American Society of Clinical Oncology is the leading
professional body committed to decrease the burden of cancer and hence promote
any underutilized intervention that have potential to save millions of lives by
preventing cancer incidences.
An extremely
important policy statement from the American Society of Clinical Oncology
(ASCO), published ahead of print on April 11, 2016 regarding the HPV
Vaccination
ASCO states
that more than 10% of cancers worldwide (more than million cases per year) are
caused by viruses with HPV contributing about 600,000 to the pool.
In addition
to cervical cancer, HPV is also responsible for causing anal cancer, vaginal
cancer, and vulvar cancers, and increasingly of oropharyngeal cancer. It is
estimated that HPV is responsible for 60% of all oropharyngeal cancer, 90% of
which are caused by HPV 16.
HPV is the
cause of nearly all cervical cancers with 70% cases caused by genotype 16 and
18.
HPV
additionally causes of 91% of anal cancers, 75% of vaginal cancers, 69% of
vulvar cancers, and 63% of penile cancers, with HPV 16 being the predominant
oncogenic genotype.
Thus HPV
causes cancers in both sexes and oropharyngeal cancer is 3-5 times more common
in men.
“With safe
and effective vaccines readily available, no young person today should have to
face the devastating diagnosis of a preventable cancer like cervical cancer.
But unless we rapidly increase vaccination rates for boys and girls, many of
them will,” said ASCO President Julie
M. Vose, MD, MBA, FASCO.
Vaccination
against the HPV virus is incredible preventive strategy, because once the HPV
virus becomes incorporated into cells lining the cervix, anus or oropharynx it
is impossible to eradicate it and it will remain there for life.
A 2011
National immunization survey reported that only 36% of girls 14% of boys have
received the full schedule of immunization needed to protect against the virus.
A study in the same year also showed
that some of the states with highest rates of HPV related cancers have the
lowest rate of immunization.
Therefore, The
ASCO recommendations for increasing vaccination awareness and use are
summarized here.
- Education and raising the awareness among health care providers, public health professionals, policy makers and patients about HPV vaccine and the cancers it causes.
- Increasing the vaccination rates in society by combining it with other vaccines like eg, Tdap and meningococcal virus) for young adolescents. Distribution of educational pamplets, reminders by e-messaging or mailing should also be considered to bring on increase contacts among Drs and patients.
- ASCO strongly urges the policy makers and insurance company to increase the vaccination coverage, thereby decreasing out of pocket expenses because vaccination rates are strongly related to these factors.
- Addressing critical knowledge gaps through research and development, making vaccinations safe and effective.
- ASCO strongly believed that oncologists can play a very important role in increasing patients compliance for vaccination. They should keep abreast the recent advances by CDC and WHO regarding vaccination and interact with internists, gynecologists and primary care physicians to raise their awareness and interaction. Play a role in policy making in the society so that leaders can understand the critical role played by vaccines in avoiding cancers.
Bivalent (Cervarix), quadrivalent (Gardasil),
and, more recently, nonavalent (nine-valent) vaccines against HPV genotypes
(targeting those most commonly causing cancer globally) are approved in the
United States and other countries for primary prevention of HPV infections
The current Advisory Committee for Immunization Practices (ACIP) Vaccine Recommendations are:
Usual Adult Dose for Human Papillomavirus
Prophylaxis
Gardasil
- women and men:
Cervical, vulvar, vaginal, and anal cancer caused by HPV and genital warts (condyloma acuminata) caused by HPV:
9 years through 26 years: one dose (0.5 mL) intramuscularly once. Repeat dose in 2 months and 6 months for a total of 3 doses.
Cervarix - women:
9 years through 25 years: one dose (0.5 mL) intramuscularly at 0, 1, and 6 months.
Cervical, vulvar, vaginal, and anal cancer caused by HPV and genital warts (condyloma acuminata) caused by HPV:
9 years through 26 years: one dose (0.5 mL) intramuscularly once. Repeat dose in 2 months and 6 months for a total of 3 doses.
Cervarix - women:
9 years through 25 years: one dose (0.5 mL) intramuscularly at 0, 1, and 6 months.
Usual
Pediatric Dose for Human Papillomavirus Prophylaxis
Gardasil
- girls and boys:
9 years or older: one dose (0.5 mL) intramuscularly once. Repeat dose in 2 months and 6 months for a total of 3 doses.
Cervarix - girls:
9 years or older: one dose (0.5 mL) intramuscularly at 0, 1, and 6 months.
Vaccine is usually initiated at 11 to 12 years old; optimally, vaccination should be completed prior to onset of sexual activity.
9 years or older: one dose (0.5 mL) intramuscularly once. Repeat dose in 2 months and 6 months for a total of 3 doses.
Cervarix - girls:
9 years or older: one dose (0.5 mL) intramuscularly at 0, 1, and 6 months.
Vaccine is usually initiated at 11 to 12 years old; optimally, vaccination should be completed prior to onset of sexual activity.
References.
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