Carolann Risley MSN WHNP Kim Geisinger MD University of Mississippi Medical center Purpose Describe the number of women under 21 who were diagnosed with premalignant cervical cancer and correlate their history of vaccination ID: 779338
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Slide1
Premalignant Cervical Disease and Delayed HPV Vaccination
Carolann Risley, MSN, WHNP, Kim Geisinger, MD
University of Mississippi Medical center
Slide2Purpose
Describe the number of women under 21 who were diagnosed with premalignant cervical cancer and correlate their history of vaccination.
Slide3What is the Problem?
HPV causes cancer.HPV vaccination is grossly underutilized.
Mississippi
- highest rate of cervical cancer deaths.
Lowest
rate of HPV Vaccination.
BUT – MS has
highest
vaccination rates for all other vaccines.
Slide4Slide5Lack of provider recommendation is reported as the most likely cause of the low uptake of the vaccine.
Center for Disease Control and Prevention
Slide6Slide7Pap smear screening decreased
Consensus guidelines
–
2012 American Cancer Society, pathology organizations ASCCP
ACOG – American College of Obstetrics and Gynecologists
US Preventative Task Force
HPV disease typically grows slowly 5-10 years
HPV genotype prevalence younger - clear
Slide8When to start screening Paps – Age?
U.S. Preventive Services Task Force (USPSTF) Age 21.
Recommend against screening women aged under 21.
“A” recommendation
American College of Obstetricians and Gynecologists (ACOG)
Age 21
Regardless of the age of onset of sexual activity.
“A” recommendation
Slide9Who, Where, When – Sample N=179
Retrospective Analysis – 15,201 recordsWho
- Females age 14 – 20
Where
– USA, Mississippi State Health Department
When
– Between 2011-2014 – 4 years
What
– High grade Pap Test Results – Moderate, Severe
Why
– vaccinated or not?
Slide10Data Analysis
Total paps – 15,508 done (14 – 20 YOA)
Total abnormal high grade paps – 179 – 1%
F/U Biopsy done
Total biopsy done w results – 110 – 62% High grade
From 110 bx = 62% potential to progress to cancer.
Slide11Age at Abnormal Pap Smear
Slide12Sample with HPV vaccine
No HPV 0 Dose – 58.7%
HPV
1 Dose – 28.5%
Slide13Sample - HPV Shot vs No HPV Shot
Frequency Percent
Yes Had HPV 1 shot
51 28.5
No HPV shot given
105 58.7
No record
23 12.8
Total 179
100.0 100.0
Slide14HPV vaccination given late vs early
Using the current CDC guidelines HPV vaccinationage recommended HPV 9-12 years old,
Only
1 of the 179
females in sample were vaccinated between 9-12
Mean age – 16 shot given
Slide15Age at HPV Shot 1
Slide16Take Home Point – Too late
Mean age at 1st HPV shot – 16,
potential already exposed to virus
Lower immune response
Only 1 out of 179 females with premalignant cervical cancer received the HPV shot at recommended age 12
Slide17Other significance in this data
Race and abnormal pap smears and biopsy Even though White to Black had even number of abn paps the degree of biopsy severity – higher in black. – Disparity
Mortality 2014 Blacks 3x more likely Whites ICC
Slide18Slide19Pearson
chi square =
Black Females were significantly more likely to receive the HPV vaccine than White Females.
Vaccine Hesitancy?
12.166
df = 2
p = 0.002
Slide20Missed Opportunities prior to Disease Onset
37 prior vaccine visits
T dap
53 Doses
Meningococcal
32 Doses
Varicella
38 Doses
Slide21Software / Clinic prompts
MIIX State Data base – immunizations
DOES NOT have HPV listed in the Vaccination View that prompts the nurse to offer the vaccine,
For example, Tdap, Hep B, etc. All listed
The RN must manually input HPV on this table in this sample.
Slide22Clinical questions – Future implications?
1. Should we adjust screening guidelines for females if they have not been vaccinated at age 9-12
2. Data shows increase in abnormal high grade paps at age 17
3. Should we adjust screening guidelines for race ?
4. P U S H HPV Vaccination
Slide23Slide24Slide25Joke
Q: What's the best kind of cancer? A: The one you don't get.
#HPV vaccine is #cancer prevention! #2shots2stopCancer
Slide26END OF Slides
Remaining slides for my information.
Slide27Consensus Guidelines based
Clinical Trial - ATHENA Trial and ALTs TrialClinical trials – science sound, but stats debated, can we generalize to our population.
Genomics – generalize to the individual and that individual cohort.
Age – “Cervical Cancer rare in adolescents and young women” –Schiffman, M, Castle,P. 2007. Lancet HPV and Cervical Cancer
Slide28Persistent HPV high-grade Causes Cancer
Concern lasts more than 6 monthsCauses action in clinical world
Slide29Question
Did anyone in the most severe cin3 or cis have hpv vaccine?