ACS Recommends HPV Vaccine for Girls and Boys Ages 11-12

Veronica Hackethal, MD

July 19, 2016

The American Cancer Society (ACS) has issued new guidelines for human papillomavirus (HPV) vaccination, recommending that all girls and boys ages 11 to 12 years should receive the vaccine.

The guidelines represent an endorsement of the Centers for Disease Control and Prevention (CDC)'s Advisory Committee on Immunization Practices (ACIP), the lead US organization on vaccination policy. The ACS recommendations focus on three key issues: late age at vaccination, vaccination of males as well as females, and use of the 9-valent HPV (9vHPV) vaccine. They were published online July 19 in CA: A Cancer Journal for Clinicians.

Evidence suggests that vaccine effectiveness is highest in preteens and early teens. The new recommendations add a caveat to ACIP recommendations: patients aged 22 to 26 years who have not received the vaccine or have not completed the series should be advised that the vaccine becomes less effective at lowering cancer risk at older ages.

"The main point is to give the HPV vaccine to every boy and girl around age 11 to 12. They can start a little earlier, but they should finish the series by their 13th birthday," first author Debbie Saslow, PhD, director of cancer control intervention for HPV vaccination and women's cancers at the ACS, told Medscape Medical News.

"ACS differs from ACIP and everybody else in one important way. We've been a lot more cautious in our language about vaccinating anyone up to the age of 26. I think we're the only ones saying this is about cancer prevention. You must vaccinate early in order to prevent HPV-related cancers," she stressed.

You must vaccinate early in order to prevent HPV-related cancers. Dr Debbie Saslow

HPV is linked to most cervical, vulvar, vaginal, anal, oropharyngeal, and penile cancers in US women and men. ACS estimates that HPV vaccination with the 9vHPV vaccine could prevent about 28,500 cancers each year in the United States. Vaccinating males may also provide additional protection to females.

The new recommendations update 2007 ACS guidelines, which did not address use of the newly licensed 9vHPV vaccine, or HPV vaccination in males, for whom trials were unfinished and the vaccine was not approved at that time. The earlier guidance also did not include recent evidence about the declining effectiveness of late vaccination between ages 19 to 26 years.

The update comes on the heels of a recent step-up in efforts by professional organizations to prioritize HPV vaccination.

In April 2016, the American Society of Clinical Oncology (ASCO) issued a policy statement calling for aggressive efforts to increase HPV vaccination rates. ACS is also working through the National HPV Vaccination Roundtable, which includes over 70 organizations collaborating to prevent HPV-associated cancers. And ACS has created the Vaccinate Adolescents Against Cancer program, focused on increasing provider awareness and education in order to improve HPV vaccination rates.

"If there's a provider out there who doesn't think that this vaccine is safe and effective, all the evidence is right there. There's a lot of misinformation among providers, who think parents don't value or want the vaccine, or need a long explanation about sex, which they're hesitant to give," Dr Saslow stressed.

Research suggests, however, that most parents will accept the HPV vaccine when it is provided as part of the routine vaccination schedule for youths aged 11 to 12, along with whooping cough and meningitis vaccines, she explained.

The new guidelines represent an evolution of the ACS's process for developing guidelines, as well as the development of a new process for endorsing other organization's guidelines.

In 2012, ACS convened a Guideline Development Group, which used a guideline endorsement process similar to that used by ASCO for endorsing other society's guidelines. The process included a methodologic and content review of the ACIP recommendations by using the Appraisal for Guidelines for Research and Evaluations II (AGREE II) instrument and a supplemental evidence review.

Key Recommendations

  • HPV vaccination for all patients age 11 to 12 years, which should be given along with other routine adolescent vaccines, such as Tdap and MCV4.

  • The HPV vaccination series can be started at age 9 years.

  • Females can receive vaccination with the bivalent (2vHPV), quadrivalent (4vHPV) (as long as the vaccine remains available), or 9vHPV vaccine.

  • Males can receive vaccination with the 4vHPV (as long as the vaccine remains available) or 9vHPV vaccine.

  • Vaccination should occur in females aged 13 to 26 years and males aged 13 to 21 years who have not been previously vaccinated or who have not completed the three-dose series.

  • Males aged 22 to 26 years may be vaccinated.

  • The vaccination series should be completed by age 13 years to increase effectiveness; late vaccination should be completed as soon as possible.

  • Vaccination is recommended though age 26 years in men who have sex with men and for immunocompromised individuals, including those with HIV, if not previously vaccinated.

  • ACS qualifying statement: Providers should inform individuals aged 22 to 26 years who have not been previously vaccinated or who have not completed the series that vaccination at older ages is less effective in lowering cancer risk.

Currently, three HPV vaccines are licensed in the United States: the Cervarix (GlaxoSmithKline) 2vHPV vaccine and the Gardasil (Merck & Co) 4Vhpv and 9Vhpv vaccines.

The guidelines were funded by the ACS. Dr Saslow reports being a principal investigator on two cooperative agreements about HPV vaccination between the ACS and the CDC and Public Health Fund. Dr Fisher-Borne reports being a co-principal investigator and receiving salary support from one of these agreements.

CA Can J Clin. Published online July 19, 2016. Abstract

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