The human papillomavirus is responsible for a broad swath of cancer diagnoses annually, but Iowans have been slow to adopt vaccination recommendations — sitting well below a national goal of vaccinating 80 percent of 13- to- 15-year-olds by 2020.
Meanwhile, hard-to-treat cancers related to HPV — including cervix and oropharynx cancers — are on the rise, according to a 2019 Cancer in Iowa report issued Tuesday out of the University of Iowa-based State Health Registry of Iowa.
In the United States, HPV causes nearly 34,000 cases of cancer annually, according to the report. Iowa tracked about 450 cases of HPV-related cancer in men and women combined in 2015, the most recent data available, according to Mary Charlton, assistant professor of epidemiology in the UI College of Public Health.
HPV-related cancers are more common in women than men, although diagnoses are increasing in men, driven largely by oropharyngeal cancers — associated with the middle throat, like at the base of the tongue, in the tonsils or on the surface of the soft palate.
HPV is a group of viruses that includes more than 150 different high- and low-risk types, with high-risk types capable of causing cancer and inflammatory lesions. The new Cancer in Iowa report notes most sexually active men and women will be infected with HPV at some point in their lives, although most will never know.
Research in 2006 produced a vaccine capable of preventing 90 percent of HPV-related cancers every year, but its uptake has been slow nationally and in Iowa, according to the report.
Although HPV vaccination when given before initial exposure to the virus provides nearly 100 percent protection from nine of the virus’ variants — making it “highly effective” in preventing the types of HPV that can cause cancer — just 38 percent of Iowa adolescents ages 13 to 15 had the full recommended vaccine series in 2017, according to the new report.
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That is below the U.S. rate of 49 percent and well below a national and state goal of getting 80 percent of 13- to 15-year-olds fully vaccinated by 2020.
“It’s terribly inadequate,” George Weiner, professor and director of the UI Holden Comprehensive Cancer Center, told reporters after the report’s release Tuesday. “We have a vaccine here that can prevent future cancers. And only 38 percent of people are getting it.”
The HPV vaccination rate in Iowa is half the 76 percent of 13- to 15-year-olds who received the Tdap vaccine, protecting against tetanus, diphtheria and pertussis. In 2017, according to the report, more than half of Iowa’s counties reported HPV vaccination rates below the state’s already dismal average — including Johnson County, which reported a 35 percent vaccination rate despite being home to the University of Iowa and its hospitals and clinics.
Davis County in southern Iowa reported the lowest HPV vaccination rate at 16 percent, while Adair County southwest of Des Moines reported the highest at 64 percent. In addition to the 51 Iowa counties below the state average, 39 were either at or above the 38 percent average but still below 50 — meaning just nine counties reported more than half their targeted adolescents had received the vaccination, according to the report.
Part of the lag relates to stigma associated with the preventive measure, which initially was discussed as a vaccine for sexually transmitted diseases, according to Weiner.
“That’s some of the stigma that has come along — that by vaccinating young children, you’re assuming that they will be sexually active at a certain age,” he said. “But that’s not the reason at all. It’s a cancer prevention vaccine.”
In addition to researching prevention, detection and treatment of HPV-related cancers, Weiner said public health officials are investigating methods to improve public awareness and understanding. He and other state cancer experts said no one is discussing mandating the HPV vaccination to attend school — as is the case for other vaccines.
“But it would definitely save lives if it were required for school,” said Nathan Boonstra, a pediatrician at Blank Children’s Hospital in Des Moines
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The most common type of cancer among women in Iowa continues to be breast cancer — with 2,500 new cases expected this year, according to the 2019 report. For men in Iowa, the most common is prostate cancer — with 2,050 new cases expected this year.
The deadliest type of cancer for women and men in Iowa is lung cancer, with 730 deaths anticipated for women and 900 projected for men in 2019.
National studies show HPV is responsible for more than 90 percent of anal and cervical cancers, 75 percent of vaginal cancers, 70 percent of vulvar and oropharyngeal cancers, and 60 percent of penile cancers.
Although cervical cancer has seen a sharp decline since the 1970s, it’s edged back up in recent years. And oropharyngeal cancer in men steadily has become more common, as have other male- and female HPV-related cancers.
Although Iowa’s total number of cancer cases remains relatively unchanged from year to year, Weiner said improvement in HPV vaccination rates will help shift that hard-to-move needle.
“They will drop dramatically,” he said of Iowa’s cancer rates.
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