A 2022 Physician's Guide to Hopes and Challenges of Cervical Cancer Eradication through HPV Prevention

Each year more than 14,000 people will be diagnosed with cervical cancer and more than 4,000 people will die from it. However, cervical cancer is a potentially preventable disease. Throughout January, ACOG will recognize Cervical Cancer Awareness Month by joining with partners and sharing resources and guidance to emphasize the importance of cervical cancer screening and HPV vaccination, both of which can be lifesaving. Cervical Cancer Awareness Month and HPV Awareness Week provide a platform for us to remind our colleagues and our patients of the importance of cervical cancer screening and the remarkable effectiveness of the HPV vaccines in addition to the ongoing challenges of vaccine hesitancy and skepticism.

Expanding vaccination acceptance is a key element of my presidential term. We have known since the 1990s that HPV causes cervical cancer, and we know now that HPV vaccines are among the most effective immunizations available worldwide. Recent studies from around the world have captured dramatic declines in cervical cancer among populations with high HPV vaccination rates. These vaccines are safe and wildly effective, preventing over 99% of some HPV types in women who have not yet been exposed. In Australia, which has high rates of vaccination and screening, experts predict the elimination of cervical cancer as a public health problem within 20 years. We can expect HPV vaccination to greatly reduce the risk of other HPV-related cancers—anal, vaginal, vulvar, penile, and throat—too. Close to 59% of U.S. teens were up to date on HPV vaccinations in 2020—a rate that, while low, reflected a steady, gradual climb in recent years. Unfortunately, the COVID-19 pandemic has disrupted that trend, according to the CDC.

Opportunities for Encouraging HPV Vaccination throughout Patients’ Adult Lives

As physicians, we can encourage our patients to get the HPV vaccine and counter the inaccurate messages about HPV vaccination that circulate on social media with the help of our physician FAQs. Fortunately, our patients offer us frequent and ongoing opportunities:

• Young adult patients up to age 26 may be more receptive to HPV vaccination than their parents may be on their behalf. We know that HPV vaccination rates are higher in states where adolescents are able to consent without parental involvement.
• Unvaccinated patients ages 27–45 may also discuss their risk of new HPV infection and the potential benefits of HPV vaccination.
• Patients who are parents may be more open to vaccinating their children when we emphasize vaccines’ capacity to protect their children from a variety of HPV-related cancers and other conditions such as condyloma.

How to Speak with Patients about HPV Vaccination

How we communicate with our patients influences their vaccination decisions. Key facts are important—but effective conversation is equally important. Physicians and other health care professionals should discuss HPV vaccination routinely, as firmly and comfortably as we talk about other preventive health care measures. For patients, the approval of their peers and communities also matters. An uptick in interest in the vaccine and mainstream media coverage of the vaccine’s effectiveness will increase uptake of the vaccine over time.

When we have opportunities to speak with parents about vaccinating their children against HPV, it makes sense to focus on the vaccine’s effectiveness in preventing multiple cancers and parents’ role in protecting their children. It is also helpful to emphasize the impact of preinvasive HPV disease in the general population, including condyloma and men’s risk of HPV-related cancers, in addition to the growing evidence of nonsexual HPV transmission. Parents’ concern about the HPV vaccine influencing their children’s sexual activity appears to have declined. Overexplaining this vaccine and placing too much emphasis on its relation to sexual activity may inadvertently reinforce stigma around sexually transmitted infections.

Additional Challenges

Overcoming vaccine hesitancy is not the only barrier to eradicating this disease. Patients with a cervix who have not been vaccinated and who have not undergone recommended screening remain at risk. Smoking and compromised immune systems are also risk factors. Current HPV testing does not cover all strains of HPV. In addition, HPV infection, persistence (latency), and reactivation in older women are not well understood. The inequities that currently exist in cervical cancer screening also apply to vaccination and affect vaccination opportunities.

Despite the challenges, the progress we’ve made in tackling cervical cancer is nevertheless a compelling reminder of the role of obstetricians and gynecologists in our patients’ ongoing health and safety and of the profound difference we can make in their lives.