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Human papillomavirus March 2019

Robert Lichtenberg, MD
Cleveland Clinic Journal of Medicine May 2019, 86 (5) 300; DOI: https://doi.org/10.3949/ccjm.86c.05001
Robert Lichtenberg
Berwyn, IL
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TO THE EDITOR: I am an active primary care provider. After reading the update on human papillomavirus (HPV) in the March 2019 issue by Zhang and Batur,1 I was hoping for some clarification on a few points.

The statement is made that up to 70% of HPV-related cervical cancer cases can be prevented with vaccination. I have pulled the reference2 but cannot find supporting data for this claim. Is this proven or optimistic thinking based on the decreased incidence of abnormal Papanicolaou (Pap) test results such as noted in the University of New Mexico HPV Pap registry database3? The authors do cite an additional reference4 documenting a decreased incidence of cervical cancer in the United States among 15- to 24-year-olds from 2003–2006 compared with 2011–2014. This study reported a 29% relative risk reduction in the group receiving the vaccine, with the absolute numbers 6 vs 8.4 cases per 1,000,000. Thus, can the authors provide further references to the statement that 70% of cervical cancers can be prevented by vaccination?

The authors also state that vaccine acceptance rates are highest when primary care providers announce that the vaccine is due rather than invite open-ended discussions. At first this shocked me, but then made me pause and wonder how often I do that—and when I do, why. I regularly do it with all the other vaccines recommended by the Advisory Committee on Immunization Practices. When the parent or patient asks for further information, I am armed to provide it. To date, I am struggling to provide data to educate the patient on the efficacy of the HPV vaccine, particularly the claim that it will prevent 70% of cervical cancers. Are there more data that I am missing?

Finally, let me state that I am a “vaccinator”— always have been, and always will be. I discuss the HPV vaccine with my patients and their parents and try to provide data to support my recommendation. However, I am concerned that this current practice regarding the HPV vaccine has been driven by scare tactics and has now turned to “just give it because I say so.” The University of New Mexico Center for HPV prevention reports up to a 50% reduction in cervical intraepithelial neoplasias (precancer lesions) in teens.3 This is exciting information and raises hope for the future successful battle against cervical cancer. I think it is also more accurate than stating to parents and patients that we have proof that we have prevented 70% of cervical cancers. When we explain it in this manner, the majority of parents and patients buy in and, I believe, enjoy and welcome this open-ended discussion.

  • Copyright © 2019 The Cleveland Clinic Foundation. All Rights Reserved.

REFERENCES

  1. ↵
    1. Zhang S,
    2. Batur P
    . Human papillomavirus in 2019: an update on cervical cancer prevention and screening guidelines. Cleve Clin J Med 2019; 86(3):173–178. doi:10.3949/ccjm.86a.18018
    OpenUrlAbstract/FREE Full Text
  2. ↵
    1. Thaxton L,
    2. Waxman AG
    . Cervical cancer prevention: immunization and screening 2015. Med Clin North Am 2015; 99(3): 469–477.
    OpenUrl
  3. ↵
    1. Benard VB,
    2. Castle PE,
    3. Jenison SA,
    4. et al
    . Population-based incidence rates of cervical intraepithelial neoplasia in the human papillomavirus vaccine era. JAMA Oncol 2017; 3(6):833–837. doi:10.1001/jamaoncol.2016.3609
    OpenUrlCrossRef
  4. ↵
    1. Guo F,
    2. Cofie LE,
    3. Berenson AB
    . Cervical cancer incidence in young US females after human papillomavirus vaccine introduction. Am J Prev Med 2018; 55(2):197–204. doi:10.1016/j.amepre.2018.03.013
    OpenUrlCrossRef
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Cleveland Clinic Journal of Medicine: 86 (5)
Cleveland Clinic Journal of Medicine
Vol. 86, Issue 5
1 May 2019
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Human papillomavirus March 2019
Robert Lichtenberg
Cleveland Clinic Journal of Medicine May 2019, 86 (5) 300; DOI: 10.3949/ccjm.86c.05001

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Robert Lichtenberg
Cleveland Clinic Journal of Medicine May 2019, 86 (5) 300; DOI: 10.3949/ccjm.86c.05001
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