Provider and parental assumptions on teen sex yield 'missed opportunities' for HPV vaccine

Researchers at Boston University School of Medicine (BUSM) conducted hundreds of interviews to offer new insights into this frequent—and often controversial—clinic room conversation. Their findings and recommendations will appear in the September 2014 issue of Pediatrics.

Specifically researchers found that vaccination rates could be traced to personal biases and communication styles of providers. Providers who believed a child was at low risk for sexual activity—an assessment, they admitted, not always accurate—were more likely to delay administration.

Often, this deferred decision was never readdressed. Those with high vaccination rates approached HPV vaccines as a routine part of the age 11 vaccine bundle, unequivocally recommended it to parents, and framed the conversation as one about cancer prevention.

“Emphasis on cancer prevention and concurrent administration with other routine childhood vaccines has the potential to dramatically reduce missed opportunities occurring among well- intentioned providers and parents,” explained lead author Rebecca Perkins, MD, MSc, assistant professor of Obstetrics and Gynecology at BUSM and a gynecologist at Boston Medical Center.

The researchers interviewed 124 parents and 37 health-care providers at four clinics between September 2012 and August 2013. Parents and providers were asked to discuss their reasons why their HPV vaccine eligible girls did or did not ultimately receive the vaccine.

Remarkably, the most common parental reason (44 percent) was that their child was never offered the vaccine. Other common reasons included the perception that the vaccination was optional instead of recommended or being told by their provider that it was unnecessary prior to sexual debut. Among those that declined the vaccine, the rationale often involved safety concerns and a belief that their daughters were too young to need it.

About HPV

A common and deadly cancer—12,000 women are diagnosed and 4,000 will die from it annually—cervical cancer is unique in that it is the only cancer that can be prevented by a vaccine. HPV causes not only cervical, vaginal and vulvar cancers in women, but penile cancers in men, as well as cancers of the mouth, tongue, tonsils and anus in men and women. The same viral strains are responsible for most of these cancers, and are covered by currently available vaccines.

Cervical cancer arises from abnormal cells on the cervix, known as cervical dysplasia; the majority of dysplasia arises from HPV strains numbered 16 and 18. The HPV vaccine, in turn, prevents 98 percent of cases caused by strains 16 and 18. Despite this evidence, HPV vaccination rates for girls lag far behind that of other types of vaccination; only 54 percent of eligible girls will ever get one of the three required doses, whereas only 33 percent will ever complete the entire sequence. This lag in uptake stems, in large part, from unfounded concerns about vaccine safety promulgated in popular media and, because HPV is transmitted sexually, parental / provider discomfort when contemplating a child's future sexuality. The HPV vaccine is currently recommended to be administered to girls and boys at ages 11-12, with catch-up vaccination through age 26 for girls and 21 for boys.

Funding for this study was provided by Centers for Disease Control and the American Cancer Society.