Transcript ACS Guideline for Human Papilloma Virus (HPV) Vaccine Use

ACS Guideline for Human Papilloma
Virus (HPV) Vaccine Use:
Implications for Eliminating Cervical
Cancer Disparities
Edward E. Partridge, MD
Interim Director, Comprehensive Cancer Center
Margaret Cameron Spain Chair in Obstetrics and Gynecology
University of Alabama at Birmingham
ACS Guideline

Routine HPV vaccination females age 11 to 12

HPV vaccination for female age 13-18 to catch
up missed vaccine or complete series

Insufficient data to recommend for or against
universal vaccine age 19-26

Not currently recommended for women over
age 26

Screening should continue
Saslow et al, 2007
Disparities
African-American
General Population
Disparities
Hispanics
Non-Hispanic Whites
Reasons for Disparities
(Complex)




Low education
Low income
Limited/no access
Reduced follow-up for abnormal screen

Differences in quality of care
Poor follow-up with recommended care

Multiple visit model

Disparities almost always
are a result of
New technology/treatment
or
New benefit
differentially disseminated
5 Year Relative Survival Rates
Cancer
74-74
W
Breast
Colon
Cervix
75
51
70
Pancreas
Kidney
Ovary
3
52
37
AA
83-85
W
Screen
63
79
46
58
64
71
No Screen
3
3
49
56
41
40
95-01
AA
W
AA
64
49
61
90
65
75
76
55
66
5
55
42
4
65
44
4
64
38
Cancer Facts and Figures, 2006
Age-Adjusted, Age-race-gender-specific Breast Cancer Mortality
Rates Among Black Women and White Women Ages 25-44,
45-64, and 65-85+ Years. United States of America, 1979-2003
Universal Dissemination
of Vaccine Overcomes

Low education

Low income

Access limitations

Reduced follow-up

Difference in quality of care

Multiple visit model
Reported Acute Hepatitis B Incidence* Among
Persons aged <19 Years, by Race/Ethnicity and
Year – United States, 1990-2004
*Per 100,000 population; †Asian/Pacific Islander;
§American Indian/Alaska Native
CDC. MMWR 2005;54:1-32
Acceptability of Vaccine

Overall high

Improved with increased knowledge

Higher for older adolescents
Davis, 2004
Olshen, 2005
Adolescent Vaccination
Problematic

Do not receive annual examination
Other venues



Sport physicals
School programs
Acute care visits
Mandates
Effective but controversial

Impact on sexual behavior

Religious objections

Philosophical objections

Cost
Focus on the Family

Supports widespread (universal)
availability of HPV vaccine

Opposes mandatory vaccination
for entry into public schools
www.family.org
Texas House rejects
order on vaccines
“… the State House of Representatives
voted 119-21 Tuesday to approve a bill
that would nullify the order.”
Wire report, March 14th, 2007
Bottom Line
Public, Medical, Public Health,
and Policy Committees
must be informed, educated,
and deliberative in providing
full dissemination of the vaccine