Lois Ramondetta, MD
FAKE NEWS, junk science, and alternative facts seem pervasive in our current culture, to the detriment of important, verified scientific advancements. One area where this is quite evident is the vaccine against human papillomavirus (HPV). Although we have had a safe, effective vaccine since 2006 that can protect against several cancers, vaccination rates in the United States remain low— just 63% of teenage girls and 50% of teenage boys have received at least 1 dose of the HPV vaccine1— thanks in part to the propagation of vaccine misinformation.
In other countries such as Ireland, Denmark, and Japan, various media outlets and social networking platforms have provided a virtual bullhorn to families needing someone or to blame for tragic and rare, but not causally related, medical events. The result of this bombardment is the heartbreaking potential for tens of thousands to lose their lives by rejecting an anticancer vaccination. In Japan, for example, HPV vaccination rates have dropped from 70% to 1% as a result of reporting these unfounded claims.2
Poignantly, on the heels of the global March for Science this past April, the Irish Minister for Health, Simon Harris, led his own rally in support of fact-based knowledge. In an address to the Irish Medical Organization, Mr. Harris said we should “come out fighting. Let’s take on the scaremongers. Let’s tell people … if you want to give medical advice on vaccinations, become a doctor. If not, get out of the way.”3
Protecting Children Against HPV-Related Cancers
HPV INFECTIONS have been associated with six different types of cancers in both men and women. Furthermore, we have evidence that the HPV vaccine, if given before exposure to any of the nine HPV subtypes, is 100% effective in preventing infection and downstream neoplastic effects in those tissues we are able to biopsy.
For full protection, current recommendations from the Centers for Disease Control and Prevention require a series of 2 doses of the vaccine for children under 15 years old and 3 doses for adolescents between the ages of 15 and 26.4 However, as stated earlier, just 63% of teenage girls and 50% of teenage boys in the United States receive even 1 dose, leaving many at risk for these cancers.
Combating Myths and Fears
UNDERSTANDABLY, PARENTS are concerned about the safety of vaccines given to their children. Unfortunately, vaccine opponents and even political figures have stoked fear in parents about the HPV vaccine by citing results from disproven studies and propagating false safety claims, discouraging parents from having their children vaccinated. The belief that vaccination is unnecessary because their children are not sexually active is another reason parents refuse to vaccinate their children.
We can help debunk the false myths and claims about vaccines through our scientifically based method for affirming their safety. The Vaccine Adverse Event Reporting System collects and analyzes reports on adverse events following immunizations. However, the information in this system is raw data that do not establish causal connections between vaccines and adverse experiences. Events are studied and evaluated for coincidence or scientific evidence of vaccine association. Worldwide, 200 million doses of the HPV vaccine have been evaluated by the Vaccine Adverse Event Reporting System, the U.S. Food and Drug Administration (FDA), the European Medicines Agency, and the World Health Organization, as well as many peer-reviewed publications.
If harmful associations are found, the vaccine is removed from distribution. The oral rotavirus vaccine, RotaShield, offers one of the best examples of how the safety process works. Within 9 months of FDA approval, the oral vaccine was linked to intussusception in 15 infants and quickly removed from public use.
The link between vaccines and autism has been extensively disproven, but junk science has had a dramatic impact on perpetuating this falsehood. Even with extensive scientific rejection of such tragic coincidences, scientific facts continue to be challenged at many levels. If our government does not fully support the use of the HPV vaccine, vaccination rates will continue to fall far below the U.S. Department of Health and Human Services Healthy People goal of 80% by 2020.5
Doing Our Part
WHAT IS the role of oncologists, cancer centers, and professional societies in combating this media stream of falsehoods? And more importantly, how should we engage the public to help increase vaccination rates and protect those most vulnerable against HPV-related cancers?
In 2016, ASCO published a statement6 supporting the vaccine, but is this enough? Is every member of ASCO working within his or her own community to increase vaccination rates through partnerships with state primary care professional societies? Are we all working within our own practices to alert and educate our patients, especially those who have been diagnosed with HPV-related cancers? Have we empowered our patients with HPV-related cancers to get involved in immunization efforts at the local, state, and national levels? Are our medical societies partnering with respected organizations, such as the American Cancer Society, Centers for Medicare & Medicaid Services, and American Academy of Pediatrics, to visibly combat misinformation?
We all have to do our part to prevent HPV-related cancers. Perhaps ASCO’s media outlets should not only distribute the latest study findings, but also actively counter false, contorted, and misrepresented science.
“While we need the collaboration of vaccine experts, patient advocates, primary care and pediatric specialties, and insurance providers to succeed in raising awareness of the benefits of the vaccine, oncologists need to do their part, too, and strongly support HPV vaccination, inform the uninformed, and speak out against misinformation.”— Lois M. Ramondetta, MD
For our voices to be effective, as individuals, institutions, and societies, we must work together with tenacity on both the local and national levels. Over the past 4 years, The University of Texas MD Anderson Cancer Center has made it a priority to become involved in local and national efforts to raise HPV vaccination rates and partner with others who share this objective.
