Despite strong intentions among physicians to administer the vaccine
among patients, few of the women eligible have been inoculated for human
papillomavirus since the FDA approved the treatment in 2006.
Sherri Sheinfeld Gorin, PhD, an associate professor of health behavior at Columbia University, member, Herbert Irving Comprehensive Cancer Center, and director and principal investigator at New York Physicians Against Cancer, presented the
study results at the 2008 ASCO Annual Meeting.
In a survey taken before the FDA approval of the HPV vaccine, the vast
majority (91%) of the 235 physicians taking part in a study from sections of Manhattan, Brooklyn and the
Bronx told researchers they were extremely or somewhat likely to vaccinate
their patients.
Thirty-four of their age-eligible patients were polled and 67% said they were extremely or
somewhat likely to get vaccinated.
Medical audits conducted at 24 months after FDA approval
found that only 17% of the surveyed physicians had administered the vaccine.
The researchers found that, as of the first quarter of 2008, only 10% of young women and girls aged 9 to 26 (n=98) included in the study had been vaccinated, and
only 2% had completed the three-dose regimen.
Based on these preliminary findings, the study team determined that inoculation is lagging among black and
Hispanic women and girls. The major barriers to inoculation were awareness,
cost and availability of the vaccine.
Gorin said it is important for physicians to develop office-based
approaches to cue vaccination schedules, and that population-based research on
HPV inoculation by race/ethnicity and income is critical to developing robust estimates
of HPV vaccination prevalence.
The HPV vaccine has already been licensed in a multitude of countries
all around the world for both girls and boys: Why is this vaccine currently
just for girls in the United States?
In the United States, it was determined that there were not enough data
to show the human papillomavirus vaccine was effective in boys. We had pap
smears and the well-established and well-accepted ability to do screenings for
precancerous lesions and HPV infection in girls; however, demonstrating HPV
vaccine efficacy in boys was more difficult. Many other countries that have
licensed the vaccine for boys and young men have conducted bridging studies, as
well as some DNA testing of epithelia cells to demonstrate HPV infection, and
the results show the vaccine is safe in boys and young men.
There are those who say, “If we vaccinate all the girls we
won’t have any more cases.” Given that HPV is a sexually transmitted
disease, an HPV vaccine targeted only at girls is like forgetting the elephant
in the room, and also ignores men who have sex with men. It is also very
relevant that we have such a low rate of uptake among the girls. Vaccinating
the boys would help us develop more herd immunity, and actually have more
effect on the rate of HPV prevalence and the rate of cancers.
We also seem to forget that this vaccine could help prevent anal, penile
and oropharyngeal cancers.
We focus on the HPV vaccine as a cervical cancer vaccine, yet we see
that anywhere from 20% to 70% of these other cancers are directly attributable
to HPV, and therefore we are denying people potential prevention.
– Andrea Sutherland, MD
Greenwall Fellow at the Johns Hopkins Berman Institute of
Bioethics
For more information:
- S. Sheinfeld Gorin, R. Franco, C. Westhoff, New York Physicians
against Cancer Study Group. HPV vaccinations one year post FDA approval. #1513.
2008 ASCO Annual Meeting; May 30-June 3, 2008; Chicago.