New Strategies for Cervical Cancer Prevention With HPV Vaccines

Catherine Herrman, MD

The human papillomavirus (HPV) vaccine has been shown to significantly reduce the incidence of cervical cancer by nearly 90%¹; however, only an estimated 60% of adult women have been vaccinated for HPV.² Researchers at NYU Langone, including Catherine Herrman, MD, investigated whether offering HPV vaccines at the time of abortion care could increase vaccination rates among women of reproductive age.

The quality improvement initiative was done at a clinic that offers abortion services. The researchers gave staff extra training about HPV and the vaccine. They also created a new system for talking to patients about the vaccine and getting them vaccinated. This system included prompts for doctors to talk to patients about the vaccine, making it easier for patients to get the vaccine during their clinic visit, and reminding patients to come back for the extra shots they need.

Before the new system was in place, about 24% of women who could have gotten the HPV vaccine were counseled, and about 7% started the vaccine series. After the new system was put in place, these numbers went up to 69% and 34%, respectively.³

The researchers also found that most of the women who got the vaccine were Hispanic or Latina and spoke Spanish as a first language.

The study shows that giving HPV vaccines in clinics that offer abortion services is a viable method to get more patients vaccinated for HPV, thus lowering cervical cancer risks for patients as they age.

In an interview with Targeted Oncology^TM, Herrman, second-year fellow at NYU Langone, discussed findings and implications from the study she presented at the 2024 Society of Gynecologic Oncology (SGO) Annual Meeting on Women’s Health.

Targeted Oncology: What was the rationale behind the study you presented at SGO?
Herrman: Despite a lot of data about how effective the HPV vaccine is at preventing cervical cancer, the vaccination rates in the United States are still quite low. Unfortunately, both HPV and cervical cancer are disproportionately affecting women who belong to groups that have been marginalized. To improve that vaccine uptake and help resolve these disparities, we felt like a creative solution was needed, which was why we thought of abortion care. It is common; 1 in 4 women get an abortion during the reproductive years, and it may help capture women earlier in the reproductive years when the vaccine is most likely to be beneficial.

What was the methodology for your analysis?

[We did a] quality improvement study. Before we initiated our workflow, we did a retrospective chart review in the preceding 6 months leading up to when we implemented the study workflow, just to capture our baseline counseling and vaccination rates. Then, we implemented the workflow for 31 weeks that incorporated 4 different tenets. The first was standardizing counseling. To do that, we embedded a standardized note template that everyone could use. We also did some in-person education with providers, and then also provided them with a handout on commonly asked patient questions to help with their counseling. We then also worked with our [post anesthesia care unit] and clinic nursing teams to help streamline same-day vaccinations for patients who were either getting a medical or surgical abortion. We also had a follow-up workflow that consisted of a tracking list that was embedded within the [electronic medical record]. Patients were scheduled by the nurse administering their current vaccine for their follow-up vaccine. We also did reminder texts or phone calls based on patient preference.

Can you discuss your findings?

Before we implemented the workflow, we had 265 patients who were eligible for vaccination in the 6 months leading up to the study. Only 20.3% of those patients were counseled on HPV vaccination. Of the eligible patients, only 6.8% went on to start the series. After we implemented this study, we had 300 patients who were eligible. During the 31 weeks that we had the study running, the counseling rate increased to 68.7%. Of the patients who are counseled, 63% accepted it. Among the patients who accepted it, 78.5% received at least 1 dose. Our overall rate of patients who were eligible who then received at least 1 dose of the vaccine went from 6.8% to 34%.

During the study period, our data on completing the vaccine series [are not] fully mature yet. We are still waiting on several [patients] to determine whether or not they have completed it. But we have had 41.4% of the 99 patients who were due for a subsequent dose come back to get at least 1 additional dose and we've had 13 patients who have completed the series.

Were there any patients subgroups where this initiative appeared particularly effective?

We did not do any sort of subgroup analysis, but I will say that our cohort was quite diverse. We naturally sort of had a breakdown of what some people might consider subgroups in other studies. Our median age was 30. The most common language among the patients who were vaccinated with Spanish; that was 66% of patients. We had self-identified ethnicity data on 50 of the patients. The most common was Ecuadorian, that was at 41%. We also had Mexican at 12%, and Dominican at 8%. We had a very diverse group of patients.

What are the implications of these findings for patients and clinicians?

I think the conclusions we can draw from this is that it is feasible and effective to implement an HPV vaccine workflow into an abortion clinic. I think it speaks to the fact that abortion care is a huge opportunity to address vaccination gaps in reproductive-age patients. We know from the population that we implemented this in that it can be effective among patients who are very under resourced and those patients who are most at risk for cervical cancer disparities. I think it is a call to action for referral centers who are still performing abortions. The states that have implemented abortion bans tend to be the states that also have the lowest rates of HPV vaccination. As patients are coming from those states to get abortions, we now have the opportunity to address 2 disparities at once. I think that's a something that we need to be mindful of as providers.

REFERENCES:

1. Large study confirms that HPV vaccine prevents cervical cancer. News release. National Cancer Institute. October 14, 2020. Accessed March 29, 2024. https://tinyurl.com/yr7c5unj

2. HPV Vaccination. National Cancer Institute. Updated March 2024. Accessed March 29, 2024. https://tinyurl.com/u2hjd9ks

3. Herrman C, Lipkin P, Hunter A, et al. Gardasil at the time of abortion visit: a quality improvement initiative. Presented at: 2024 Society of Gynecologic Oncology Annual Meeting on Women’s Health. March 15-18, 2024. San Diego, CA.