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Overcoming the barriers to HPV vaccination in high-risk populations in the US

      Abstract

      Objectives

      To review populations of women in the United States at high risk for cervical cancer, assess known reasons for existing outcome disparities, and discuss potential strategies to reduce barriers to HPV vaccination and current strategies for cervical cancer prevention.

      Methods

      An expert forum conducted September 12–13, 2008, by the Society of Gynecologic Oncologists including 56 experts in cervical cancer and titled "Future strategies of cervical cancer prevention: what do we need to do now to prepare?"

      Results

      Although epidemiological data is useful and necessary to identify populations at high risk for cervical cancer, an understanding of the knowledge and attitudes regarding HPV and cervical cancer prevention of racial/ethnic groups and sub-groups within racial/ethnic categories is critical for the implementation of effective targeted and effective educational efforts. Inequities in cervical cancer screening, diagnosis and treatment and HPV vaccination may arise from a number of barriers including access to healthcare, cultural beliefs, and limited awareness of options.

      Conclusions

      Initiatives to promote uptake of prophylactic HPV vaccination that target high-risk women need to be implemented before existing disparities widen. Although acceptability of HPV vaccination is promising, uptake is still low among low-income populations and specific racial/ethnic minorities. To address limited vaccine uptake it may be beneficial to establish national/state guidelines as well as culturally relevant interventions at the individual and community levels. The successful implementation of multiple integrated initiatives on HPV awareness, knowledge, and vaccination will diminish existing disparities in cervical cancer incidence and mortality.

      Keywords

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      References

        • American Cancer Society
        Cancer Facts & Figures 2008.
        American Cancer Society, Atlanta, Georgia2009
        • Freeman H.
        • Wingrove B.
        Excess cervical cancer mortality: a marker for low access to health care in poor communities.
        in: Rockville, MD: National Cancer Institute, Center to Reduce Cancer Health Disparities. 2005 (NIH Pub. No. 05-5282)
        • Smith H.O.
        • Tiffany M.F.
        • Qualls C.R.
        • Key C.R.
        The rising incidence of adenocarcinoma relative to squamous cell carcinoma of the uterine cervix in the United States—a 24-year population-based study.
        Gynecol Oncol. Aug 2000; 78: 97-105
        • Smith J.S.
        Ethnic disparities in cervical cancer illness burden and subsequent care: a prospective view in managed care.
        Am J Manag Care. Jun 2008; 14: S193-S199
        • Kahn J.A.
        • Lan D.
        • Kahn R.S.
        Sociodemographic factors associated with high-risk human papillomavirus infection.
        Obstet Gynecol. Jul 2007; 110: 87-95
        • Howe H.L.
        • Wu X.
        • Ries L.A.
        • et al.
        Annual report to the nation on the status of cancer, 1975–2003, featuring cancer among U.S. Hispanic/Latino populations.
        Cancer. Oct 15 2006; 107: 1711-1742
        • Singh G.K.
        • Miller B.A.
        • Hankey B.F.
        • Edwards B.K.
        Persistent area socioeconomic disparities in U.S. incidence of cervical cancer, mortality, stage, and survival, 1975–2000.
        Cancer. Sep 1 2004; 101: 1051-1057
      1. Ries L. Melbert D. Krapcho M. Stinchcomb D.G. Howlander N. Horner M.J. SEER Cancer Statistics Review, 1975–2005, National Cancer Institute. Bethesda, MD, based on November 2007 SEER data submission, posted to the SEER web site, 2008. 2008 (http://seer.cancer.gov/csr/1975_2004/)
      2. US Census Bureau. US Population Projections. 2008; http://www.census.gov/population/www/projections/summarytables.html. Accessed January 22, 2009.

