HPV Vaccination in Women
Updated: Sep 5, 2019
In the United States, 96% of cervix cancer is attributable to human papillomavirus (HPV), according to the 2004-2008 data from the National Program of Cancer Registries (1). Cervical cancer screening and HPV vaccination is largely known to reduce the rate of cancer incidence. However despite a wealth of resources for cervical cancer prevention, an average of 33,369 HPV-associated cancers were diagnosed annually in the United States during 2004–2008 (1). Disparities exist significantly among women with cervical cancer. The existence of population disparities in cervical cancer incidence, a treatable and preventable disease, is an indication of the deficiency of our health system. Understanding the reasons for the disparities can help policy makers to resolve the barriers for cervical cancer treatment and prevention.
The reasons for the disparity can be contributed by race, ethnicity, education and income (2). Cervical cancer incidence is closely correlated to poverty in the US. Women live below the poverty line are 3 times more likely to be infected with HPV (3). Poverty is an obstacle to have access to healthcare. Women live in poverty are less likely to use health care system and only visit them for urgent health issues. Preventive care such as screening and vaccination is less likely accessible for low-income women compared to the mainstream population. Cultural belief is also a contributing barrier for the cervical cancer incidence disparity among US women. Hispanic women are less likely to undergo Pap smears by non-spanish speaking clinicians. Lack of awareness and knowledge also hinders HPV vaccination coverage. A pooled data from 2007 indicates among Alabama Hispanic women, only 51% are aware of HPV (2). Many women also do not consider themselves as being at risk of HPV infection. Women who do not believe in cervical cancer prevention measures are also unlikely to educate their daughter to be vaccinated for HPV. Parents also fear that HPV vaccination will promote sexual activities for their daughters.
One way increase vaccine uptake to prevent HPV infection is support and encourage health providers to make strong HPV vaccine recommendations. The strongest predictor of vaccine uptake is a provider's recommendation so it is important that health care providers make strong and timely recommendations about the vaccine and also address parental concerns. It may be hard to discuss HPV association with sex to parents of young teen, but if providers have the proper information about vaccine safety and efficacy it may help to increase HPV vaccination rates. Health providers should use communication tools when discussing the HPV vaccine with patients. This ensures that the information is accurately conveyed to the patients. Additionally, if adolescents had the vaccine combined with other routine vaccines, they would at least start the three-dose series. To minimized missed opportunities for vaccine uptake, providers should recommend the vaccine during sick visits along with preventative visits. It would also be extremely beneficial to start the conversation about the vaccine way before it is due. This would break the association between HPV and sexual activity that makes parents uncomfortable. Strategies can be used,such as automated phone calls or text messages that would remind parents to bring their child in to receive the vaccine. There could be some practice-based policies that give access of the HPV vaccine to hard to reach people. Some parents cannot make business hours so there could be walk in hours or after-school vaccination clinics. Additionally, there should be state and federal policies that improve access to the HPV vaccine. There could be laws that mandate the competition of the HPV vaccine before school entry. Teens should be allowed to receive the HPV vaccination without parent consent. This could drastically increase vaccination uptake because some parents refuse the vaccine because of its connotation to sexual activity. Finally, there should be public education and awareness efforts that target parents and teens (4).
1. Gillison ML, Chaturvedi AK, Lowy DR. “HPV Prophylactic Vaccines and the Potential Prevention of Noncervical Cancers in Both Men and Women.” Cancer 113.10 (2008): 3036–3046.
2. Downs, Levi S et al. “Overcoming the Barriers to HPV Vaccination in High-Risk Populations in the US ☆.” Gynecologic Oncology 117 (2010): 486–490.
3. Kahn, Jessica A, Dongmei Lan, and Robert S Kahn. “Sociodemographic Factors Associated with High-Risk Human Papillomavirus Infection.” Obstetrics and gynecology 110.1 (2007): 87–95.
4. Gable, J., Eder, J., Noonan, K., & Feemster, K. (2015). Increasing HPV Vaccination Rates Among Adolescents: Challenges and Opportunities. Retrieved from