In the United States, HPV is estimated to cause approximately 99.7% of cervical cancers, 60% of oropharyngeal cancers, 91% of anal cancers, 75% of vaginal cancers, 69% of vulvar cancers, and 63% of penile cancers. Despite Centers for Disease Control and Prevention (CDC) recommendations that all boys and girls receive the HPV vaccine at age 11 to 12 years, data from a 2011 National Immunization Survey indicate that only approximately 36% of girls and 14% of boys had completed the vaccine series.² 

As related by the ASCO statement authors, “[O]ur patients, their families, and our communities look to us for guidance regarding all things cancer related, including cancer prevention. Through this statement and accompanying recommendations, ASCO hopes to increase awareness of the tremendous global impact of [HPV]-caused cancers, refocus the discussion of HPV vaccination on its likely ability to prevent millions of cancer deaths, and increase HPV vaccination uptake. This may be accomplished via greater involvement of oncology professionals in ensuring accurate public discourse about HPV vaccination and calling for the implementation of concrete strategies to address barriers to vaccine access and acceptance.”

The ASCO recommendations for increasing vaccination awareness and use are summarized here. 

Education and Awareness

• Disseminate evidence-based information to the public, professionals, and policymakers to increase awareness of the relationship between HPV and cancer.
• Promote shared understanding of safety and effectiveness of available vaccines in preventing HPV infections and development of precancerous lesions (with expected reduction in HPV-caused cancers).

Clinical Service Delivery Improvements

• Promote (and bundle) HPV vaccine with other recommended vaccines for young adolescents.
• Provide a clear, strong recommendation for the vaccine to patients, using culturally relevant approaches.
• Consider use of reminder or recall systems, follow-up systems, and readily available patient education materials.

Coverage, Access, and Incentives for Vaccination

• Consider delivery through primary care medical home, alternative health–related entities (eg, pharmacies), and voluntary or mandatory school-based vaccination programs.
• Adequate payment and reimbursement for delivery of vaccinations should be provided through private and government-based insurance and the state-based Vaccines for Children programs.
• Continue limiting out-of-pocket costs as part of the Patient Protection and Affordable Care Act.
• Advise patients of industry-sponsored free vaccine programs when available.

Research

• Increase research to advance prevention of HPV-related cancers, with a focus on what is needed to improve vaccination programs.
• Continue to monitor the safety and effectiveness of HPV vaccines, with periodic reassessments of their impact on the prevalence of HPV infections, precancers, and invasive cancers.
• Additional research is needed on the relationship of antibody levels with the number of immunizations needed, the duration of immunity conferred, and the effect of age of immunization.
• Cost-effectiveness analyses of administration of different types (bivalent, quadrivalent, and nine-valent) and schedules (two vs three shots) are needed.

Role of Oncology Providers

• Stay abreast of established guidelines from the CDC and the World Health Organization regarding HPV vaccination, and recommend vaccines to patients when appropriate.
• Use interactions with patients, primary care colleagues, and health-care systems to raise awareness of HPV-related cancers and the role of vaccination in avoiding them.
• Serve as community educators to disseminate evidence-based information and combat misconceptions concerning the safety and effectiveness of HPV vaccines.
• Advocate and actively promote policy change to increase HPV vaccination uptake. ■

Disclosure: For full disclosures of the statement authors, visit jco.ascopubs.org.

References

1. Bailey HH, Chuang LT, duPont NC, et al: American Society of Clinical Oncology statement: Human papillomavirus vaccination for cancer prevention. J Clin Oncol 34:1803-1812, 2016.

2. Hopkins TG, Wood N: Female human papillomavirus (HPV) vaccination: Global uptake and the impact of attitudes. Vaccine 31:1673-1679, 2013.