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Preface

The President's Cancer Panel (PCP, the Panel), established by the National Cancer Act of 1971 (P.L. 92-218), is charged with monitoring progress of the National Cancer Program and identifying barriers to its fullest and most rapid implementation. The Panel investigates topics of high importance to the National Cancer Program, collecting information through a series of meetings and additional information gathering. Findings and recommendations are compiled in reports to the President of the United States. While reports are to the President, they are also for a larger group of stakeholders, public and private, that comprise the National Cancer Program. Together, these organizations and others can make a positive difference in accelerating progress against cancer.

For its 2012-2013 series, the Panel chose to focus on human papillomavirus (HPV) vaccines, with the goal of catalyzing stakeholders to accelerate uptake of these effective but underused interventions to prevent cancers and other diseases and conditions caused by HPV. Such a significant opportunity to prevent cancers in the U.S. and around the world is rare. The Panel convened four workshops on HPV vaccination to gather information from many stakeholders in this area, including representatives from the public, academic, nongovernmental, and private sectors with expertise and responsibility in HPV-associated cancer research, vaccine-related public health policy, and vaccine program development and implementation. Three workshops focused on HPV vaccination in the United States. The fourth focused on issues related to global HPV vaccination. (See Appendix A for more information on the workshops.)

HPV-associated cancers are life-threatening, and the incidence of some is increasing in the United States and many other countries. Many of these cancers are preventable by HPV vaccines. The U.S. Advisory Committee on Immunization Practices (ACIP) recommends HPV vaccination for adolescents and young adults. This recommendation has been endorsed and/or echoed by the National Cancer Institute (NCI), the Centers for Disease Control and Prevention (CDC), and numerous U.S. medical professional societies and other organizations.* Increased uptake of HPV vaccines for females also is an objective of the U.S. Department of Health and Human Services Healthy People 2020 initiative.[1-6] The World Health Organization (WHO) recommends that HPV vaccines be integrated into national immunization programs whenever possible.[7] Panel members communicated with representatives of many of these organizations and were impressed by their commitment to increase uptake of HPV vaccines.

Despite strong recommendations from experts in the medical and public health fields, rates of U.S. HPV vaccination have fallen short of target levels. It will take concerted action by multiple individuals and organizations to increase HPV vaccine uptake. In this report, the Panel presents high-priority goals and objectives that stakeholders should embrace to increase uptake of HPV vaccines. In many cases, these recommendations call for implementation of strategies shown to be effective for increasing uptake of other vaccines.[8] The Panel's recommendations are consistent with those issued by the National Vaccine Advisory Committee (NVAC) for improving uptake of vaccines in general [9] and adolescent vaccines in particular.[10,11] The U.S. National Cancer Program, in aggregate, has a major opportunity to accelerate uptake of HPV vaccines in the United States and support their adoption around the world. The Panel believes that concerted action could create a tipping point that would lead to large increases in HPV vaccine uptake. The potential to prevent cervical and other cancers on a global scale is achievable.

Footnotes

* These include the American Academy of Family Physicians, American Academy of Pediatrics, American Cancer Society, American College of Obstetricians and Gynecologists, and Society for Adolescent Health and Medicine. See Appendix C for more information on HPV vaccine recommendations, endorsements, and goals.

WHO recommends that routine HPV vaccination be included in national immunization programs if: (1) prevention of cervical cancer and/or other HPV-related diseases is a public health priority,
(2) vaccine introduction is programmatically feasible, (3) sustainable financing can be secured, and
(4) cost-effectiveness of vaccination strategies is taken into account.

References

  1. American Academy of Family Physicians. Policies: immunizations [Internet]. Leawood (KS): AAFP; [cited 2013 Aug 20]. Available from: http://www.aafp.org/about/policies/all/immunizations.html
  2. American Cancer Society. American Cancer Society recommendations for human papillomavirus (HPV) vaccine use to prevent cervical cancer and pre-cancers [Internet]. Atlanta (GA): ACS; [updated 2013 Apr 10; cited 2013 Sep 10]. Available from: http://www.cancer.org/cancer/cancercauses/othercarcinogens/infectiousagents/hpv/acs-recommendations-for-hpv-vaccine-use
  3. ACOG Committee on Adolescent Health Care. Committee Opinion number 467: human papillomavirus vaccination. Obstet Gynecol. 2010 Sep;116:800-3. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20733476
  4. Friedman LS, Kahn J, Middleman AB, Rosenthal SL, Zimet GD. Human papillomavirus (HPV) vaccine: a position statement of the Society for Adolescent Medicine. J Adolesc Health. 2006;39(4):620. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16982407
  5. U.S. Department of Health and Human Services. 2020 topics and objectives: immunization and infectious diseases objectives [Internet]. Washington (DC): DHHS; [updated 2013 Apr 24; cited 2013 Jul 26]. Available from: http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=23
  6. AAP Committee on Infectious Diseases. HPV vaccine recommendations. Pediatrics. 2012;129(3):602-5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22371460
  7. World Health Organization. Human papillomavirus vaccines WHO position paper. Wkly Epidemiol Rec. 2009 Apr 10;84:117-32. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19360985
  8. Community Preventive Services Task Force. The guide to community preventive services. Increasing appropriate vaccination [Internet]. Atlanta (GA): the Task Force; [updated 2013 Aug 5; cited 2013 Sep 14]. Available from: http://www.thecommunityguide.org/vaccines/index.html
  9. U.S. Department of Health and Human Services. 2010 national vaccine plan: protecting the nation's health through immunization. Washington (DC): DHHS. Available from: http://www.hhs.gov/nvpo/vacc_plan/2010%20Plan/nationalvaccineplan.pdf
  10. Stokley S, Freed G, Curtis R, Gordon L, Humiston S, Parnell T, et al. Adolescent vaccination: recommendations from the National Vaccine Advisory Committee. Am J Prev Med. 2009;36(3):278-9.e6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19162432
  11. Lindley M, Orenstein W, Shen A, Rodewald L, Birkhead G. Assuring vaccination of children and adolescents without financial barriers: recommendations from the National Vaccine Advisory Committee (NVAC). Washington (DC): U.S. Department of Health and Human Services; 2009 Mar 2. Available from: http://www.hhs.gov/nvpo/nvac/nvacfwgreport.pdf