Physicians increasing HPV vaccine rates for populations with greatest cancer risk
Mays Cancer Center Annual Report
In 2006, the first publicity campaigns that encouraged parents to have their teenagers vaccinated against the human papillomavirus (HPV) targeted females. At that time, of the six types of cancer caused by HPV, the only routine screening that existed was for cervical cancer via pap smears. This is still the case today.
“Most folks in the community associated HPV with cervical cancer. Unfortunately, we have not done a very good job educating the community about all the other HPV-related cancers,” explains Allison Grimes, M.D., assistant professor of pediatrics and investigator with the Greehey Children’s Cancer Research Institute at UT Health San Antonio.
Currently, 34,800 people are diagnosed with an HPV-related cancer every year in the U.S., shared Dr. Grimes, a pediatric oncologist. The family of HPV cancers includes penile, anal, oropharyngeal (head and neck), vaginal and vulvar cancers.
“We did a disservice to males by advertising the HPV immunization as strictly a vaccine for females because of cervical cancer,” she said.
Investigators led by Dr. Grimes are on the forefront of correcting these misconceptions and promoting the vaccination of anyone ages 9 to 45. HPV vaccinations could prevent more than 90 percent of HPV-related cancers, and more than 98 percent of individuals receiving the full vaccine course develop an antibody response.
Dr. Grimes’ team complements the work of Amelie Ramirez, Dr.P.H., associate director for population sciences for the Mays Cancer Center. Dr. Ramirez, director of the Institute for Health Promotion Research (IHPR) and chair of Population Health Sciences at UT Health, works with community partners focusing on Latinos to disseminate health information to a population that often lacks health insurance and does not receive information in a language they understand.
Dr. Ramirez said the Hispanic community is a challenge with the HPV vaccine because “there are misconceptions about what the vaccine is for. If daughters get it, will they be more promiscuous? Is the vaccine safe?”
Hispanic women are at higher risk than non-Hispanic women for developing some HPV-related cancers, including cervical cancer, their studies show.
The IHPR team uses mass media, social media and text messaging to share information. Using role models from the community to share testimonials on these different mediums about why screening is important has proven effective, Dr. Ramirez said.
IHPR also has promotoras —trained bilingual community health workers — who provide small group educational sessions in zip code areas identified with high rates of cervical cancer. These sessions provide women with the most up-to-date information on the importance of screening and the HPV vaccination.
“Today, no woman should die from cervical cancer, as we now have all the tools to screen, treat and prevent cervical cancer,” Dr. Ramirez said.
The IHPR’s Entre Familia program (led by Deborah Parra Medina, Ph.D., former IHPR faculty, and funded by the Cancer Prevention and Research Institute of Texas) also uses promotoras to deliver health education about the HPV vaccine and cancer prevention and help people schedule and remember vaccination appointments for girls and boys ages 11 to 17 in South Texas. Their efforts produced a 30 percent vaccination completion for the HPV vaccine over a two-year period.
Dr. Grimes, meanwhile, is targeting a group described as “the most vulnerable in the community — survivors of childhood cancer.”
A $1 million, three-year grant from CPRIT is allowing Dr. Grimes and co-investigator Gail Tomlinson, M.D., Ph.D., co-leader of population science and prevention for the Mays Cancer Center, and grant co-director L. Aubree Shay, Ph.D., assistant professor and health services researcher at The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in San Antonio, to work with four other cancer centers in Texas to increase the vaccination rate of children, teens and young adults who had cancer as children.
“We found that, compared to their age-matched peers, they were developing second cancers from HPV at an alarmingly higher rate and sooner. Female survivors of childhood cancer had a 40-fold increase of HPV-related cancers and male survivors had a 150-fold increase,” she said.
While those with no history of cancer developed it about 20 years after exposure, the cancer-survivor population developed the HPV-related cancer in only 10 years or less.
The reasons were easy to understand. When children started seeing an oncologist, they usually stopped seeing their regular pediatrician and missed the normal vaccination schedules for 11-year-olds. Cancer center clinics did not routinely provide the vaccine, and children were not receiving it through other community-based efforts.
To identify the need, they reviewed the Texas Immunization Registry. “What we found was shocking,” she said. “Of all our childhood cancer survivors at our institution, not one male finished the series. Less than 10 percent had started the series. Just under 20 percent of females initiated the series but only 10 percent completed it.”
They had identified a “gap population” that community initiatives were not reaching and that was particularly vulnerable to HPV cancers. “If any group was going to be motivated to prevent cancer, it’s going to be a group of patients that already had one,” she said.
