CDC Expands Age Range for Human Papillomavirus Vaccine

July 25, 2019

The Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) recently expanded its HPV vaccination age range recommendations. These expansions include catch-up vaccinations for persons through age 26 who are not adequately vaccinated, and recommended vaccination based on shared clinical decision making for individuals ages 27 through 45 years who are not adequately vaccinated.

This expansion follows the Food and Drug Administration’s (FDA) approval of a supplemental application for HPV vaccination—expanding the approved use to include women and men aged 27 through 45 years. The ACIP did not mirror the FDA’s decision and instead recommended vaccination based on shared clinical decision for these individuals.

ASCO broadly endorsed the CDC’s recommendations for the vaccine in its “Human Papillomavirus Vaccination for Cancer Prevention” statement.  ASCO is pleased that ACIP has expanded the age range to 26. While ASCO recognizes that it would not be appropriate to make a population-level recommendation for those age 27-45, the Society is concerned that the recommendation for shared decision making in this age range could impact coverage and may inadvertently increase disparities for those who cannot self-pay for the vaccine and are still at high risk of contracting HPV.

Based on CDC data from 2011 to 2015, about 42,700 HPV-associated cancers occurred annually in the United States (24,400 among women, and 18,300 among men). Cervical cancer is the most common HPV-associated cancer among women, and oropharyngeal cancers are the most common among men. Overall, HPV is thought to be responsible for more than 90% of anal and cervical cancers, about 70% of vaginal and vulvar cancers, and more than 60% of penile cancers

As a part of ASCO’s commitment to promoting prevention science and integrating evidence-based prevention strategies into oncology practice, the society has expanded its efforts in recent years to increase provider and public awareness of the HPV vaccination as a key cancer prevention measure.  Through various statements, campaigns, and materials, ASCO has helped to promote education and training in HPV prevention and control.

ASCO Statement

In an April 2016 statement, “Human Papillomavirus Vaccination for Cancer Prevention,” ASCO addressed the low HPV vaccination rates in the United States and urged aggressive efforts to increase vaccination and prevent cancer. Through this statement and accompanying recommendations, ASCO aimed to increase awareness of the tremendous global impact of HPV-caused cancers, refocus the discussion of HPV vaccination on its likely ability to prevent millions of cancer deaths, and increase HPV vaccination uptake via greater involvement of oncology professionals in ensuring accurate public discourse about HPV vaccination. The statement also called for the implementation of concrete strategies to address barriers to vaccine access and acceptance.

ASCO Resource-Stratified Guideline

In 2017, ASCO issued a Resource-Stratified Guideline on the primary prevention of cervical cancer globally. As part of this effort, ASCO convened a multidisciplinary, multinational panel of oncology, obstetrics/gynecology, public health, cancer control, epidemiology/biostatistics, health economics, behavioral/implementation science, and patient advocacy experts as part of a formal consensus process. The guideline recommended that in all resource settings, two doses of HPV vaccine are recommended for girls age 9 to 14 years, with an interval of at least 6 months and possibly up to 12 to 15 months. This guideline was also supported as an educational tool by the American College of Obstetricians and Gynecologists.

Endorsement of National Cancer Institute Statement

In 2018, ASCO officially endorsed a statement by the 70 National Cancer Institute (NCI)-designated cancer centers calling for increased HPV vaccination and screening to eliminate human papillomavirus (HPV)-related cancers. The full uptake of the vaccine and screening could prevent 12,000 cervical cancers and nearly 40,000 other HPV-related cancers (oropharyngeal, anal, penile, vulvar, and vaginal cancers) among men and women annually in the United States.

International HPV Awareness Day

March 4 is International HPV Awareness Day, which aims to promote education about HPV, raise awareness about prevention methods, and encourage governments and individuals to take advantage of the HPV vaccine and screening for cancer. ASCO has been a supporter of the important initiative for the past two years.

Patient Resources

As ASCO’s Cancer.Net has a variety of resources focused on HPV and cancer, including information on the disease and how it spreads, prevention, and disease management. Since many people may only think about HPV being related to cervical cancer, Cancer.Net created an infographic to explain the effects of HPV and the importance of vaccination for both girls and boys.

Watch a video about ASCO’s recommendations for reducing the global burden of cervical cancer.