Disagreement between ACS and CDC on HPV vaccination in older adults

  • Saslow D & al.
  • CA Cancer J Clin
  • 1 Jul 2020

  • curated by Pavankumar Kamat
  • Univadis Clinical Summaries
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Takeaway

  • The new guidance on HPV vaccination from the American Cancer Society (ACS) deviates from the recommendations of the Centers for Disease Control and Prevention (CDC)'s Advisory Committee on Immunization Practices (ACIP).
  • The ACS does not endorse shared decision-making regarding HPV vaccination in adults ages 27-45 years who are not adequately vaccinated.

Key points

  • ACIP recommends routine HPV vaccination in boys and girls ages 9-12 years and catch-up vaccination in individuals up to age 26 years who have not been fully immunized against HPV.
    • The ACS endorses both recommendations.
  • After the US Food and Drug Administration approved the HPV vaccine for adults ages 27-45 years, the ACIP updated its recommendations stating that older adults could discuss the risks and benefits of the vaccine with their provider to make a decision about getting immunized.
    • After conducting a methodological review of the ACIP's recommendations, the ACS decided not to endorse the shared decision-making recommendation for older adults.
  • According to the ACS, HPV vaccination in adults age >26 years would prevent only an estimated 0.5% additional cancer cases, 0.4% additional cases of cervical precancer, and 0.3% additional cases of genital warts over the next 100 years vs vaccination under the age of 26 years.
  • Other factors that ACS considered in their decision were the burden of decision-making on patients and clinicians, the lack of adequate guidance on the selection of individuals likely to benefit, and the ongoing HPV vaccine shortage.
  • However, proponents of the shared decision-making recommendation say that the lower effectiveness of the HPV vaccine in older adults should also be considered relative to an individual's risk of acquiring HPV.