Lois Ramondetta, MD
According to the Centers for Disease Control and Prevention (CDC), incidence rates of HPV-associated cancers continue to rise, with approximately 39,000 new HPV-associated cancers now diagnosed each year in the United States. Although HPV vaccines can prevent the majority of these cancers, vaccination rates remain low.
In response to this, The University of Texas MD Anderson Cancer Center has united with the 68 other National Cancer Institute (NCI)–designated cancer centers in issuing a joint statement that endorses the recently revised vaccination recommendations from the CDC.
The updated guidelines recommend that 11- to 12-year-old boys and girls receive 2 doses of the 9-valent HPV vaccine at least 6 months apart. Adolescents and young adults 15 and older are recommended to continue to complete the 3-dose series.
In an interview with OncLive
, Lois Ramondetta, MD, professor of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, discusses the updated recommendations and the importance of advocating for lesser-known HPV-associated cancers.
OncLive: Please begin by summarizing these updated recommendations.
: The Advisory Committee on Immunization Practices voted on this in the early fall, and the Morbidity and Mortality Weekly Report came out in December, and it reported that kids who get the series started before age 15 only need 2 doses to have the same effectiveness as someone older than 15 who gets all 3 doses.
So now, the rule is that you can start as early as age 9 and, again, still as late as age 26 to have it covered by your insurance company, but if you start it even a day before your 15th birthday, you only need 2 shots, and the difference for the 2 shots is that they might be separated by a minimum of 5 months. We recommend 6 months between the first 2 shots, but you could do it even a year apart; perhaps get your first shot at age 10, and the next shot at age 11.
What are your thoughts on these updates?
I am a gynecologic oncologist, and I work for MD Anderson Cancer Center, but I also work at the Harris Health System, which is a system that takes care of under-insured, sometimes uninsured, individuals, and what I see on a weekly basis are patients with advanced cervical cancer. To me, that’s my sole motivation. It’s terrible to be diagnosed with cancer, but add to that, that it could have been prevented with a shot, by screening, or Pap smears, or you could have even detected it early and then gotten rid of it, and had the patient have essentially a 100% survival rate. I’m seeing ladies come in with very large cancers, and they are losing their lives, or at least a significant quality of life. It’s appalling and sad that it’s happening everywhere in the world, but it definitely should not be happening in a developed country where we have access to everything we need to eradicate this.
On top of that, I’ve been fighting this fight for such a long time, and what we found over the last 10 years is that, the most quickly rising cancer associated with HPV is that of oropharynx cancer, and specifically, the tonsils and back of the tongue. The people who are being diagnosed are men between the ages of 55 and 65. The interesting thing about that is that these are usually insured men, and it’s not necessarily associated as much with smoking and drinking.
Fortunately, there are men out there who are raising awareness about HPV-related disease, and we’re really appreciative of that, because we haven’t been able to get the attention that we wanted. You can imagine talking to a bunch of legislators about uninsured women versus men in that specific age group; that makes their ears go up a little more.
We also know that HPV causes about 90% of anal cancers. All of these issues are things that are helping to raise awareness.
For my involvement in this, I felt like I had something to offer pediatricians and the family practice doctors by saying, “This is happening. This is not something that only happens to a particular type of person. This is something that 80% of the world will be exposed to at some point in life. We need you to pay attention, we need you to vaccinate, and it’s your job in standard of care to vaccinate and eliminate this disease.”
Do you think there’s a widespread lack of awareness about the associations between diseases like anal cancer or oropharynx cancer and HPV?
Yes, I do. I think people have only associated HPV with cervical cancer, and perhaps the marketing of the vaccine is partly to blame.