      3. CDC. DATA 2010. The Healthy People 2010 database.
        in: The Centers for Disease Control and Prevention. 2007 (http://wonder.cdc.gov/scripts/broker.exe. Accessed May 15, 2007)
        • Eggleston K.S.
        • Coker A.L.
        • Das I.P.
        • Cordray S.T.
        • Luchok K.J.
        Understanding barriers for adherence to follow-up care for abnormal pap tests.
        J Womens Health (Larchmt). Apr 2007; 16: 311-330
      4. Centers for Disease Control and Prevention.
        in: Health Risk Behaviors by Race/Ethnicity. National YRBS, 2007
        • Downs L.S.
        • Smith J.S.
        • Scarinci I.
        • Flowers L.
        • Parham G.
        The disparity of cervical cancer in diverse populations.
        Gynecol Oncol. May 2008; 109: S22-S30
        • Howell E.A.
        • Chen Y.T.
        • Concato J.
        Differences in cervical cancer mortality among black and white women.
        Obstet Gynecol. Oct 1999; 94: 509-515
        • Brookfield K.F.
        • Cheung M.C.
        • Lucci J.
        • Fleming L.E.
        • Koniaris L.G.
        Disparities in survival among women with invasive cervical cancer: a problem of access to care.
        Cancer. Jan 1 2009; 115: 166-178
        • Merrill R.M.
        • Merrill A.V.
        • Mayer L.S.
        Factors associated with no surgery or radiation therapy for invasive cervical cancer in Black and White women.
        Ethn Dis Spring–Summer. 2000; 10: 248-256
        • McCracken M.
        • Olsen M.
        • Chen M.S.
        • Jemal A.
        • Thun M.
        • Cokkinides V.
        • et al.
        Cancer incidence, mortality, and associated risk factors among Asian Americans of Chinese,Filipino, Vietnamese, Korean, and Japanese ethnicities.
        CA Cancer J Clin. 2007; 57: 190-205
        • Bates J.H.
        • Hofer B.M.
        • Parikh-Patel A.
        Cervical cancer incidence, mortality, and survival among Asian subgroups in California, 1990–2004.
        Cancer. Nov 15 2008; 113: 2955-2963
        • Seeff L.C.
        • McKenna M.T.
        Cervical cancer mortality among foreign-born women living in the United States, 1985 to 1996.
        Cancer Detect Prev. 2003; 27: 203-208
        • Garner E.I.
        Cervical cancer: disparities in screening, treatment, and survival.
        Cancer Epidemiol Biomarkers Prev. Mar 2003; 12: 242s-247s
        • Penchansky R.
        • Thomas J.W.
        The concept of access: definition and relationship to consumer satisfaction.
        Med Care. 1981; 19: 127-140
        • Scarinci I.C.
        • Slawson D.L.
        • Watson D.L.
        • Klesges R.C.
        • Murray D.M.
        Socioeconomic status, ethnicity, and health care access among young and healthy women.
        Ethn Dis. 2001; 11: 60-71
        • Sambamoorthi U.
        • McAlpine D.D.
        Racial, ethnic, socioeconomic, and access disparities in the use of preventive services among women.
        Prev Med. Nov 2003; 37: 475-484
        • Behbakht K.
        • Lynch A.
        • Teal S.
        • Degeest K.
        • Massad S.
        Social and cultural barriers to Papanicolaou test screening in an urban population.
        Obstet Gynecol. Dec 2004; 104: 1355-1361
        • Ponce N.A.
        • Chawla N.
        • Babey S.H.
        • et al.
        Is there a language divide in pap test use?.
        Med Care. Nov 2006; 44: 998-1004
        • Prislin R.
        • Sawyer M.H.
        • Nader P.R.
        • Goerlitz M.
        • De Guire M.
        • Ho S.
        Provider–staff discrepancies in reported immunization knowledge and practices.
        Prev Med. May 2002; 34: 554-561
        • Klug S.J.
        • Hukelmann M.
        • Blettner M.
        Knowledge about infection with human papillomavirus: a systematic review.
        Prev Med. Feb 2008; 46: 87-98
        • Tiro J.
        What do women in the U.S. know about human papillomavirus and cervical cancer?.
        Cancer Epidemiol Biomarkers Prev. 2007; 16 (288): 288-294
        • Constatine N.
        • Jerman P.
        Acceptance of human papillomarvirus vaccination among Californian parents of daughters: a representative statewide analysis.
        J Adolesc Health. 2007; 40: 108-115
        • Watts L.A.
        • Joseph N.
        • Wallace M.
        • et al.
        HPV vaccine: a comparison of attitudes and behavioral perspectives between Latino and non-Latino women.
        Gynecol Oncol. Mar 2009; 112: 577-582
        • Bair R.M.
        • Mays R.M.
        • Sturm L.A.
        • Zimet G.D.
        Acceptability of the human papillomavirus vaccine among Latina mothers.
        J Pediatr Adolesc Gynecol. Dec 2008; 21: 329-334
        • Fazekas K.I.
        • Brewer N.T.
        • Smith J.S.
        HPV vaccine acceptability in a rural Southern area.
        J Womens Health (Larchmt). May 2008; 17: 539-548
        • Scarinci I.C.
        • Garcés-Palacio I.C.
        • Partridge E.E.
        An examination of acceptability of HPV vaccination among African American women and Latina immigrants.
        J Womens Health (Larchmt). Oct 2007; 16: 1224-1233
        • Friedman A.L.
        • Shepeard H.
        Exploring the knowledge, attitudes, beliefs, and communication preferences of the general public regarding HPV: findings from CDC focus group research and implications for practice.
        Health Educ Behav. Jun 2007; 34: 471-485
      5. Centers for Medicare and Medicaid. PQTI Overview. 2008; http://www.cms.hhs.gov/pqri/. Accessed February 13, 2009.

        • Goff B.A.
        Quality measures in gynecologic cancers: what and when?.
        Gynecol Oncol. Jul 2008; 110: 3-4
        • Haber G.
        • Malow R.M.
        • Zimet G.D.
        The HPV vaccine mandate controversy.
        J Pediatr Adolesc Gynecol. Dec 2007; 20: 325-331
        • Breitkopf C.R.
        • Pearson H.C.
        • Breitkopf D.M.
        Poor knowledge regarding the Pap test among low-income women undergoing routine screening.
        Perspect Sex Reprod Health. Jun 2005; 37: 78-84