American Cancer Society Updates Guidelines for HPV Vaccination

Following a review of 2 new 2019 Federal Advisory Committee on Immunization Practices (ACIP) recommendations, the American Cancer Society (ACS) has updated its guidelines for human papillomavirus (HPV) vaccination.²

Guidelines for use of the HPV vaccine were first issued in 2007; an update to those guidelines were published in 2016. The latest update addresses key concerns surrounding when routine vaccination should begin, the effectiveness of subsequent catch-up vaccinations, and whether to recommend shared clinical decision-making about vaccination. The ACS, in adapting these concerns, also provided several qualifying statements regarding their own interpretation of the new set of guidelines.¹

What Age Should HPV Vaccination Begin?

Both the ACIP and ACS recommend that girls and boys should receive 2 doses of the HPV vaccine when they are between the ages of 9 and 12.²

In their qualifying statement, the ACS noted the presence of emerging evidence suggesting that series completion rates and vaccine acceptance tended to be higher when vaccination began as early as 9 instead of 11, which previous guidelines had recommended.

Parents also reported a greater sense of ease with administering vaccines early on, preferring to have fewer shots per visit. The ACS affirmed that the subsequent higher rates of completion and vaccine acceptance meant higher rates of cancer prevention, thereby increasing overall vaccine effectiveness.¹

Catch-up Vaccination

The newest guidelines emphasize that children and young adults up to age 26, who have not received the vaccine, should be vaccinated, since vaccination of young adults will not prevent as many cancers as vaccination of children and teens.²

The ACS qualified their statement by suggesting that providers inform individuals from the age range of 22-26 about the risk of lower efficacy. This updates the previous 2016 guidelines, which could not determine a harmonized age range between both men and women, and also reaffirms increased opportunity for college-aged individuals and those still under their parents’ household to gain access to vaccination.¹

Adult Vaccination

The ACS does not recommend that individuals older than 26 receive the HPV vaccination.²

Although the ACIP suggested that adults aged 27 to 45 years should receive the HPV vaccination, the ACS does not endorse this, due to the low effectiveness and low cancer prevention rate within this age group. The effectiveness of the HPV vaccine dramatically decreases by age 18 and minimal benefits are noted by age 20. The ACS also noted that although the vaccine is safe to receive for adults in the 27 to 45 age range, the benefits are severely limited.¹

Regarding the additional recommendation that the ACIP made about having shared clinical decision making for clinicians and adults, the ACS worries that such a discussion may interfere with efforts for vaccination at younger ages. Furthermore, the ACS noted that the recommendation may unintentionally suggest increased parental focus on their children’s future sexual behavior rather than on cancer prevention.¹

The HPV vaccination, since its 2006 unveiling, has successfully reduced the number of genital warts, recurrent respiratory papillomatosis, cervical precancers, and cervical cancers in the global population. Yet, lower rates of HPV vaccination in the United States have prompted a re-commitment to eliminating the disease as early as possible.

Combining HPV vaccination and cervical cancer screening could possibly prevent tens of thousands of cancer-related mortalities each year, the ACS concluded. Vaccination of adolescents ages 9 to 12 years will prevent almost 90% of cancers for which HPV is responsible. Given this, the ACS hopes that this will lead to the first elimination of a cancer in history.¹

References

1. Saslow D, Andrews KS, Manassaram-Baptiste D, Smith RA, Fontham ETH. Human papillomavirus vaccination 2020 guideline update: American Cancer Society guideline adaptation. CA: A Cancer Journal for Clinicians. July 8, 2020. Accessed July 8, 2020. https://doi.org/10.3322/caac.21616.
2. ACS Updates HPV Vaccination Recommendations to Start at Age 9. News Release. American Cancer Society; July 8, 2020. Accessed July 8, 2020. https://www.cancer.org/latest-news/acs-updates-hpv-vaccination-recommendations-to-start-at-age-9.html