Saturday, January 20, 2007

American Cancer Society Issues New HPV Vaccine Guidelines

The American Cancer Society released this press release regarding new ACS guidelines that purportedly recommend that girls should receive the HPV vaccine when they're 11-12 years old. The new guidelines were developed by an expert panel who reviewed existing published and unpublished data on HPV vaccines. The guidelines do not explicitly state that girls 11-12 years old receive the HPV vaccine, but discuss the barriers reaching adolescents for vaccination and the recommendation by many health organizations that adolescents receive a routine healthcare visit at 11-12, thus creating a time during which teens could receive booster and other vaccines, including the HPV vaccine.

The core explicit recommendations of the guideline are as follows: unvaccinated and vaccinated women should continue Pap screenings; HPV testing prior to vaccination is not recommended; public health and policy efforts are needed to reduce disparities in HPV vaccine access; healthcare visits for specific problems such as minor illness and sports physicals and other nontraditional venues could be used to more widely distribute vaccine; educators, policy-makers, young girls and others need to be educated about cervical cancer detection and early prevention; ongoing research and surveillance is needed.

Cervical cancer/HPV information from the guideline:
  • In 2006, an estimated 9,710 cases of invasive cervical cancer will be diagnosed in the United States, and an estimated 3,700 women will die from this disease.
  • Globally, cervical cancer is the second most common cause of cancer death in women, with an estimated 510,000 newly diagnosed cervical cancer cases and 288,000 deaths.11 In developing countries, cervical cancer is often the most common cancer in women.
  • The greatest burden of cervical cancer is found in underserved, resource-poor populations of women in whom at least 80% of all incident cervical cancer and related mortality occurs. The highest rates of cervical cancer have been observed in regions of Africa, Central and South America, and Micronesia, where age-standardized incidence rates exceeding 50 cases per 100,000 women per year have been observed.
  • In the U.S. -- Although disparities in incidence and mortality have decreased in recent years, cervical cancer incidence remains about 60% higher among black women (10.5/100,000) compared with white women (6.6/100,000), and cervical cancer mortality among black women is the highest (4.7/100,000) of any racial or ethnic group. Rates are particularly high among those African Americans living in the rural South (eg, the Mississippi Delta) and also in some urban areas (eg, Washington, DC)
  • Other US racial/ethnic/geographic groups experience cervical cancer incidence and mortality higher than the population average. These include (1) Hispanics living along the US-Mexico border areas; (2) White (non-Hispanic) women living in Appalachia, rural New York State, and Northern New England; (3) American Indian women living in the Northern Plains and Alaskan Natives; and (4) Vietnamese Americans. Cervical cancer incidence remains high among these groups because of limited resources and poor access to health care, which is further exacerbated by social and cultural barriers.
  • ...more than 50% of college-age women acquired an HPV infection within 4 years of first intercourse
  • Transmission by nonpenetrative genital contact is rare, but infection has been reported in women who did not have a history of penetrative intercourse
  • The lower age limit for vaccine efficacy studies of Gardasil is 16 years and for Cervarix is 15 years. As the vaccine is prophylactic, it is important to consider risk of prior infection, which is best estimated by prior sexual activity. In the United States, according to national survey data, 24% of females report being sexually active by age 15 years, 40% by age 16 years, and 70% by age 18 years. Seven percent of high school students (male and female) reported having initiated intercourse before aged 13 years, and 10% of sexually active ninth graders reported having had 4 or more lifetime sex partners...From a public health perspective, routine vaccination before sexual debut or shortly thereafter is important to achieve optimal effectiveness.
  • Efficacy trials in young men are ongoing, with results expected in 2007.
  • While data are limited, several examples cited below may provide some insight into the potential impact of HPV vaccination on behavior. National Survey of Family Growth data show that only 10% of male and 7% of female adolescents who have never had sex cite "don't want STD" as the main reason for not having sex.
  • The citation for the guidelines, published in an academic medical journal: Saslow D, Castle PE, Cox JT, Davey DD, Einstein MH, Ferris DG, Goldie SJ, Harper DM, Kinney W, Moscicki AB, Noller KL, Wheeler CM, Ades T, Andrews KS, Doroshenk MK, Kahn KG, Schmidt C, Shafey O, Smith RA, Partridge EE, Garcia F. American Cancer Society guideline for human papillomavirus (HPV) vaccine use to prevent cervical cancer and its precursors. CA Canjcer J Clin. 2007 Jan-Feb;57(1):7-28 Free Full Text

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    MeSH Tags: American Cancer Society; Guidelines; Papillomaviridae; Papillomavirus Vaccines; Uterine Cervical Neoplasms

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