Fighting HPV by learning to talk about the disease

When asked why she’s so passionate about preventing the spread of HPV, Lois Ramondetta, M.D., is quick to answer.

“Cancers are horrible, no matter what type or how a person gets them. But nothing is more upsetting than seeing a cancer that’s completely preventable.”

Unfortunately, stopping the most common sexually transmitted infection — one that almost all sexually active men and women will get at some time in their lives — will take more time.

That’s OK. Passion projects aren’t completed overnight. The professor of Gynecologic Oncology and Reproductive Medicine has devoted herself to raising awareness of — and accessibility to — the vaccine that blocks transmission of the human papillomavirus (HPV).

To be effective, three doses of the vaccine are administered over a six-month period. After the first shot, a second is required one or two months later. After the second shot, a third is required four to five months later.

The more than 40 strains of HPV are divided into two categories: those that cause cervical and other forms of cancer, and those that cause genital warts.

Two strains — HPV 16 and 18 — cause the majority of cervical cancer cases, as well as most anal cancers and a large share of vaginal, vulvar and penile cancers. The strains can also cause cancers in the back of the throat, in an area known as the oropharynx. These are called oropharyngeal cancers.

“To develop maximum immunity, it’s important to receive all three doses,” Ramondetta stresses.

As of 2013, nearly 38% of girls in the United States between the ages of 13 and 17 received all three doses of the vaccine. Only 14% of boys aged 13-17 received all three.

By comparison, the vaccination rates for 13- to 17-year-olds in 2013 were 77.8% for the meningococcal conjugate vaccine and 86% for Tdap (the tetanus, diphtheria and pertussis vaccine).

“Our goal for the HPV vaccine is to more closely match the vaccination rates seen for Tdap and meningococcal,” says Ramondetta. “We’re shooting for 80%, at least, by 2020. We’re not aiming low.”

A major obstacle to higher HPV vaccination rates is communication. Specifically, Ramondetta points out the need for better communication between providers such as pediatricians and family practitioners and patients. Because this is a sexually transmitted infection, some doctors and parents can find it an awkward subject to address.

“The biggest barrier is hesitancy on the part of providers to talk to patients and their parents about the vaccine.”

Ramondetta cites a Centers for Disease Control and Prevention study that shows physicians overestimate parents’ hesitancy regarding the vaccine and, therefore, become more hesitant themselves, which results in missed opportunities to vaccinate kids at the recommended ages of 11 and 12.

“The key point with adolescents is, a lot of times, they only come to the doctor to get Tdap and meningococcal vaccines before entering sixth grade,” Ramondetta says. “If providers hesitate, they miss the opportunity. You don’t get theses multiple-visit opportunities you get with elementary-school age and younger children.”

To help improve the communication skills and knowledge of providers, and discuss the implementation of evidence-based best practices for HPV-associated disease prevention and treatment, the HPV Pilot Moon Shot is taking part in MD Anderson’s 2015 Summit on HPV-related Diseases on June 18. The summit will focus on providers such as nurse practitioners, physician assistants, family practitioners and pediatricians, school nurses and principals and community advocates to present facts about HPV, safety and efficacy of the vaccine, and the poor rates of vaccination.

The pilot moon shot is part of MD Anderson’s Moon Shots Program, a bold plan to quickly improve survival rates for many of the deadliest cancers.

Ronda Wendler contributed to this report.