Atlanta, Georgia - The American Cancer Society (ACS) has endorsed HPV vaccination recommendations from the CDC’s Advisory Committee on Immunization Practices (ACIP), the principal source of guidance on U.S. immunization policy. The ACS’s updated guideline supports the ACIP recommendation to vaccinate males as well as females at ages 11 to 12 to protect against HPV, which is associated not only with cervical cancers, but also penile, anal, oropharyngeal (mouth/throat), and other cancers.
The ACS first published a guideline for the use of prophylactic HPV vaccines for the prevention of cervical cancer and pre-cancer in 2007. At the time, the vaccine was not approved for use in males and there was insufficient evidence for vaccinations beyond the age of 18.
Since then, additional studies have added to the evidence, new versions of the vaccine have been licensed for use in the United States, and there have been new immunization recommendations from ACIP.
Studies indicate that vaccination in males will be effective against cancers related to HPV in males, as it is in females. Those cancers include penile cancer in males, cervical, vaginal, and vulvar cancer in females, and anal and oropharyngeal cancers in males and females. Vaccinating males may also provide additional protection to females.
To update its recommendations, the ACS implemented a guideline endorsement process, similar to the approach taken by the American Society of Clinical Oncology (ASCO) for endorsing another organization’s guidelines. The adapted ACS endorsement process for the HPV vaccine update included a methodologic assessment of the ACIP recommendations, a supplemental evidence review, a content review of the ACIP recommendations, approval of recommendations and endorsement statements by the ACS Guideline Development Group, review of the evidence report and endorsement manuscript by expert advisors, and finally approval of by the ACS National Board of Directors.
A summary of the recommendations:
- Routine HPV vaccination of all children should be initiated at age 11 or 12. The vaccination series can be started beginning as early as age 9.
- Vaccination is also recommended for females ages 13 to 26 and for males aged 13 to 21 who have not been vaccinated previously or who have not completed the 3-dose series. Males 22 through 26 years old may also be vaccinated.
- The guideline emphasizes that late vaccination for adolescents who were not vaccinated at the recommended age should be completed as soon as possible.
- Individuals ages 22 to 26 who were not previously vaccinated should be informed that vaccination at older ages is less effective in lowering cancer risk, which is not specifically recommended by the ACIP.
- Vaccination of females is recommended with any of the three available vaccines: 2vHPV, 4vHPV (as long as this formulation is available), or 9vHPV*. Vaccination of males is recommended with 4vHPV (as long as this formulation is available) or 9vHPV.
- Vaccination is also recommended through age 26 for men who have sex with men and for immunocompromised persons (including those with HIV infection) if not vaccinated previously.
“HPV vaccination has the potential to prevent tens of thousands of cancers and hundreds of thousands of pre-cancers each year,” said Debbie Saslow, PhD, director of cancer control intervention for HPV vaccination and women’s cancers, and lead author of the report. “It is critical that all stakeholders—families, health care providers, and others—make HPV vaccination a priority, so that prevention of the vast majority of cervical, vaginal, vulvar, anal, penile, and oropharyngeal cancers can become a reality.”
The report appears early online in CA: A Cancer Journal for Clinicians.
*The 9-valent vaccine protects against 9 types of HPV that are responsible for about 90% of cancers related to HPV. Gardasil 9 is now the sole HPV vaccine available through government programs. There is not yet any information as to if or when 2vHPV and 4vHPV will be discontinued for private purchase.