immunization and cancer prevention – what’s new with hpv?
TRANSCRIPT
Immunization and Cancer Prevention – What’s new with HPV?
Amanda F. Dempsey, MD PhD, MPHNEBGH Webinar
July 2020
Ozawa et al, Health Affairs, 2015
Average Number of New Cancers Probably Caused by HPV, by Sex, United States 2006-2010
CDC, United States Cancer Statistics (USCS), 2006-2010
Women (n = 17,600)
Oropharynxn=1,80010%
Anusn=2,60015%
Cervixn=10,40059%
Vaginan=6003%
Vulvan=2,20013%
Men (n = 9,300)
Anusn=1,40015%
Oropharynxn=7,20077%
Penisn=7008%
5% of ALL cancers are attributable to HPV!
Why HPV?
HPV Infection
• Most females and males (95+%) will be infected with at least one type of HPV at some point in their lives
• Estimated 79 million Americans currently infected
• 14 million new infections/year in the US
• HPV infection is most common in people in their teens and early 20s
• Most HPV infections are asymptomatic
Jemal A et al. J Natl Cancer Inst 2013;105:175-201
Human Papilloma Virus (HPV)• Most Common STD• Linked to numerous types of cancer:
• Cervical• Vulvar• Vaginal• Penile• Anal• Mouth and throat
Human Papilloma Virus (HPV), continued• More than 120 different types
• High-risk vs. low-risk types• Most infections are asymptomatic• Almost everyone is exposed at one
point in time (4 out of 5)• Most people clear the
infection with their own immune system within two years of infection
Every year in the US >48,000 people are diagnosed with a cancer caused by HPV
That’s 1 case every 11 minutes
Annual cost of HPV in Women*?
0
1
2
3
4
Genital Warts Cervical Cancer Abnormal Pap Smears
MMWR 2007: 56:RR2* Not including costs from other HPV-related cancers or RRP
$ B
illio
ns
$260 million$570 million
$4.1 billion
Data Source: Adopted from Chaturvedi A., 2010
Oropharyngeal cancers
Incidence projected to surpass cervical cancer
1970
1980
1990
2000
2010
2020
2030
Calendar Years
Photo Credit: Dr Michael Moore
HPV Vaccines
• Initially licensed in US in 2006 for girls• Expanded in 2010 to boys• Three “versions” made
• 2 types• 4 types• 9 types
• Only the 9 type version in use today in US• Made from other proteins – CANNOT give you HPV
Adolescent Vaccine Recommendations
• Routine at 11-12• As early as 9• Catch up to age 26
Girls
• Routine at 11-12• As early as 9• Catch up to age 26*
Boys
*For Boys, Age 21-26 if high risk
Adolescent Vaccine Recommendations
• 2 doses*• 0 and 6-12 months< Age 15
• 3 doses*• 0, 2 and 6-12 months> Age 15
* Don’t need to start over if intervals are longer than above
Estimated Vaccination Coverage among Adolescents 13–17 Years (2006-2015)
0
10
20
30
40
50
60
70
80
90
100
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Perc
ent V
acci
nate
d
Survey Year
Revised APD* definition
≥1 Tdap
≥1 MenACWY
≥1 HPV (F)
≥1 HPV (M)
≥3 HPV (F)
≥3 HPV (M)
* APD = Adequate provider data
Routine HPV recommendation
for females
Routine HPV recommendation
for males
15Reagan-Steiner MMWR 2016
Real Life Implications
• Girls <13 in US26 million
• # to develop cervical cancer if no vax168,400
• # die from cervical cancer if no vax51,400
Adapted from Chesson HW et al, Vaccine 2011;29:8443-50
New Adult HPV Vaccine Recommendations = 2018
• Routine catch up to age 26
• Selective catch up 27-45Women
• Routine catch up to age 26*
• Selective catch up 27-45Men
Adult Vaccine Recommendations
•3 doses*•0, 2 and 6-12 months
> Age 15
* Don’t need to start over if intervals are longer than above
Selective Catch Up: Category “B” Recommendations
• The clinician and patient should have a conversation• Shared decision making regarding pros and cons
• Pros - prevent infection and disease, safe, effective if given before exposure• Cons – may not be useful, hurts, costs $.
• SHOULD be covered by insurance under ACA rules as it is officially “recommended” by ACIP but questions remain.
Why Expand to Adults?
• HPV is common• Cancer from HPV occurs mostly after “new”
infections• Some adults can get newly infected• No tests can determine past infection• While many adults already exposed to HPV, few
exposed to all 9 types in the vaccine• Vaccine protective against types not exposed to before
• Vaccination is an important part of preventive care to optimize health – especially now!
Vaccine Safety
• Rigorous testing BEFORE the vaccine was licensed was done• Ongoing testing AFTER the vaccine was marketed is ongoing• More than 500 MILLION doses have been provided world wide• NO unusual safety signals have come up
What Can Employers Do to Promote Vaccination?
• Clarify insurance coverage for adults• Expand coverage to whole family
• REMIND people they need the vaccine• REMIND people of second and third doses• Help practices/people track vaccination rates – esp.
adults• Tackle the three C’s that drive low vaccination
• Complacency – education of patients, parents and providers• Convenience – offer/cover vaccination at other locations besides PCP• Confidence – education, incentives (?), don’t do anything that
undermines
HPV Vaccination Resources
• CDC• https://www.cdc.gov/vaccines/vpd/hpv/hcp/resources.html
• ACS• https://www.cancer.org/healthy/hpv-vaccine.html
• HPV Vaccine Communication AppFrom the Google Play Storehttps://play.google.com/store/apps/details?id=com.kognito.hpv_immunizationFrom the Apple iTunes Storehttps://itunes.apple.com/us/app/hpv-vaccine-same-way-same-day/id1356847181?mt=8
