Monday, November 9, 2015

Epic Fail: We Physicians Must Do More to Promote Cancer-Preventing HPV Vaccine

By Jason Terk, MD
Immediate Past President, Texas Pediatric Society
Keller Pediatrician
Member, TMA's Be Wise Immunize Advisory Panel

“Epic fail.”

A couple of years ago, this was the phrase that my teenage son used as I unsuccessfully attempted to beat him in a game we were playing. At the time, I thought to myself that it was a harsh but accurate assessment of my performance. And, I was certainly motivated to practice on my own so that the next time, things would be different.

That same phrase came to mind as I read through an alarming article of interest to physicians. The article, published in Cancer Epidemiology, Biomarkers & Prevention is titled “Quality of Physician Communication about Human Papillomavirus Vaccine: Findings from a National Survey.”

Bottom line: Physicians (primarily pediatricians and family physicians) do poorly in providing the human papillomavirus (HPV) vaccine to patients.

Another source, the most recent National Immunization Survey-Teen for the year 2014, reports another alarming trend. The survey shows the number of patients who start the shots — and also complete them — lags far behind what it should be. (The HPV vaccine is given as a series of shots.)

So, it came as no surprise to me that the first article clearly showed what I have suspected for some time and which has been hinted at by previous studies. The epic failure in providing what is essentially a cancer-prevention vaccine to the recommended population of 11-12-year-old boys and girls lies not at the feet of the anti-vaccine movement or hesitant parents. Rather, the failure belongs to us physicians!

The article describes findings from an online survey sent to 2,368 pediatricians and family physicians in 2014. The 776 respondents self-reported their own performance on strength of four criteria: endorsement (how strongly they recommend the vaccine); timeliness (whether they recommend it at 11-12 years of age, which is the most beneficial age); consistency (recommending it routinely instead of “risk-based,” primarily to patients the physician believes might be at higher risk for HPV); and urgency (whether the physician recommend the patient receive the vaccination that day). More than a quarter stated they did not strongly endorse the HPV vaccine, and a similar number reported they did not recommend it be given at 11-12 years of age. Amazingly, 59 percent said they used a risk-based approach versus a routine approach to recommending the HPV vaccine, and only half the respondents recommended giving the vaccine then and there, while the doctor discussed the HPV vaccine with the patient and parent. And these results represent a best-case scenario because respondents would be unlikely to paint an unflattering picture of their own performance.

Clearly, we have a major problem with physicians struggling with their own discomfort in talking about the HPV vaccine and who erroneously believe parents do not value it. Physicians who can’t communicate the importance of this cancer-preventing vaccine in turn fail to recommend it, which is so important to protect our patients. We are at risk of being the generation of pediatricians and family physicians who collectively failed to protect our patients from a preventable cause of cancer. Only we physicians can fix what it wrong with us: Only we can reverse this epic failure!


Monica Modelska said...

I think HPV vaccine should be advised and administered to all sexually active persons (whether they are married or not because the infidelity of a partner could put them at risk). I did not know it was “most beneficial” at age 11 and curious to understand why.
I understand the hesitance of families not getting their kids vaccinated because they do not want to admit their children will/have become sexually active at such a young age!! The whole approach was bad insofar as the promotion of this vaccine from the beginning, as the lack of explanation of why it’s beneficial was hidden by the hypocrisy of admitting the HPV is a STD. They tried to sweep that minor detail under the carpet, so go figure the reluctance!

Jason said...

Thank you for your comment. The vaccine is most beneficial at 11-12 years because the body responds best to it immunologically at that age (as opposed to older teens at 16-18 yrs). The vaccine is not given at 11-12 yrs of age because there is an expectation that kids will be sexually active at that age. Rather, it is given at that age because there is an expectation that they are not sexually active at that time.

No vaccine works if it is given after exposure to the disease it is intended to prevent. Because HPV is so common (the majority of US adults show evidence of past infection at some point in their lives), it makes sense to vaccinate the population against it and 11-12 yr olds are unlikely to have been exposed.

Yes, HPV is an STI, but it differs in one very important way from other STI's you may be familiar with like syphilis, gonorrhea, genital herpes, and chlamydia. In the baseball analogy of sex, you pretty much have to hit a home run to be infected with these types of STI's. First, second and third bases, however, are covered with HPV- it is frightfully easy to transmit it with very PG rated levels of intimacy.

So, it pays to look at this as a vaccine to prevent cancer since you cannot avoid the infection by virtue of the choices you make. Leave the value judgements aside which divert one from making what should be a no-brainer. Let's keep kids from getting an infection which may cause a cancer 2-4 decades later.

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