American Cancer Soc. Advises Offering HPV Vaccine Starting at Age 9 or 10

By Megan Brooks

July 16, 2020

NEW YORK (Reuters Health) - In an adaptation to the current Advisory Committee on Immunization Practices (ACIP) recommendation, the American Cancer Society (ACS) encourages healthcare providers to start offering the human papillomavirus (HPV) vaccine at age 9 or 10 years.

This differs slightly from current ACIP recommendations which state that HPV vaccination is routinely recommended at age 11 or 12 years and vaccination can be given starting at age 9 years.

"Following the release of updated recommendations from ACIP in June 2019, ACS convened its Guideline Development Group to review and endorse or adapt the recommendations," Dr. Debbie Saslow, ACS Managing Director for Cancer Control Interventions-HPV/GYN Cancers, told Reuters Health by email.

"We reviewed several new studies showing that starting vaccination at age 9 or 10 has potential benefits that are expected to lead to higher vaccination rates, resulting in increased numbers of cancers prevented compared to starting at ages age 11 and 12. More parents agreed to vaccination when it was offered between ages 9 and 10. Younger children were also more likely to complete the series than those who start between ages 11 and 12. The ACS felt it was important to say that starting at age 9 or 10 is more than OK; it's preferable to achieve the full cancer-preventing potential of this vaccine," said Dr. Saslow.

The ACS adapted recommendations, published in CA: A Cancer Journal for Clinicians, also make slight changes to ACIP recommendations on catch-up and adult HPV vaccination.

The ACIP currently recommends vaccination for all individuals through age 26 who are not adequately vaccinated. The ACS has added a "qualifying" statement advising providers to inform adults between 22 and 26 years old 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.

The ACIP currently recommends against catch-up HPV vaccination for all adults older than 26. Instead, the ACIP advises shared decision making on HPV vaccination for some adults between ages 27 and 45 who are not adequately vaccinated.

The ACS does not endorse shared clinical decision-making for adults aged 27 to 45 due to the "low effectiveness and low cancer prevention potential of vaccination in this age group, the burden of decision making on patients and clinicians, and the lack of sufficient guidance on selection of individuals who might benefit."

HPV vaccination rates in the United States continue to lag far behind rates in other high-income countries.

"The combination of HPV vaccination and cervical cancer screening has the potential to prevent tens of thousands of cancers caused by HPV each year in this country and to eliminate cervical cancer as a public health problem in the coming decades," Dr. Saslow and colleagues note in their report.

"Vaccination of all children between ages 9 and 12 years will prevent >90% of the cervical, oropharyngeal, anal, vaginal, vulvar, and penile cancers that are caused by HPV and, combined with screening and the treatment of cervical precancers, can lead to the first elimination of a cancer in history."

"Forging a path to elimination will take sustained action by organizations and individuals in cancer control, immunization, and public health communities in the United States and around the world," the authors add.

Dr. Saslow told Reuters Health, "Increasing HPV vaccination rates is one of the highest priorities for ACS. We launched a public health campaign in 2018, Mission: HPV Cancer Free, with a goal of increasing rates of on-time vaccination to 80% by 2026. We have hundreds of ACS staff all around the country who work with state partners, large health systems, local clinics, provider groups, and partner organizations. At the national level we convene the National HPV Vaccination Roundtable, comprised of about 70 organizations who work together with one message: to increase vaccination in order to prevent more HPV cancers."

SOURCE: CA: A Cancer Journal for Clinicians, online July 8, 2020.