Cancer Vaccine Exists, Goes Unused

The HPV vaccine could prevent thousands of people every year from getting cancer. But a new CDC report says most children still do not receive it.
(Jessica Rinaldi/Reuters)

Every 20 minutes a person in the U.S. is diagnosed with with a human-papilloma virus-associated cancer. Most of those cancers could be prevented with an HPV vaccine.

But fewer than half of American children are given the vaccination, CDC officials announced yesterday. 

If as many people got vaccinated against HPV as do against whooping cough (which is still not a perfect number, 86 percent), there would be thousands fewer cases of head, neck, and pelvic cancer in men and women every year. If the United States could reach the same vaccination rates as Rwanda, for example, CDC has previously noted, it would prevent 50,000 girls alive today from getting cervical cancer.

"We were disappointed with the overall findings," Dr. Anne Schuchat, assistant U.S. surgeon general and director of the National Center of Immunization and Respiratory Diseases, said in a press conference. There had been zero improvement in the rate of HPV vaccination between 2011 and 2012. Between 2012 and 2013, the rate increased by 5 percent, but that was still below the CDC goal.

"When a teen is in the doctor's office and receives another vaccine, but not HPV, that's a missed opportunity," Schuchat said. CDC estimates that if every time an 11 or 12-year-old was getting another vaccine, HPV was given as well, coverage with at least one of the recommended three doses would have been 91 percent instead of 47 percent. The rate of completing the entire course is much lower.

One of the top five reasons parents listed for not getting the HPV vaccine for their son or daughter was that it hadn’t been recommended to them by the doctor or nurse. 

"We think that parents who aren't planning to vaccinate lack knowledge and didn't hear a clinician recommendation. We don't think it's an issue of politics," Schuchat said, referring to the fact that HPV is sexually transmitted, and prevention of illnesses so transmitted is, you know, a matter for political debate.

That's not to say that doctors aren't bringing up the vaccine. Oklahoma pediatrician Paul Darden wrote in the journal Pediatrics recently, "Despite doctors increasingly recommending adolescent vaccines, parents increasingly intend not to vaccinate female teens with [the] HPV [vaccine]." 

It's not uncommon for practitioners to recommend vaccines against diphtheria and meningitis, and then to "initiate a conversation" about the HPV vaccination.

"We think it's a much better way to say, 'Today there are three recommended vaccines: meningitis, Tdap and HPV,'" Schuchat said. "Really mainstreaming the recommendation for HPV together with the other two recommended vaccines; we think that is a very clear way to send a strong recommendation and it's easy for parents to understand."

The optimal time for boys and girls to receive the vaccine is at age 11 or 12, when studies have shown that their bodies produce the strongest antibody response. "When people say let's talk about it, let's wait and we can do it later," Schuchat said, "so often teens are never back in the office; and you really don’t know when they'll be exposed to the virus in their later years." 

Of the 14 million new HPV infections in the U.S. every year, most happen in peoples' teens and 20s. 

Safety was not among parents' top concerns, and the preponderance of evidence does not suggest any kind of health risk associated with the HPV vaccine, Schuchat added.

Of note, teenagers do sometimes faint after HPV vaccination. "We think it's really important for the teens, the parents, and the clinicians," Schuchat said, "to observe them for 15 minutes or so after vaccine is given because kids are just running off and sometimes pass out. There was actually even a death from someone who fainted shortly after getting one of these vaccines and was in a car accident. So we think it's important to not jump off the table and run off and go about your business, but to actually rest for 15 minutes." 

In recent years, the cost of the vaccine has been a significant barrier. But the HPV, Tdap, and the meningitis vaccines are all now part of the Vaccines for Children program, which provides free vaccines to uninsured people. The HPV vaccine should also be covered by most recently-updated insurance plans.

"The results we are reporting today are disappointing," Schuchat said. "We don't really have a big news story on teen vaccination results today. But no news is bad news for cancer prevention."

Presented by

James Hamblin, MD, is a senior editor at The Atlantic. He writes the health column for the monthly magazine and hosts the video series If Our Bodies Could Talk.

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