In May 2017, we met with National Cancer Institute (NCI)-designated cancer centers for a fourth time to discuss efforts to raise HPV vaccination rates. As a result of prior summits, all 69 NCI-designated cancer centers have jointly published 2 statements in support of HPV vaccination. We have also served as subject-matter experts for HPV vaccination and cancer prevention to Texas legislators considering measures that will affect the medical care of our communities.
The road has not been easy, however. We continue to receive incessant, personal backlash, particularly from efforts to educate the public through social media awareness campaigns.
AS ONCOLOGISTS, we are also stronger working together. Recognizing the association between HPV and multiple cancers, MD Anderson leaders saw an opportunity to bring together researchers from a variety of specialties to help prevent HPV-related cancers and improve outcomes for patients. To end the historic tendency to work in tumor-based silos, the cancer center launched the HPV-Related Cancer Moon Shot. In this effort, the Moon Shot team—consisting of specialists from gastrointestinal, gynecologic, head and neck, and genitourinary oncology—works side by side with platforms in prevention, genomic medicine, and government relations to produce real opportunities and outcomes to prevent, screen, and eradicate HPV-related cancers.
Our primary prevention efforts involve an oncology-based focus on systems to remove barriers and educate providers on the importance of cancer prevention through vaccination. This requires partnerships among oncologists, pediatricians, and family medicine specialists. Furthermore, by engaging our patients, we have the opportunity to build an army of empowered and educated survivors who can potentially influence public opinion.
We held our first two HPV Cancer Survivor Workshops in February and August of this year and plan to continue educating survivors as part of our effort. We believe every cancer hospital, medical school, and medical institution has the same opportunity to convene these multidisciplinary teams to improve vaccination rates and prevent HPV-related cancers. Every tool is already available; only the champions need be identified.
Making Your Voices Heard
HPV VACCINATION rates in the United States remain inadequate, and there is a real risk they will worsen if misinformation is allowed to disseminate throughout the country—perpetuated not only by individuals, but by our government as well. Japan and Ireland are already experiencing the disaster of low vaccination rates and have to fight to regain the public’s trust in what should be a no-brainer.
While we need the collaboration of vaccine experts, patient advocates, primary care and pediatric specialists, and insurance providers to succeed in raising awareness of the benefits of the vaccine, oncologists need to do their part, too, and strongly support HPV vaccination, inform the uninformed, and speak out against misinformation.
DISCLOSURE: Dr. Ramondetta reported no conflicts of interest.
1. Centers for Disease Control and Prevention: HPV vaccination coverage data. Available at www.cdc.gov/hpv/hcp/vacc-coverage.html. Accessed August 1, 2017.
2. Nelson R: HPV vaccination controversy in Japan, rates plummet to 1%. Medscape. July 20, 2016. Available at www.medscape.com/viewarticle/866405. Accessed August 1, 2017.
3. O’Regan E: ‘Scaremongering’ over HPV vaccine puts lives at risk: Harris. Sunday Independent (Ireland). April 23, 2017. Available at www.independent. ie/irish-news/health/scaremongering-over-hpv-vaccine-puts-lives-at-risk-harris-35645734.html. Accessed August 1, 2017.
4. Centers for Disease Control and Prevention: CDC recommends only two HPV shots for younger adolescents. Available at www.cdc.gov/media/releases/2016/p1020-hpv-shots.html. Accessed August 1, 2017.
5. Office of Disease Prevention and Health Promotion: Healthy People 2020: Immunization and infectious diseases. Available at www.healthypeople. gov/2020/topics-objectives/topic/immunization-and-infectious-diseases/objectives. Accessed August 1, 2017.
6. Bailey HH, Chuang LT, duPont NC, et al: American Society of Clinical Oncology Statement: Human papillomavirus vaccination for cancer prevention. J Clin Oncol 34:1803-1812, 2016.
Acknowledgment: This column was written in partnership with my colleagues at The University of Texas MD Anderson Cancer Center, including Cathy Eng, MD, Professor in the Department of Gastrointestinal Medical Oncology; Curtis A. Pettaway, MD, Professor in the Department of Urology; Erich Sturgis, MD, Professor in the Department of Head and Neck Surgery; Kathleen M. Schmeler, MD, Associate Professor in the Department of Gynecologic Oncology and Reproductive Medicine; and Behrouz Zand, MD, MS, Assistant Professor in the Department of Gynecologic Oncology and Reproductive Medicine. I also would like to acknowledge Sherri Patterson for her contribution in the preparation of this column.
For additional information, please contact HPVMoonShotTeam@mdanderson.org.