COMMENTARY

HPV Vaccines Work, So Why Aren't Doctors Recommending Them?

Arthur L. Caplan, PhD

Disclosures

July 27, 2016

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Hi. I'm Art Caplan from the Division of Medical Ethics at the NYU Langone Medical Center. We have a problem in this country. There is a very successful preventive intervention that just isn't getting used. It's the vaccine for human papillomavirus (HPV), the virus that is responsible for, among other cancers, cervical cancer. The vaccine has been around for a while. Two companies make the vaccine. I think Merck's vaccine has been around for at least 10 years, and GlaxoSmithKline's has been around for maybe 7 years. The vaccines are very safe, they're very effective, and almost no American women use them, much less American men.

So what's going on? What's the problem? Apparently, pediatricians do not raise the subject of getting the HPV vaccine with their patients. There could be many reasons for this. They see people who don't get cervical cancer or penile cancer or oral cancer. They're too young. It may be that there's some awkwardness in talking about sexuality, since the primary route of transmission for HPV is through sexual contact. Maybe they're nervous about talking about it with the parents of younger patients. But, inexcusably, we still have a couple of thousand people who die every year from cervical cancer; 10,000 or more cases of invasive cervical cancer, which requires major surgery; and an untold number of abnormal cells appearing on tests that have to be retaken because of precancerous states. Many of these cases could have been prevented if vaccination had been offered to both women and men. Men can get some rare forms of cancer and they are carriers [of the virus].

Finally, the oncology and ob/gyn communities are being called upon to get on the HPV vaccination bandwagon. I think it's a strategy that we ought to pursue. It's tough to talk about a sexually transmitted disease; it's awkward to do so. It's also hard to talk about a disease that may not happen for many years to come, but it's simply unethical to allow cases of preventable disease to go on and not bring up the fact that this is a cancer-preventing vaccine. If sex is not the way into the subject, then cancer surely ought to be. I think it's a good thing that other specialties are getting involved. They are going to have to train themselves, because they often don't give vaccinations. Having more voices than just relying on doctors who see the youngest patients may help us get past what is almost a moral scandal—with preventable cancers and surgeries just going on and on—because we're not talking enough and firmly recommending the HPV vaccine.

I'm Art Caplan at the NYU Division of Medical Ethics. Thanks for watching.

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