptake is a cancer prevention and public health priority. Action is required to change parental perception of the vaccine, increase its usage, prevent further spread of HPV.

1President's Cancer Panel, National Cancer Institute. (2014). President's Cancer Panel Annual Report 2012-2013. Available from

2US Department of Health and Human Services, Centers for Disease Control and Prevention. (2013). Human papillomavirus (HPV)-associated cancers. Available from

3US Department of Health and Human Services, Centers for Disease Control and Prevention. (2013). National and State Vaccination Coverage Among Adolescents Aged 13-17 Years –United States, 2012. Morbidity and Mortality Weekly Report 62(34):685-693.

4Kester, LM, Zimet, GD, Fortenberry, JD, Kahn, JA, & Shew, ML. (2013) A National Study of HPV Vaccination of Adolescent Girls: Rates, Predictors, and Reasons for Non-Vaccination. Matern Child Health J, 17:879–885.

5Dorell, C, Yankey, D, & Strasser, S. (2011). Parent-reported reasons for nonreceipt of recommended adolescent vaccinations, National Immunization Survey–Teen, 2009. Clinical Pediatrics, 50(12), 1116–1124.