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Study says doctors passively discourage HPV vaccines

Sexual aspect may make talks uncomfortable

University of Miami pediatrician Judith L. Schaechter gives an HPV vaccination to a 13-year-old girl in her office at the Miller School of Medicine in Miami.
Joe Raedle/Getty Images
University of Miami pediatrician Judith L. Schaechter gives an HPV vaccination to a 13-year-old girl in her office at the Miller School of Medicine in Miami.

Doctors may be inadvertently discouraging some parents from having their preteens vaccinated against human papillomavirus, according to a new study, which suggests clinicians often don’t recommend the vaccine strongly enough.

Many pediatricians and family physicians — who deliver the bulk of HPV vaccines — don’t appear to be using the same matter-of-fact approaches as they do when they urge parents to vaccinate adolescents against meningococcal disease or to get tetanus, diphtheria, and pertussis booster shots, it said.

The study, which is based on a national online survey of 776 doctors, found a quarter did not strongly endorse the need for HPV vaccination with the parents of the 11- and 12-year-olds under their care.

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Nearly 60 percent were more likely to recommend the vaccine for adolescents they thought were at higher risk of becoming infected — perhaps because the doctors knew or suspected they were sexually active — than for all 11- and 12-year-olds.

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“You kind of get the sense that some [health care] providers see this as a somewhat uncomfortable situation,” said lead author Melissa Gilkey, a behavioral scientist in the department of population medicine at Harvard Medical School.

“They don’t anticipate that parents are going to be highly supportive of vaccinating their 11- and 12-year-olds.”

HPV vaccines protect against infection with viruses that cause cervical, penile, and anal cancers; two of the three vaccines also protect against viruses that cause genital warts.

The idea of vaccinating kids against sexually transmitted viruses when they are 11 or 12 makes some people squeamish.

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But the Centers for Disease Control and Prevention recommends the vaccine for preteens, in part because the viruses are so ubiquitous that people who have not been vaccinated generally become infected shortly after they start having sex. Studies have also shown preteens get the best immune response to the vaccines.

Evidence generated by one of Gilkey’s earlier studies suggests doctors appear to be overestimating the hesitancy of parents when it comes to HPV vaccination. As a result, they may approach the subject gingerly.

“It’s not necessarily that physicians always are negative about it. But it’s kind of that HPV vaccine may get damned with faint praise, if you will,” Gilkey said. “Compared to the way that they recommend these other vaccines, parents may suspect that there’s something wrong with it.”

The aim of the research is to help figure out why HPV vaccination rates remain disappointingly low. The CDC reported that in 2014, 40 percent of adolescent girls and 22 percent of adolescent boys had received the recommended three doses of HPV vaccine. The agency says girls and boys should have all three doses by their 13th birthday.

By comparison, between 70 percent and 80 percent of 11- and 12-year-olds had received the two other vaccines recommended for that age group, said Susan Vadaparampil, a researcher at the Moffitt Cancer Center in Tampa, who also studies HPV vaccine acceptance.

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Vadaparampil, who was not involved in Gilkey’s study, noted the differences in the vaccination rates inspired the CDC to devise a campaign called “Same Way, Same Day.” It urges doctors to recommend vaccines for 11- and 12-year-olds with equal importance and at the same time.

Studies have shown that a doctor’s recommendation — whether for a colonoscopy to look for early colon cancer or a vaccination to prevent against cancer-causing HPV infections — leads to higher acceptance on the part of the patient.

The new research found doctors who started conversations about the HPV vaccination by telling parents the vaccines protect against cancers and genital warts gave stronger recommendations than those who opened saying HPV viruses are sexually transmitted.

“Words matter. And the tone matters. And how you lead [into the discussion] matters,” Vadaparampil said.

The study was published Thursday in Cancer Epidemiology, Biomarkers and Prevention, a journal of the American Association for Cancer Research.

Although Gilkey declared no conflicts of interest, the senior author of the study, Noel Brewer of the University of North Carolina, has received research funding and speaker fees from companies that sell HPV vaccines.

Helen Branswell can be reached at helen.branswell@statnews
.com
. Follow her on Twitter @HelenBranswell. Follow Stat on Twitter: @statnews.