08 January 2013

HPV Cancers Increasing, Vaccination Levels Are Too Low

The special feature section of The Annual Report to the Nation on the Status of Cancer, 1975-2009, on human papillomavirus (HPV)-associated cancers shows that incidence rates are increasing for HPV-associated oropharyngeal and anal cancers and that vaccination coverage levels in the U.S. during 2008 and 2010 remained low among adolescent girls.

The special feature section of the report includes an evaluation of the burden and trends in HPV-associated cancers as well as HPV vaccination coverage levels among adolescent girls. The report shows that from 2000 through 2009, incidence rates for HPV-associated oropharyngeal cancer increased among white men and women, as did rates for anal cancer among white and black men and women. Incidence rates for cancer of the vulva increased among white and black women. Rates of cervical cancer declined among all women except American Indian/Alaska Natives. In addition, cervical cancer incidence rates were higher among women living in low versus high socioeconomic areas. Among men, rates for penile cancer were stable.

"This year's Report correctly and usefully emphasizes the importance of HPV infection as a cause of the growing number of cancers of the mouth and throat, the anus, and the vulva, as well as cancers of the uterine cervix, and the availability of vaccines against the major cancer-causing strains of HPV" said NCI Director Harold Varmus, M.D. "But the investments we have made in HPV research to establish these relationships and to develop effective and safe vaccines against HPV will have the expected payoffs only if vaccination rates for girls and boys improve markedly."

The report also showed that in 2010, fewer than half (48.7 percent) of girls ages 13 through 17 had received at least one dose of the HPV vaccine, and only 32 percent had received all three recommended doses. Vaccination series completion rates were generally lower among certain sub-populations, including girls living in the South, those living below the poverty level, and among Hispanics. The national three-dose coverage estimate among girls ages 13 through17 in 2010 falls well short of the U.S. Government's Healthy People 2020 target of 80 percent for three-dose coverage among girls ages 13 through15, and is much lower than vaccination rates reported in Canada (50-85 percent) and the United Kingdom and Australia combined (greater than 70 percent). The authors note that low overall vaccine uptake in the U.S. is likely due to a number of issues, including inadequate provider recommendations, provider reimbursement concerns, infrequent use of reminder/recall systems that would foster completion of the three-dose series, and other factors.

"As incidence rates for some HPV-associated cancers continue to rise," noted NAACCR director Betsy Kohler, Ph.D., "these cases will contribute to the overall growing number of cancers associated with population aging and expansion, requiring additional resources for medical research and treatment, in addition to our careful tracking of these trends."

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