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Why Many U.S. Preteens Aren't Getting the HPV Shot
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Cost and parental concerns about the link to sexual activity may be why relatively low numbers of girls and boys are getting the HPV vaccine as recommended.
Educating doctors and parents about the benefits of the vaccine and debunking some of the myths that surround it may help improve these rates and protect more adolescents, experts said.
Two available HPV vaccines -- Cervarix and Gardasil -- protect against the strains of genital warts responsible for 70 percent of all cases of cervical cancer. The U.S. Centers for Disease Control and Prevention currently recommends routine HPV vaccination for girls aged 11 to 12.
They also recommend Gardasil for males starting at age 11 to protect against genital warts, as well as oral, penis and rectal cancers.
But "parents have a number of concerns including the mindset that 'my child isn't sexually active yet,' and many may hope that they will remain inactive for years to come," said study author Dawn Holman.
However, "vaccinating young is when the shot is most effective and a great way to protect your child's health, even if they wait to get married to become sexually active," said Holman, a behavioral scientist at the CDC's Division of Cancer Prevention and Control.
Holman and colleagues reviewed 55 studies on the HPV vaccine published from 2009 through 2012 to see why the rates remain low in comparison to other recommended vaccines. Their findings appear online in the Nov. 25 issue of JAMA Pediatrics.
Cost was cited as a major barrier by many parents. The American Cancer Society reports that the vaccine can cost about $130 per dose, and a series of three shots is required. Current changes in health care may help remove the cost barrier for some people, Holman said, and financial assistance programs are available to help pay for the shots.
Beside identifying barriers, the new study also highlighted ways to improve rates of HPV vaccine acceptance.
"Parents report that a recommendation from their health care provider is the key factor in their decision," Holman said, yet the study found that many didn't get this recommendation from their doctor.
Dr. Greg Yapalater, a pediatrician in New York City, routinely counsels adolescents and their parents about the HPV shot. "People shy away from anything that has to do with sex, and this shot has to do with the sex talk," he noted.
When talking to families, Yapalater discusses puberty and sexually transmitted diseases and how not to get them. "This opens up the chapter in terms of condoms and vaccinations," he said. "I spend time discussing this with the entire family as ultimately the parents are the ones who will say yes or no to the vaccine."
Many parents fear that vaccinating against HPV will encourage their children to be promiscuous, but this is not the case, he said. "Educating families can help debunk any of these myths or concerns associated with the vaccine. This is an amazing vaccine because it prevents cancer."
Dr. Mark Wakabayashi, co-director of the gynecological cancers program and chief of gynecologic oncology at City of Hope Cancer Center in Duarte, Calif., treats people who have some of the cancers this shot may help prevent. So he finds less resistance among his patients.
Wakabayashi said that because the HPV vaccine targets a sexually transmitted infection, stigma often plays a role in people's decision for or against it. ""If this was like the chickenpox vaccine, there would be a higher rate of acceptance," he said.
More education is needed to increase acceptance of this vaccine, and this starts by educating the doctors who are tasked with providing it, he said.
Dr. Jennifer Wu, an ob/gyn at Lenox Hill Hospital in New York City, said that cost is the primary barrier among her patients when it comes to the HPV shot. Still, parents' fears about their children becoming sexually active can also be an obstacle.
"Some parents want to wait until their child is older, but the goal is to complete the series of vaccinations before the child becomes sexually active," Wu said. "You are protecting the general population, too. That is why we want boys and girls to get the shot."
SOURCES: Dawn Holman, M.P.H., behavioral scientist, division of cancer prevention and control, U.S. Centers for Disease Control and Prevention; Mark Wakabayashi, M.D., co-director, gynecological cancers program, and chief, gynecologic oncology, City of Hope Cancer Center, Duarte, Calif.; Jennifer Wu, ob/gyn, Lenox Hill Hospital, New York City;Greg Yapalater, M.D., pediatrician, New York City; Nov. 25, 2013, JAMA Pediatrics