1. You are the Key to HPV Cancer Prevention
Matt Flory
Minnesota State Health Systems Manager
American Cancer Society
April 27, 2017

2. HPV Types Differ in their Disease Associations
Mucosal
sites of infection
Cutaneous
~ 80 Types
“Common” Hand and Foot
Warts
~40 Types
Genital Warts
Laryngeal Papillomas
Low Grade Cervical Disease
Low risk (non-oncogenic) HPV 6, 11 most common
High risk (oncogenic) HPV 16, 18 most common
Cervical Cancer Anogenital Cancers Oropharyngeal Cancer Cancer Precursors

3. HPV Infection
Most females and males will be infected with at least one type of mucosal HPV at some point in their lives
Estimated 79 million Americans currently infected
14 million new infections/year in the US
HPV infection is most common in people in their teens and early 20s
Most people will never know that they have been infected
Jemal A et al. J Natl Cancer Inst 2013;105:

4. Cancers Caused by HPV, U.S.
Cancer site
Average number of cancers per year associated with HPV
Percentage per year
Male
Female
Both Sexes
Anus
1,600
3,000
4,600
91%
Cervix
10,700
Oropharynx
9,100
2,000
11,100
70%
Penis
700
63%
Rectum
200
500
Vagina
600
75%
Vulva
2,400
2,200
69%
TOTAL
11,600
19,200
30,800
CDC, United States Cancer Statistics (USCS),

5. New Cancers Caused by HPV per Year United States 2008-2012
Rectum n=500 3%
Men (n = 11,600)
Anus n=1,600 14%
Oropharynx n=9,100 78%
Penis n=700 6%
Rectum n=200 2%
Anus n=3,000 16%
Cervix n=10,700 56%
Vagina n=600 3%
Vulva n=2, %
Oropharynx n=2,000 10%
Women (n = 19,200)
CDC, United States Cancer Statistics (USCS),

6. Cervical Cancer
Cervical cancer is the most common HPV-associated cancer among women
500,000+ new cases and 275,000 attributable deaths world-wide in 2008
~11,000 new cases and 4,000 attributable deaths in 2012 in the U.S.
25% cervical cancers occur in women who are between the ages of 20 and 39
CDC. HPV–associated cancers—US, MMWR 2012;61(15):258–261.
Cervical Cancer Counts by Age. US Cancer Statistics data from 2010, CDC.gov.

7. Evidence-Based HPV Disease Prevention
HPV Vaccine

8. Why HPV? Why ACS? We have a vaccine
This vaccine prevents (multiple) cancers
We need to vaccinate more kids
Cancer and immunization need to work together
Success is achievable
HPV vaccination + ACS = focus on cancer prevention, adolescents and their families, and new public health partners

9. HPV Vaccination Rates Remain Too Low
HPV vaccination prevents most cervical, vaginal, vulvar, & anal cancers and are expected to prevent most penile & oropharyngeal cancers
Rates of several of these cancers are increasing
HPV vaccination is underutilized despite the overwhelming evidence for its safety and effectiveness
While vaccination rates continue to improve for other adolescent vaccines, HPV vaccination rates have not
Vaccination rates are lowest where cervical cancer rates are highest

10. Framing the conversation
Talking about HPV vaccine
Framing the conversation

11. Impact of Eliminating Missed Opportunities by Age 13 Years in Girls Born in 2000
Missed opportunity: Healthcare encounter when some, but not all ACIP-recommended vaccines are given. HPV-1: Receipt of at least one dose of HPV. MMWR. 63(29);

12. Reasons parents won’t initiate HPV vaccination for children
MMWR 2014; 63(29); ;

13. Value Parents Place on the Vaccines
Adapted from Healy et al. Vaccine. 2014;32:

14. Provider estimations
Adapted from Healy et al. Vaccine. 2014;32:

15. Clinicians underestimate the value parents place on HPV vaccine
Adapted from Healy et al. Vaccine. 2014;32:

16. Clinicians Underestimate the Value Parents Place on HPV Vaccine
The perceived and real concerns of parents influence how the provider recommends and administers HPV vaccine.
Clinicians Underestimate the Value Parents Place on HPV Vaccine
Adapted from Healy et al. Vaccine. 2014;32:

