'It’s not just a girl problem': When offering HPV vaccine, doctors advised to focus on cancer prevention

In her children’s pediatrician’s office two years ago, Lockport mother Kelly DiFilippo declined the HPV vaccine for her oldest daughter, and “no one batted an eye,” she said.

But when it was time for her second daughter’s sixth-grade physical last winter, DiFilippo’s refusal of the vaccine was met with a different reaction from the same doctor.

“My pediatrician said, ‘I really want you to think about this,’” DiFilippo said. “She really kind of put the pressure on me.”

As HPV vaccination rates continue to lag behind other, less controversial immunizations, medical experts are urging pediatricians to stress the importance of the vaccine just as strongly as they do other shots and to tout the link to cancer prevention.

As part of the effort, the American Cancer Society is rolling out a public campaign this summer, pledging to eventually eradicate cancers related to HPV, a sexually transmitted disease, through use of the vaccine for adolescents, as well as screenings for adults who came of age before it became available in 2006.

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How doctors present the vaccine to patients — and their parents — is a key component of the campaign, said Debbie Saslow, senior director of HPV and women’s cancers at the American Cancer Society, which will supply materials and data to doctors to aid them in talking with patients about the vaccine and address common concerns, she said.

“If we can get all providers to recommend the HPV vaccine the same way they do other vaccines, that will be the biggest impact,” Saslow said.

“I don’t think there’s ever been an opportunity in history to eliminate a cancer” until now, she said. “That’s been a big rallying cry. This could be like polio.”

Although HPV vaccination rates have increased over the past decade, physicians and medical groups say they remain too low.

Just under half of girls age 13 to 17 and 37.5 percent of boys in the same age group were up to date on the HPV vaccine in 2016, according to the most recent data from the Centers for Disease Control. In Illinois, the numbers were slightly higher — about 53 percent of girls and about 43 percent of boys.

While parents initially were slow to consent to the vaccine, squeamish over thoughts of their preteens’ future sexual encounters and worried about promoting sexual promiscuity, experts say expanding the vaccination pool now lies with pediatricians and other health care providers.

The words they choose when presenting the vaccine can make a difference, said Dr. Robert Jacobson, professor of pediatrics at Mayo Clinic College of Medicine and Science.

Studies of patient-doctor interactions show “clinicians tend to make (the HPV vaccine) sound optional rather than give them a strong recommendation,” he said.

Even physicians who recommend the HPV vaccine often offer it separately from those required by schools, Jacobson added.

“What’s often heard is, ‘Well, your child is due for a Tdap and meningitis vaccine. What are your thoughts on (the flu shot) and the HPV vaccine?’” Jacobson said. “That kind of language … doesn’t sound like they’re routinely recommending all children have it. We’re sending the wrong message,” he said.

According to the CDC, the human papillomavirus is a sexually transmitted infection that “nearly every” sexually active, unvaccinated person will contract at some point in his or her life, yet some never show symptoms. Some strains cause genital warts, while others can lead to six cancers — throat, penile, anal, vaginal, vulva and cervical cancer.

The CDC recommends girls and boys age 11 or 12 receive the HPV vaccine — a course of two shots if you begin by age 15, and three shots for those starting the vaccine at ages 15 to 26. The earlier the vaccine is given, the more effective it is, doctors say.

When given at the recommended age, the HPV vaccine can prevent 90 percent of HPV-related cancers, according to the CDC. Saslow said the vaccine is about 97 percent effective in preventing those cancers, but protection decreases as age of vaccination increases.

The American Cancer Society’s campaign, called “Mission: HPV Cancer Free,” aims to shift thinking surrounding the vaccine toward cancer prevention, rather than just the HPV infection.

In addition to outreach to doctors, the organization will launch social media campaigns, inviting volunteers and cancer survivors to post that they chose to give their child the HPV vaccine to protect them from cancer, Saslow said. “That needs to be the message.”

Dr. Kathryn Edwards, professor of pediatrics at Vanderbilt University and member of the American Academy of Pediatrics committee on infectious diseases, said pediatricians have had to learn how to talk to parents of adolescents about vaccines.

“Pediatricians have been used to talking about infant vaccines … and do a really good job at that. It’s been a little more challenging with vaccines for adolescents,” she said. “We didn’t do a very good job at explaining what HPV was. The initial message wasn’t crafted in the best way. We’ve learned something from this.”

Dr. Faith Myers, the Lemont pediatrician who has treated DiFilippo’s children since birth, said that while she’s recommended the vaccine for years, she only recently started pushing back against parents who say no.

“I won’t force anyone … but I’m going to come back and talk to you about it later,” said Myers, who now makes sure not to single out the HPV vaccine when presenting it along with others that are required by schools. She said she also helps dispel myths and shares that she had her own children vaccinated, including her sons.

DiFilippo, a mother of four daughters, said that although none of her children has gotten the vaccine, she is now “on the fence.” She may bring her older daughters back for the vaccine and is still considering what she’ll do for her younger two.

Elmhurst pediatrician Dr. Don Seidman said fewer parents are worried about the vaccine promoting sexual promiscuity than before, but he hears uncertainty over giving the vaccine at an early age. And some parents still don’t realize boys are at risk for HPV-related cancers.

“It’s not just for women; that’s not really well appreciated,” he said.

Beth Major, a Hanover Park mother of four, chose to vaccinate her daughters but not her 15-year-old twin sons.

“I’m on the fence about the boys because I see a direct link to preventative care for the girls as far as cervical cancer,” she said. “For the boys, I’m not sure of the consequences of the HPV virus, of what it would actually prevent for them.”

“I’m looking to learn more, to ask more and more questions,” she added.

Dr. Erik Johnson, a Hoffman Estates pediatrician who treats the Major family, said he tries to point out to parents that boys are also at risk, particularly with throat cancers caused by HPV.

“It’s not just a girl problem,” he said.

While 60 to 70 percent of his patients get the HPV vaccine, Johnson said those parents who refuse it for their children still think of it as a relatively new vaccine, or they don’t understand why it’s given before most are sexually active.

Johnson said his approach is to start discussing the vaccine with parents when their child turns 10, so they have plenty of time to do their own research before the shot is offered the next year.

“My job is to help dispel medical myths, so come in with questions, and let’s go over them,” he said.

kthayer@chicagotribune.com

Twitter @knthayer

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