Source: www.wsj.com
Author: Ron Winslow

The top cancer centers in the U.S. jointly called for an increase in vaccination against the human papilloma virus, or HPV, saying low uptake of the three-shot regimens amounts to a “public health threat” and a major missed opportunity to prevent a variety of potentially lethal malignancies.

In a statement issued Wednesday, all 69 of the nation’s National Cancer Institute-designated centers urged parents and health-care providers to “protect the health of our children” by taking steps to have all boys and girls complete the three-dose vaccination by their 13th birthdays, as recommended by federal guidelines, or as soon as possible in children between 13 and 17 years old.

Currently, just 40% of girls and 21% of boys in the U.S. have received the vaccine, according to a report last year by the U.S. Centers for Disease Control and Prevention. The U.S. Department of Health and Human Services Healthy People 2020 initiative has set the goal for HPV vaccination for both boys and girls at 80%.

The first HPV vaccine, Merck & Co.’s Gardasil, was approved by the U.S. Food and Drug Administration in 2006. A second version of Gardasil and GlaxoSmithKline PLC’s Cervarix are now on the market. Neither company was involved in development of the cancer centers’ statement, those involved in the effort said.

The CDC estimates that 79 million Americans are infected with HPV, a sexually transmitted virus that causes 14 million new infections each year. While the body’s immune system fights off the virus in most cases, certain high-risk strains are responsible for cancers of the cervix, anus, and various genital sites as well as a growing rate of oropharyngeal or throat cancers, all told affecting about 27,000 patients a year in the U.S.

“We have everything we need to eliminate at least cervix cancer and many other HPV-related cancers and we haven’t taken advantage in this country,” said Lois Ramondetta, professor of gynecologic oncology at University of Texas MD Anderson Cancer Center, Houston. She said she is already seeing patients in their 20s and 30s who have developed precursors to cancer that she says could have been prevented had they been vaccinated.

The U.S. rates stand in contrast to those in some other countries, including Australia, where 75% of boys and girls are fully vaccinated; the U.K., with a rate between 84% and 92%;, and Rwanda, where 93% of children are in compliance with World Health Organization recommendations for HPV shots.

When the first vaccine hit the market a decade ago, it was targeted at girls in hopes of preventing cervix cancer. But the rising incidence of HPV-related head and neck cancers, especially among men, in recent years, led to including boys in the prevention effort as well.

Factors responsible for the low U.S. rates include resistance among antivaccination groups, a “misunderstanding” that vaccination might promote sexual activity and a reluctance of pediatricians to discuss prevention of a sexually transmitted virus for children, said Sarah Krobin, acting chief of health systems and interventions research at the NCI. Research shows no link between the vaccine and sexual activity, she said. Early administration is required because “for the vaccine to work, the child shouldn’t have yet had sex,” she said.

The three-dose vaccine can cost around $500, including doctor fees, according to the American Cancer Society, though it is often covered by insurance. It is available free to beneficiaries of the Medicaid program, a key reason why children in low-income families are more likely to have been fully vaccinated than those from wealthier families, Dr. Krobin said.

The statement emerged from a meeting of HPV experts from many of the cancer centers at MD Anderson in November, which in turn resulted from a special NCI initiative among 18 designated centers to study factors affecting HPV vaccination rates in their local markets. NCI designation recognizes centers for excellence in cancer research and care. The NCI wasn’t involved in drafting the document.

The statement urges physicians and other providers “to be advocates for cancer prevention by strongly recommending the vaccine for children. It encourages men up to age 21 and women up to 26 to get vaccinated if they missed the younger age targets.

“This is really a sentinel event to have all the centers get together and say we’re really not doing the best for our kids,” said Dr. Ramondetta, who is also co-director of MD Anderson’s HPV-related Moon Shot initiative. “We feel this is an effective, safe and long-lasting vaccine that we’re not taking advantage of.”

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