17. Give an Effective Recommendation to Receive HPV Vaccine at Ages 11 or 12
An effective recommendation from you is the main reason parents decide to vaccinate
Many moms in focus groups stated that they trust their child’s doctor and would get the vaccine for their child as long as they received a recommendation from the doctor
Unpublished CDC data, 2013.

18. What is an
EFFECTIVE
recommendation
for HPV vaccination?

19. Same Way Same Day

20. Make an Effective Recommendation
Same way: Effective recommendations group all of the adolescent vaccines Recommend HPV vaccination the same way you recommend Tdap & meningococcal vaccines.
Same day: Recommend HPV vaccine today Recommend HPV vaccination the same day you recommend Tdap & meningococcal vaccines.
Unpublished CDC data, 2013.

21. Your preteen needs three vaccines today to protect against meningitis, HPV cancers, and pertussis.

22. Tdap
HPV
MenACWY
Preteen Vaccines

23. Now that Sophia is 11, she is due for three vaccines
Now that Sophia is 11, she is due for three vaccines. These will help protect her from meningitis, HPV cancers, and pertussis. We’ll give those shots at the end of the visit.

24. Some Parents Need Reassurance
Many parents simply accept of this bundled recommendation
Some parents may be interested in vaccinating, yet still have questions. Interpret a question as they need additional reassurance from YOU, the clinician they trust with their child’s health care
Ask parents about their main concern (be sure you are addressing their real concern)
Unpublished CDC data, 2013.

25. If I could reduce their cancer risk?

26. Keep Julia’s age in mind

27. Actual conversation I had at a medical visit
Matt: “I’ve been reading more about the HPV vaccine. I’m hopeful for what it may mean for my children, especially my daughter” Nurse: “Why? Do you think she will be one of those?”

28. Why does my child need HPV vaccine?

29. HPV vaccination is important because it prevents cancer
HPV vaccination is important because it prevents cancer. That’s why I’m recommending that your child start the HPV vaccine series today.

30. What cancers are caused by HPV infection?

31. Certain HPV types can cause cancer of the cervix, vagina, and vulva in females, cancer of the penis in men, and in both females and males, cancers of the anus and the throat. We can help prevent infection with the HPV types that cause these cancers by starting the HPV vaccine series today.

32. Is my child really at risk for HPV?

33. HPV is a very common and widespread virus that infects both females and males. We can help protect your child from the cancers and diseases caused by the virus by starting HPV vaccination today.

34. Why as early as 9 years old?
Why before 13 years old?

35. When should the bike helmet go on?A B C

36. HPV Vaccine Recommendation
Girls & Boys can start HPV vaccination at age 9
Preteens should finish HPV vaccine series by 13th birthday
Plus girls years old who haven’t started or finished HPV vaccine series
Plus boys years old who haven’t started or finished HPV vaccine series

37. Most clinicians wait too long to make strong recommendations for HPV vaccine
Allison et al.

38. “As with all vaccine-preventable diseases, we want to protect your child early. If we start now, it’s one less thing for you to worry about. Also, your child will only need two shots of HPV vaccine at this age. If you wait until 15, your child will need three shots. We’ll give the first shot today and then you’ll need to bring your child back in 6 to 12 months from now for the second shot.”

39. HPV VACCINE IS CANCER PREVENTION
And YOU are the key!
#WeCanStopHPV

40. TOOLS: Steps for Increasing HPV Vaccination in Practice
Flyer & PowerPoint

42. TOOLS: Myth Busting Flyer & PowerPoint

44. Middle School Health Website

45. Middle School Health Website

46. Middle School Health Website