Racial Correlates and the HPV Vaccination
By: Sereena Jivraj, Mansi Rana, Ameya Menta, Eimaan Anwar of the MOTHER Lab
Vaccination is by far the most essential thing we can do to protect ourselves from disease, and it is especially crucial when it comes to the human papillomavirus (HPV). HPV is widespread, and according to the Centers for Disease Control and Prevention, “more than 42 million Americans are infected with disease-causing HPV strains, and around 13 million Americans, including teenagers, are infected each year”.1 HPV infections are present in a variety of forms including cervical cancer and precancers, oropharyngeal cancer, and other anogenital cancers, but HPV is best recognized for causing cervical cancer. HPV is the most prevalent sexually transmitted disease in the United States, and current vaccinations are advised to be administered beginning at the age of 11, or before sexual activity begins. Despite the fact that HPV-related cancer rates are expected to decline in the United States, inequalities in vaccination rates across race and ethnicity are predicted to persist.
One of the important ethical questions surrounding the HPV vaccination is why immunization rates vary based on race and socioeconomic status. Healthcare providers seek to attain a high HPV vaccine rate in patients in their early teenage years because it provides the best protection against HPV prior to exposure through any sexual activities. The current HPV vaccination is given in three doses and is recommended for both males and females starting at the age of 11 to 12. Because “young, Black women have a higher prevalence of HPV,”3 it’s important to address this correlation between immunization rates and race. An infection with HPV has the potential to impact future pregnancies in these women, as cancer treatments not only impact fertility, but pregnancy after a trachelectomy (surgical removal of the cervix) leads to a higher risk of obstetrical complications including preterm birth, premature rupture of membranes, and abnormal bleeding.4
HPV infections are more common in Black women than those in other racial and ethnic groups, emphasizing the significance of early HPV immunization for Black children.4 To enhance the health of Black women, we need to intensify HPV prevention and education initiatives. Specifically, providers should receive education on these stark differences in vaccination rates, and subsequently make efforts to educate parents of all races and encourage HPV vaccinations amongst all children. Further, even with the overwhelming benefits of the HPV vaccination, immunization rates continue to fall along socioeconomic lines.2 “Progressively higher SES was positively associated with higher rates of vaccination initiation and completion. In this observed difference, completion of the HPV vaccine varied more than initiation”.2 The barriers to health care are always shockingly present, but primarily exist with multiple-dose vaccines. For completion of the HPV vaccine series, healthcare providers should remind patients and parents at each subsequent visit and establish policies that encourage medical staff to follow up with parents, reminding them of their child’s next dose date. Considering the barriers to transportation and the inability to take time off work, those in a lower socioeconomic bracket are at a disproportionate disadvantage.2 By communicating with patients and guardians, providers can determine how to best meet the needs of these patients and connect with other allied providers such as social workers to arrange solutions to address transportation barriers.
Furthermore, it’s important to understand that Black women have a higher incidence of HPV-related cancers.3 Despite the fact that the incidence of cervical cancer in Black women has decreased in recent years, higher rates continue to persist and “young Black women were found to have significantly longer persistence of high-risk HPV types when compared to young white women.”3 In the United States, Black women account for 25% of cervical cancer cases. In contrast, Caucasian women account for only 18%.3 These inequalities illustrate how racial and ethnic disparities in healthcare persist to this day.
When considering women who have been diagnosed with cervical cancer while pregnant, there is data to support that many of them were in their early stages of the illness.5 If an individual is more than three months pregnant, their physician will likely encourage them to continue with the pregnancy, but the baby is at a higher risk for preterm delivery via cesarean section, further increasing risk for mortality in both the mother and baby.5 Additionally, because of the HPV presence, it’s possible that following delivery, the mother will undergo a hysterectomy along with subsequent chemotherapy and radiation to address the underlying cervical cancer.5 Thus, not only do these women face higher mortality rates, but they also face higher odds of requiring hysterectomies, which prevent them from becoming pregnant in the future.
To increase HPV vaccination rates amongst women of color and prevent these pregnancy-related complications, we as a healthcare community must commit to providing education on how the HPV vaccine works and introduce the vaccine as a social norm. The first step is to encourage Black parents to get their children vaccinated, and one of the most effective methods to do so is to highlight the importance of vaccination and its role against cervical cancer. One of the most successful strategies to raise the percentage of the target population that receives the HPV vaccination is to connect with parents and family members regularly to remind them to get the vaccine and encourage communication around any reservations against the vaccine.