Vaccination against human papillomavirus is deemed crucial for protection against certain cancers, but some parents choose not to get their child vaccinated against the virus. Now, a new study suggests the decision to avoid vaccination may largely be down to discouragement from doctors.
Study author Melissa B. Gilkey, PhD, of Harvard Medical School and Harvard Pilgrim Health Care Institute in Boston, MA, and colleagues publish their findings in the journal Cancer Epidemiology, Biomarkers & Prevention.
Human papillomavirus (HPV) is a group of over 150 viruses, of which more than 40 can infect the genital areas of men and women. These include HPV types 16 and 18, which are responsible for 70% of cervical cancer cases worldwide and can also cause anal, penile and some oropharyngeal cancers.
According to the Centers for Disease Control and Prevention (CDC), HPV is the most common sexually transmitted infection in the US, affecting around 14 million people in the country every year, including teenagers.
It is recommended that girls and boys receive the full three-dose series of the HPV vaccine at the age of 11 or 12 in order to protect against cancers related to the virus. However, a report from the CDC earlier this year found that 4 in 10 teenage girls and 6 in 10 teenage boys in the US have yet to start the recommended HPV vaccine series.
Gilroy and colleagues note that previous research has indicated that doctors' recommendations are the primary influence on whether parents decide to get their children vaccinated against HPV.
For their study, the team decided to investigate how doctors communicate HPV vaccination to parents, which they say could shed light on ways to increase vaccination coverage among adolescents.
27% of doctors do not strongly endorse HPV vaccination
In 2014, the team conducted a national online survey involving 776 pediatricians and family doctors in the US, of whom 68% were male and 55% had at least 20 years experience in practice.
The survey was created to measure five communication practices that are indicators of HPV vaccine recommendation quality.
- HPV is most commonly spread through vaginal or anal sex
- Most people who become infected with HPV are unaware they have it
- Each year, more than 27,000 people in the US are affected by a cancer caused by HPV - the equivalent to one new case every 20 minutes.
These included whether they offered timely recommendation of the vaccine for both boys and girls - that is, whether they recommended HPV vaccination by the age of 11 or 12 - whether their recommendations were consistent, whether they highlighted the importance of HPV vaccination and whether they offered same-day vaccination for adolescents.
Overall, the researchers found that around half of doctors reported at least two communication practices that could discourage parents from getting their children vaccinated against HPV.
The results of the survey revealed that 27% of the doctors reported that they do not strongly endorse HPV vaccination, while 26% of doctors said they do not offer timely HPV vaccine recommendations for girls, and 39% reported not offering timely recommendations for boys.
Rather than consistently offering HPV vaccination to all adolescents, 59% of doctors reported more frequent vaccine recommendations for teenagers who they deemed to be at higher risk of HPV infections.
Little more than half of doctors said they recommend same-day vaccination, with the remaining physicians reporting that they recommend vaccinations at a later date.
Overall, the researchers found that HPV vaccine recommendation quality was stronger among doctors who started conversations with parents by stating their child's vaccination was due, rather than just offering information about the vaccine or asking parents if they had questions about vaccination.
Lower HPV vaccine recommendation quality was identified among doctors who reported feeling uncomfortable about discussing sexually transmitted infections or who perceived parents to deem the vaccine as unimportant.
Findings highlight 'missed opportunities' to protect adolescents
According to Gilkey, these findings highlight "missed opportunities" to protect adolescents against HPV-related cancers. He adds:
"Helping providers communicate about the HPV vaccine effectively is a promising strategy for getting more adolescents vaccinated. Physicians have a lot of influence on whether adolescents receive the HPV vaccine.
Our findings suggest that physicians can improve their recommendations in three ways: by recommending HPV vaccination for all 11- to 12-year-olds and not just those who appear to be at risk; by saying the HPV vaccine is very important; and by suggesting vaccination on the day of the visit rather than at a later date."
The researchers admit there are some limitations to their study. For example, because the data was self-reported, doctors may have overestimated their HPV vaccine recommendation quality.
Earlier this year, Medical News Today reported on a study suggesting that just one dose of the HPV vaccine could be enough to protect most women against cervical cancer.