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Sunday, March 17, 2019

Study Shows HPV-Related Cancer Incidence Rates, Not Traditional Disparities, Affect Alabama’s HPV Vaccine Uptake

HONOLULU—A study presented at the Society of Gynecologic Oncology's 50th Annual Meeting on Women's Cancer shows that human papillomavirus (HPV) vaccination rates in Alabama are highest in counties with high incidence rates of HPV-related cancer (Abstract 13).

"The higher the rate of cancer in the county, the higher the rate of vaccination," said presenter Jennifer Young Pierce, MD, MPH, USA Health Mitchell Cancer Institute.

The study aimed to discover reasons behind the wide variance of HPV vaccination rates throughout Alabama, where the cervical cancer incidence rate is higher than the U.S. rate and county vaccination rates range from 33 percent to 66 percent.

"It's really impossible to generalize across the state that we are or are not doing well," said Pierce. "We drilled down the data to the county level to see what's associated with this."

Of Alabama's 67 counties, 32 are considered rural and 40 suffer from poverty levels below the state average. The study's authors expected to see lower HPV vaccine uptake in Alabama's rural counties, which would be consistent with CDC reports. Instead, the data showed little difference in HPV vaccine uptake between metro and rural areas or affluent and impoverished counties. The seven counties with the highest HPV vaccine uptake, in fact, were all rural areas with above average poverty rates.

"It was exactly the opposite of what we expected," said Pierce. "In the rest of the country, there's an urban/rural disparity, an 11-point difference between rural and urban vaccine uptake, and we do not see that in Alabama. If you take all the rural counties and all the urban counties, it's more even."

The study yielded other unpredicted results: a strong link between higher HPV vaccine uptake among residents receiving government-funded healthcare, and the highest HPV vaccine rates in some of the 23 counties without a single pediatrician.

The main takeaway from the study, said Pierce, is that perception of high cancer risk overcomes traditional disparities (income level, location, type of healthcare insurance) that can affect HPV vaccine uptake.

The HPV vaccine protects against several types of cancer in both males and females, including cervical, vulvar, vaginal, penile, anal, and head and neck. U.S. vaccination rates lag behind other countries.