President’s Cancer Panel Identifies Urgent Need to Build on Progress and Increase HPV Vaccination

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Vaccine HPV healthcare

Each year, human papillomaviruses or HPV causes nearly 630,000 cases of cancer worldwide. The majority of these cancers, roughly 530,000 cases, are cervical cancers, but HPV is also responsible for about 100,000 cancers at five other cancers, including the cancer of oropharynx, anus, penis, vulva, and vagina. HPV also causes genital warts and recurrent respiratory papillomatosis.[1]*

The incidence of HPV-associated cancers can be dramatically reduced by HPV vaccines but uptake of the vaccines has fallen short of target levels.

Safe
HPV vaccines are safe. Since January 2017, only Human Papillomavirus 9-valent Vaccine, Recombinant (Gardasil 9®Merck & Co) which protects against HPV 16, 18, 6, 11, and five additional cancer-causing HPV types (HPV 31, 33, 45, 52, 58) has been available in the United States.

Other vaccines, including human papillomavirus bivalent (Types 16 and 18) vaccine, recombinant (Cervarix®; GlaxoSmithKline) and human papillomavirus quadrivalent (Types 6, 11, 16, 18) vaccine, recombinant (Gardasil®;Merck & Co) designed to protect against the two most common cancer-causing types of HPV—HPV 16 and HPV 18—which together account for about two-thirds of cervical cancers are used in some other countries. These vaccines also protects against HPV 6 and 11, which cause genital warts and recurrent respiratory papillomatosis, a rare but debilitating disease characterized by noncancerous growths in the respiratory tract.

Vaccination rate
Now a Federal Panel reports that while HPV vaccination rates have improved in recent years, they remain too low to achieve full potential for cancer prevention.  And, as the federal panel noted in their new report “HPV Vaccination for Cancer Prevention: Progress, Opportunities, and a Renewed Call to Action,” underuse of the HPV vaccine remains a serious threat to progress against cancer in the United States. The report was released today by the President’s Cancer Panel Chair.**


…the percentage of adolescents who started the HPV vaccine series increased 5% each year between 2013 and 2017. But as of 2017, less than half of U.S. adolescents were fully vaccinated…


Unacceptably low
The authors of the report, find that while there has been demonstrated progress in HPV vaccine uptake in the U.S. over the past five years, vaccination rates remain unacceptably low. The concern is that the rate is well below the government’s Healthy People 2020 goal of 80% of age-eligible adolescents.

The Panel Chair concludes that recent, notable strides must be amplified and expanded, and recommends several steps to increase HPV vaccination both in the United States as well as globally.

Photo 1.0: Barbara K. Rimer, DrPH, Chair of the President’s Cancer Panel.

“We have a safe, effective vaccine that protects against a cancer-causing virus, and we applaud the efforts of cancer and immunization leaders joining forces and rising to the challenge of accelerating HPV vaccine uptake,” noted Barbara K. Rimer, DrPH, Chair of the President’s Cancer Panel.

“Yet, the fact remains, that this vaccine remains seriously underutilized—we are still missing opportunities to prevent cancer and save lives,” Rimer added.

In its 2012-2013 report, Accelerating HPV Vaccine Uptake: Urgency for Action to Prevent Cancer, the President’s Cancer Panel issued a call for action that was later echoed in other high-profile reports, including 2015 and 2018 reports from the National Vaccine Advisory Committee and 2016 reports from the Cancer Moonshot Blue Ribbon Panel and Cancer Moonshot Task Force.[2]

On average, the percentage of adolescents who started the HPV vaccine series increased 5% each year between 2013 and 2017. But as of 2017, less than half of U.S. adolescents were fully vaccinated. In addition, HPV vaccines are not included in the national vaccine programs of many low- and middle-income countries, where the vast majority of cervical cancer cases and deaths occur.

Current landscape
In the current report the Panel Chair provides an update on the landscape of HPV cancers and HPV vaccination and identifies strategies for building on recent progress and overcoming persistent barriers to vaccine uptake. The report concludes that provider- and system-level changes hold the greatest potential to increase HPV vaccination rates in the United States, and that partnerships and collaborations among key stakeholders have been and will continue to be essential for sustaining momentum and expanding the reach of this urgent call to action.

Additionally, the Panel Chair calls for renewed action around four key goals and opportunities that were identified in the Panel’s 2012-2013 report:

  • Reduce missed clinical opportunities to recommend and administer the HPV vaccine;
  • Increase parents’ acceptance of HPV vaccination;
  • Maximize access to HPV vaccination services; and
  • Promote global HPV vaccine uptake.

The report also recommends four core research priorities in support of the ultimate goal of preventing cancer.

Reference
[1] de Martel C, Plummer M, Vignat J, Franceschi S. Worldwide burden of cancer attributable to HPV by site, country and HPV type. Online Int J Cancer. 2017;141(4):664-70. Last accessed November 1, 2018.
[2] Accelerating HPV vaccine uptake: urgency for action to prevent cancer: a report to the President of the United States from the President’s Cancer Panel. Bethesda (MD): National Cancer Institute; 2014. Online Last accessed November 1, 2018.


*de Martel et al. include cancers of the oral cavity and larynx in their estimate of HPV-attributable cancers. The U.S. Centers for Disease Control and Prevention has concluded that HPV causes some cancers of the oropharynx, but that the evidence that HPV causes cancers of the oral cavity and larynx is insufficient. Thus, numbers in this report include estimates for oropharyngeal but not oral cavity and laryngeal cancers.

**The President’s Cancer Panel was established by the National Cancer Act of 1971, and is charged with monitoring progress of the National Cancer Program and identifying barriers to its fullest and most rapid implementation. The Panel investigates topics of high importance to the National Cancer Program and presents findings and recommendations in reports to the President of the United States.

Last Editorial Review: November 1, 2018

Featured Image: Vaccination. Courtesy: © 2018 Fotolia. Used with permission.

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1 COMMENT

  1. In the paragraph under the heading “Safe”, there is an error in the last sentence, which talks about protection against HPV types 6 and 11 by Cervarix and Gardasil. Cervarix does NOT protect against these two HPV types – only Gardasil and Gardasil 9 do.

    Katherine M. Nicol
    on behalf of the President’s Cancer Panel,
    an advisory panel to the President of the United States

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