Too Soon to Protect Against Cervical Cancer?

The human papillomavirus (HPV) vaccine was licensed in 2006.  Before this licensure, physician attitudes were generally positive with an exception regarding vaccination of the youngest adolescents.  In an effort to revisit and update this data, Matthew F. Daley, MD and other researchers from the University of Colorado School of Medicine and the Kaiser  Permanente Institute for Health Research surveyed nearly 850 family physicians and pediatricians during 2008 to understand attitudes and practices regarding the HPV vaccine.  This research is published in the September volume of Pediatrics, the official journal of the American Academy of Pediatrics.  The study found that

“Eighteen months after licensure [of the HPV vaccine], the vast majority of pediatricians and family physicians reported offering HPV vaccine. Fewer physicians strongly recommended the vaccine for younger adolescents than for older adolescents, and physicians reported financial obstacles to vaccination.”

The survey revealed that barriers to vaccination were both financial and social. Financially, individuals were deterred by lack of insurance coverage and actual cost of the vaccination.  Social barriers included physicians’ preference not to discuss sex issues which they deemed necessary before recommending the HPV vaccine to adolescents 11 and 12 years of age.  Physicians also reported a greater rate of vaccine refusal among parents of the younger adolescents as compared to the parents of older adolescents.

Only 57% of pediatricians and 50% of family physicians surveyed reported “strongly recommending” HPV vaccine to 11-12 year old adolescents.  Vaccinations are meant to be a primary prevention.  This means they have to be administered before the individual is exposed to the offending microorganism.  In my opinion, it appears that this vaccine is facing the same barriers as sex education in the schools and access to birth control.  Many adults continue to fear that by discussing sex, they are giving young adolescents the idea that they should have sex.  The truth remains that sexual curiousity and experimentation is a natural stage of human development and generally occurs far sooner than most parents and even many adults in general are willing to accept.  Administering or completing the 3-dose HPV vaccine after adolescent girls have had a sexual encounter greatly reduces the ability of the vaccine to be effective.  After all, if one were planning a trip to Central Africa, they would get their vaccination to protect against Typhoid Fever before they traveled not after they returned and had been exposed to the disease.   If physicians are at least willing to share this information with parents and explain how the 3-dose vaccine works, perhaps more gains will be made in the primary prevention of HPV infection and cervical cancer.

Source: Daley, MF, Crane, LA, et al. Human Papillomavirus Vaccination Practices: Survey of US Physicians 18 Months After Licensure Pediatrics published online August 2, 2010 (10.1542/peds.2009-3500)

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