TMC PULSE

t m c » p u l s e | m a r c h 2 0 1 6 9 recommendations by health care pro- viders, anti-vaccination sentiments and insurance gaps. These were then shared with all 69 centers in November 2015 to develop a collective strategy to address those challenges. The proliferation of misinformation and general lack of understanding of the HPV vaccine—such as the notion that it promotes sexual promiscuity, only needs to be taken by women and is not effective—are detrimental to building healthy communities, making it all the more pressing to raise public awareness and education on the importance of the vaccinations for everyone. Amid the heated debates and confu- sion, both Hawk and Lois Ramondetta, M.D., professor of gynecologic oncol- ogy and reproductive medicine, and chief of gynecologic oncology at Lyndon B. Johnson General Hospital and co-leader of MD Anderson's HPV- related Moon Shots program, said it's important to not only raise awareness and prevention education, but also to support the health care providers on the front lines of family care. "Most professionals know what to do, but they're hesitant to get into the conversation because of all these myths, as well as the fact that they feel a little bit isolated in advocating this," Hawk said. "That's one thing we could do: Help practitioners be more inten- tional in their advocacy of receiving the vaccine." While many pediatricians mandatorily provide pertussis and meningococcal vaccinations to children, HPV vaccines are not given the same priority. "It's really not a good idea to, as we say, 'put it in its special chair.' We need to be saying, 'You're due for the pertussis, your HPV and meningococ- cal. Which arm would you like it in?'" Ramondetta said, explaining that it is effective and there are no significant side effects of administering the HPV vaccine simultaneously with the others. "Patients come in with very advanced cervical cancers, and it really blows my mind that we are still seeing this in one of the biggest medical centers in the country," she said. "We shouldn't see any cervical cancer any- more. We are a totally developed nation, so we should be able to screen for it and get rid of it." Ramondetta added that vaccination rates in the U.S. "stink" compared to the rest of the world. Even on a global scale, the U.S. falls embarrassingly behind in HPV vaccination rates among women. While the U.S. came in at 39 percent, the United Kingdom showed 84 to 92 percent of its females received the HPV vaccine; Belgium and Portugal achieved 82 and 81 percent, respec- tively; and Australia 75 percent. But the country that exceeds all the others is Rwanda. Its campaign to vaccinate sixth grade girls in schools makes it the country with the highest vaccination rate at 93 percent. Matthew Anderson, M.D., Ph.D., assistant professor of obstetrics and gynecology at Baylor College of Medicine, said that although some women with HPV may not develop cervical cancer, there are still sev- eral million women in the U.S. every year who are identified with cervical dysplasia and require additional care, evaluation and interventions that could lead to problems conceiving or staying pregnant. The added time, expense and concern over the slew of potential problems from refusing a vaccination could be prevented. "You can bypass all that with a sim- ple vaccination. The current vaccines now allow for nine different subtypes of HPV that are linked to cancer and can be prevented," Anderson said. "It's highly effective, and it can reduce or eliminate the incidence of HPV-related cancers. From that perspective, there really should be no reason why we, as a society, should not be chasing after that to make that a goal." The joint effort is aligned with the U.S. Department of Health and Human Services' Healthy People 2020 goal, a nationwide public health campaign, and strives to raise vaccination rates to 80 percent in the next four years. "It's really exciting that we have so many people working together who are all equally passionate about this," Ramondetta said. "We want to play our role as a cancer institute to make sure people understand that we think HPV vaccination is important." We shouldn't see any cervical cancer anymore. We are a totally developed nation, so we should be able to screen for it and get rid of it. — LOIS RAMONDETTA, M.D. Professor of Gynecologic Oncology and Reproductive Medicine and Chief of Gynecologic Oncology at Lyndon B. Johnson General Hospital There's very little risk for all of the reward that comes from vaccination. — ERNEST HAWK, M.D. Head of the Division of OVP and Cancer Prevention and Population Sciences at The University of Texas MD Anderson Cancer Center

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