AUSTIN (KXAN) — It is described by some health experts as a holy grail in medical research and a medical breakthrough: a vaccine given to children to prevent cancer in adulthood. Yet, not enough doctors are making a strong enough recommendation to parents to have their children vaccinated, according to numerous studies including a recent report by MD Anderson Cancer Center in Houston.
It’s called HPV or human papillomavirus and 80 percent of people will have it at some point in their lives. According to the Centers for Disease Control, HPV is the most commonly sexually transmitted disease in the world. While the majority of people will not develop cancers from the virus, there is a growing number of HPV-related cancers such as cervical cancer in women and throat cancer in men. Data from the CDC shows HPV is responsible for 27,000 cancer diagnoses each year.
KXAN examined research that shows vaccination rates are extremely low in the United States, including Texas. “It is the most amazing thing you can do for your children, is to give them a vaccine that will eventually prevent cancer,” says Dr. Kathleen Schmeler with MD Anderson Cancer Center. She is part of a group of cancer experts and researchers trying to find out why the HPV Vaccination rate is low across Texas. It’s a problem so widespread the American Association for Cancer Research suggests nationally it will lead to “serious consequences for public health translating into 53,000 future cervical cancer cases over the lifetime of girls ages 12 years and younger.”
While the number of children not being vaccinated against HPV varies, the Texas Health and Human Services department finds in 2013 there were an estimated 1,045,083 Texas teenagers ages 13-17 years old who had not received any dose of the HPV vaccine. The same analysis shows 93 percent of Texas girls could have started the HPV vaccine shots if “missed opportunities were eliminated.” What are those “missed opportunities?” KXAN found out it has to do with many doctors not strongly recommending the vaccine for what physicians nationwide describe as barriers.
One Woman’s Fight
Kara Million, a bubbly mother of two, is like any other woman trying to keep up with her babies and balance life as a working mom and wife. The hustle and bustle of that lifestyle led to a slightly delayed routine gynecological exam which ultimately led up to four words she never thought she would hear: you have cervical cancer. She was first diagnosed in 2009. After rounds of chemotherapy and treatment, Kara thought the cancer was gone. One year later she heard those dreaded four words again. The cancer was back and this time Kara needed a radical surgery to survive. “Not only what they were going to do was a total hysterectomy but remove my bladder, remove parts of my intestine, my bladder, rectum, cut me down the middle and take part of my abdomen and rectum, reconstruct things,” says Kara. She thought she was going to die with or without the surgery. “It was just the mortality of it all. You just fear the worst, especially in such an extensive surgery going into it.”
“It is the most amazing thing you can do for your children, is to give them a vaccine that will eventually prevent cancer.”—Dr. Kathleen Schmeler
Dr. Kathleen Schmeler operated on Kara for hours—as she has on thousands of other women battling cervical cancer. “We see daily here at MD Anderson, patients who come with very advanced cancers who we unfortunately were not able to cure because it was advanced,” says Dr. Schmeler.
Kara came out of the surgery literally missing parts of her body, but woke up to a new outlook on life and a mission to make sure what happens to her does not happen to her children or any others. “I understand how important it is to get them vaccinated. I don’t want them going and having to deal with the fear and put their families through it. It affects so much more than just yourself,” she says.
Targeting the Right Age Group
If HPV is sexually transmitted why must the vaccine that guards against it be given to children and not adults? It’s a question Dr. Schmeler is often asked when discussing the HPV vaccine, Dr. Schmeler says the answer is simple, “The really important thing about the vaccine is that it has to be given before individuals become sexually active. So if you give the vaccine after they have already been exposed to HPV it doesn’t work. So, it has to be given to our kids.”
Research suggests 81 percent of new cervical cancers can be prevented by HPV vaccinations, but it has to be given to children in order to be most effective. The vaccine is in the form of three doses, recommended for children—boys and girls—ages 11-12 but can be given to children as young as 9 and up to 26 years old.
However, Dr. Schmeler says HPV-related cancers develop in adults, not in children, adding “the effects of not getting vaccinated, the cancers happen much, much later so it is not something that the pediatricians see. But it is something I deal with on a daily basis, the cancers that result in this infection and that could be prevented from a vaccine.” Researchers say that is one reason there seems to be a disconnect in the urgency of pediatricians giving the HPV vaccine at routine well-child checkups leading to either delayed or weak recommendations and contributing to low vaccination rates. “The pediatric groups in Texas and elsewhere are doing a lot work to improve these rates and start providing really strong recommendations, that is what we really need,” continues Dr. Schmeler.
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Who’s Calling the Shots?
In 2014, Harvard researchers conducted a study, which included a survey of U.S. pediatricians and family doctors, dealing with how physicians communicate with their patients about the HPV vaccine. The study found almost all physicians surveyed said the vaccine prevents cervical cancer. The same study also found many pediatricians and family doctors were “recommending HPV vaccine inconsistently, behind schedule or without urgency.”
Dr. Melissa Gilkey is part of the research group at of Harvard. She says there are several factors or barriers reported by doctors that indicate providers are hesitant to recommend the HPV vaccine:
1. A perception that the discussion takes a long time. It’s in reference to the research that suggests a stigma exists with HPV being an STD. Dr. Gilkey says the survey found “doctors assumed parents would be hesitant to having their 11-12-year-old vaccinated against a sexual transmitted infection,” also adding some providers anticipate discomfort with the prospect of having to talk with preteens about a sexually transmitted infection.
2. Lack of consistency. GIlkey’s research group found “about one quarter of physicians in our study reported that they did not routinely recommend HPV vaccine for 11-12 year old girls. Over a one third of physicians did not do so for boys of the same age.” The 11-12 year old age group is the same age doctors recommend kids get the Tdap and meningococcal vaccines, both of which are required for students in Texas while the HPV vaccine is not (although in 2007 then-Gov. Rick Perry did try to make it mandatory). It is another barrier cited by pediatricians according to a similar study by MD Anderson as to why they are not strongly recommending the HPV vaccine.
3. A lack of awareness that the vaccine prevents cancer in boys too. Both the Harvard and MD Anderson study underscore the need to better inform physicians of the effects of HPV on men. When the HPV vaccine first became available in 2006, it was initially recommended for just girls. Further research in 2011, according to Dr. Schmeler, showed boys needed the vaccine as well, with an increasing number of men being diagnosed with oropharyngeal cancer (throat cancer), “it is becoming more and more common, rising at a very high rate and is actually surpassing the rate of cervical cancer in the United States,” says Dr. Schmeler.
While the option is ultimately up to parents on whether or not they vaccinate their children against HPV, researchers says they are not waiting to give doctors options on how to better communicate with patients and raise awareness in hopes of increasing HPV vaccination rates. There are several studies underway in an effort to examine the best way to help physicians overcome barriers to educating parents about the HPV vaccine.
The University of Texas at Austin is also raising awareness about the vaccine among its students. The University Health Services has an active campaign, which was created with the help of a student who surveyed fellow students and found many—especially men on campus—do not know about HPV or the vaccine against it.
Kara Million didn’t have the option of a vaccine to protect herself against the cervical cancer that almost killed her. “The option was to do the surgery and give myself a chance or don’t, and die,” but she says her children will have the option.