Target Populations for HPV Vaccination

Human papillomavirus (HPV) causes 30,700 cervical, anal, oropharyngeal, penile, and vaginal/vulvar cancer cases annually. Multiple vaccines are available to combat at least the main oncogenic strains 16 and 18 that cause 90% of cancer cases.

The Advisory Committee on Immunization Practices now recommends a 2-dose series starting at 11 to 12 years of age. Providers may administer the vaccine to females, men who have sex with men, immunosuppressed individuals, and HIV-infected male patients up to 26 years of age. Patients should defer vaccination during pregnancy.

HPV vaccine coverage is less extensive in low income, minority, limited English proficiency, under- and uninsured patients. Lack of knowledge, provider recommendation, and perceived risk contribute to low vaccine coverage.

The journal Cancer Medicine has published an article ahead of print showing that many poor, uninsured adults were unaware of HPV, its effects, and related vaccines.

The researchers assessed HPV vaccine awareness and disease and cancer knowledge with a “true,” “false,” or “don’t know” type questionnaire. A certified translator modified the English-language surveys into Spanish. Surveyed patients received a nominal gift and a CDC fact sheet on HPV.

Half of patients were aware of HPV, similar to the rate of awareness among Latinas nationwide in the United States, and a slim third were aware of the vaccine. Only 11% of patients knew that HPV causes throat cancer (an increasing problem for both sexes). Many patients were not candidates for the HPV vaccination, but were parents to children who should receive the series.

Providers and public health organizations should frame HPV vaccines as cancer prevention instead of prevention of sexually transmitted infection. Providers may bundle HPV vaccination with skin safety against skin cancer and smoking cessation/avoidance.

These findings show that these representative poor, uninsured minority adults are largely unaware of HPV disease, its oncogenic effects, and associated vaccination. Targeting these populations will produce the greatest societal benefits to shrink the race gap in cancer outcomes.