Preventing Cervical Cancer in the United States: Barriers and Resolutions for HPV Vaccination

Abstract

Human papillomavirus (HPV) vaccination rates for preadolescent and adolescent girls in the United States are far behind those of other developed nations. These rates differ substantially by region and state, socioeconomic status, and insurance status. In parents and young women, a lack of awareness and a misperception of the risk of this vaccine drive low vaccination rates. In physicians, lack of comfort with discussion of sexuality and the perception that the vaccine should be delayed to a later age contribute to low vaccination rates. Patient- and physician-targeted educational campaigns, systems-based interventions, and school-based vaccine clinics offer a variety of ways to address the barriers to HPV vaccination. A diverse and culturally appropriate approach to promoting vaccine uptake has the potential to significantly improve vaccination rates in order to reach the Healthy People 2020 goal of over 80% vaccination in adolescent girls. This article reviews the disparities in HPV vaccination rates in girls in the United States, the influences of patients’, physicians’, and parents’ attitudes on vaccine uptake, and the proposed interventions that may help the United States reach its goal for vaccine coverage.

Determinants of HPV vaccine awareness and healthcare providers' discussion of HPV vaccine among females

“…Other studies have also reported a decreased likelihood of HPV vaccine awareness (Williams et al, 2013, Ford, 2011), and receiving HPV vaccination (Williams et al, 2013, Ford, 2011, Fisher et al, 2013) among Blacks and Hispanics compared to Whites. These findings highlight a continued need for culturally-relevant educational efforts to raise HPV vaccine awareness among non-Hispanic Blacks and Hispanic females (Beavis & Levinson, 2016). Since it has been reported that compared to Whites, Blacks and Hispanics who initiate HPV vaccination are less likely to complete the vaccine series (Jeudin et al, 2014, Niccolai et al, 2011), it is crucial that such interventions incorporate strategies to ensure HPV vaccine uptake as well as completion of the three doses.…”

Clinician and Parent Perspectives on Educational Needs for Increasing Adolescent HPV Vaccination

“…For parents, certain barriers are well established in the literature including absence of provider recommendation, cost, and lack of education on HPV vaccine [4,5]. Parents also have misperceptions that the vaccination promotes sexual activity [6].…”

“…Young adult women and some adolescents have low risk perception regarding HPV infection which leads to lower rates of vaccination [8]. Education is frequently cited as a critical need in increasing the uptake of HPV vaccination however recent literature indicates that education alone does not appear to be impactful [5,9]. We conducted an environmental scan among clinicians and parents to explore barriers, opportunities, resources, and potential collaborations focused on the issues of HPV vaccination.…”

Immunotherapy against cancer-related viruses

“…In 2006, the first of these was approved in the United States for prevention of both cervical cancer and genital warts. This quadrivalent vaccine (Gardasil, Merck & Co., Inc.) targets HPV genotypes 6, 11, 16, and 18, which are responsible for approximately 66% of cervical cancers and 90% of genital warts [112]. A bivalent vaccine targeting oncogenic HPV genotypes 16 and 18 (Cervarix, GalaxoSmithKline) has been marketed for female vaccine programs.…”