Saturday, May 21, 2016

Important Policy Updates from American Society of Clinical Oncology (ASCO) supporting HPV Vaccination.


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.
  1. Education and raising the awareness among health care providers, public health professionals, policy makers and patients about HPV vaccine and the cancers it causes.
  2. 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.
  3. 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.  
  4. Addressing critical knowledge gaps through research and development, making vaccinations safe and effective.
  5. 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.

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.



References.




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