Most women responding to a survey conducted at Massachusetts General Hospital (MGH) clinics indicated they would be willing to be vaccinated against the human papillomavirus (HPV) and to have their daughters and even sons vaccinated in order to prevent cancer in their children. The report in the March issue of Gynecologic Oncology also found that Latino women are just as likely, if not more so, to accept HPV vaccine as non-Latinos.
"Since the incidence and mortality of cervical cancer are higher among Latino women in the U.S., we were interested in whether the vaccine acceptance rate in this high-risk population was the same as for non-Latino women," says Marcela del Carmen, MD, a gynecologic oncology surgeon at the MGH Cancer Center and senior author of the study. "Overall, our results show that both Latino and non-Latino women are more likely to accept HPV vaccination for themselves and their children than previous reports have suggested."
HPV is the most common sexually transmitted infection, and vaccination is primarily designed to prevent cervical cancer in women. HPV infection also can cause genital warts and other genital tumors, including cancer of the penis or anus in males. Worldwide, cervical cancer is the second most common cancer in women and the third most common cause of cancer death. Cervical cancer rates in the U.S. are significantly higher in minority women, and Latino women have a 40 percent greater risk of dying from the disease than non-Latino white women do.
Vaccination against the strains of HPV that cause most cases of cervical cancer has been available for several years, but the authors note that several factors have limited its use – including incomplete knowledge among both patients and health care providers, costs and insurance coverage, and concerns about safety. To examine factors that might promote or inhibit vaccine acceptibility, the researchers surveyed adult women at three MGH clinical sites where the vaccine would be offered to eligible girls and women, those ages 11 through 26 according to current recommendations. Participants could choose to take the survey in either English or Spanish, and a total of 246 women ages 18 to 55 completed the survey – 86 identifying themselves as Latino and 141 as non-Latino.
Of 91 participants who were vaccine-eligible, only 45 had received the vaccine, but 73 percent of the participants not eligible under the current guidelines indicated they would accept the vaccine if it was available to them and they had more information. Prevention of cervical cancer was the most frequently cited motivating factor, and the level of acceptance was similar among Latino and non-Latino respondents. Importantly, participants also indicated that being vaccinated would not cause them to change the frequency at which they received Pap tests to detect cervical cancer or their likelihood of following safer sexual practices, two factors not analyzed in any earlier studies.
Among the 73 participants with daughters, almost 70 percent indicated willingness to have them vaccinated – with significantly higher acceptance among Latino women. Although HPV vaccination is not currently approved for males, among the 75 participants with sons, 86 percent responded they would have them vaccinated, also with higher acceptance among Latinos. Again, cancer prevention was the most common motivation for participants to have their children vaccinated, with only a few mothers of boys indicating that protecting their sons' future sexual partners was a consideration.
Respondents who would not have their children vaccinated cited concerns about safety or the belief that their children were not at risk of HPV infection; and contrary to some previous studies, participants' income or education level did not change their likelihood of accepting vaccination for themselves or their children. When asked about their sources of knowledge about the HPV vaccine, Latino women reported their health care provider was the primary source, while non-Latinos cited both health providers and the media.
"Our results suggest that engaging health care providers in educating women about HPV vaccination could increase overall vaccine acceptance," says del Carmen, an assistant professor of Obstetrics, Gynecology and Reproductive Biology at Harvard Medical School. "Our findings also help dissipate a concern some have raised that vaccinated women would be less likely to continue screening for cervical cancer or would choose not to vaccinate their children because they were concerned it would encourage more risky sexual practices. Now we need to look into attitudes among African American women – we didn't have enough participants in our survey to provide an accurate evaluation of this group – and in the community at large."
Lead author of the study is Luisa Watts, now a student at Miller School of Medicine, University of Miami. Co-authors are Maria Wallace, RN, Jose Rauh-Hain, MD, and Whitefield Growdon, MD, Division of Gynecologic Oncology, MGH Cancer Center and Obstetrics and Gynecology Service; Naima Joseph, University of Connecticut School of Medicine, and Alona Muzikansky, MGH Biostatistics. The study was supported by the MGH Multicultural Affairs Office and by patient philanthropy.
Massachusetts General Hospital, established in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH conducts the largest hospital-based research program in the United States, with an annual research budget of more than $500 million and major research centers in AIDS, cardiovascular research, cancer, computational and integrative biology, cutaneous biology, human genetics, medical imaging, neurodegenerative disorders, regenerative medicine, systems biology, transplantation biology and photomedicine.
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