Even as exciting developments are happening in cervical cancer research, an estimated 14,100 new cases of invasive cervical cancer will be diagnosed in the United States this year.
A central issue in the fight against cervical cancer is that more than 99 percent of cervical cancers are due to human papillomavirus (HPV) and there’s an HPV vaccine. Approved by the Centers for Disease Control in 2006, the vaccine is recommended for girls and boys at age 11-12, though it can be administered as young as 9 and up to age 45.
An ongoing HPV Education and Patient Navigation Project by the University of Colorado Cancer Center Office of Community Outreach and Engagement (COE) is focused on helping parents of adolescents and young adults to make informed decisions about the HPV vaccine.
“A lot of people believe that there should be a cure for cancer, and this vaccine is essentially a cure for certain types of cancers caused by the HPV virus,” explains José Barrón, COE outreach and recruitment coordinator. “Our end goal is just to get people vaccinated.”
Partnership with Denver Health
The HPV Education and Patient Navigation Project was initiated in 2020 with support from the National Institutes of Health. COE researchers partnered with Denver Health clinics to reach traditionally underserved communities, including the recent partnership with High Plains Community Health Center in Lamar, a town in southeast Colorado.
Initially, the project was designed for in-person education and outreach, but the COVID-19 pandemic necessitated a quick pivot to online participation. The educational program about HPV and the HPV vaccine is for Denver Health parents who have adolescent children ages 9 to 17 or for young adult patients of Denver Health ages 18 to 26
Participants complete a short pre-education survey, watch a short educational video about the HPV virus and vaccine, and complete post-education surveys immediately after watching the video, at three months after and six months after watching.
Prior to creating the videos, COE researchers researched vaccine hesitancy in the communities they were aiming to reach, including Hispanic and rural communities.
“Some people assume that if you start talking about the HPV vaccine with kids it’s going to get them to have sex at age 9 or 10,” Barrón explains. “There’s a sense of taboo for some people, and an overall lack of information. Some people were assuming it was only for women, or didn’t know that HPV types of cancers not just cervical cancer well.”
Lindsay Brubaker, MD, a CU Cancer Center member and assistant professor of gynecologic oncology in the CU School of Medicine, explains that while HPV is sexually transmitted, the most effective time for people to get vaccinated is before they become sexually active and potentially exposed to the virus.
“There are misconceptions that the vaccine will somehow increase sexual risks in some capacity, and there’s no evidence of that happening,” Brubaker says. “Parents may also not think it’s serious because their child isn’t yet sexually active so the vaccine isn’t necessary.”
Creating messages appropriate to culture
The HPV project began with educational materials from the National Institutes of Health, but COE researchers expanded the available materials with videos in English and Spanish.
“We found a study showing there are certain misconceptions with females, as matriarchs of the family, being the ones who mostly make decisions about vaccines, and males were kind of on the periphery,” Barrón says. “We found that if you frame it in a way where you emphasize the responsibility of taking care of your family, that aligns with certain male dynamics in Latino families, so you can frame it as vaccination is one way to protect your family.”
Participants in the project are given information and support in finding locations for and accessing HPV vaccines, Barrón says. As of December 2021, 36 adolescents whose parents had completed the survey had received at least one shot, and 23 young adults had completed the vaccine regimen.
Because the project is focused on people from traditionally underrepresented communities, it addresses longtime disparities in who accesses the HPV vaccine and who ends up being diagnosed with cervical cancer.
“We do see real disparities in cervical cancer,” Brubaker explains. “It’s much more prevalent in traditionally underserved populations and there are plenty of reasons for that, though most of it is driven by lack of access to care. This may be due to lack of transportation, inability to leave a job for an appointment, insurance, language barriers, worries about whether residency status will be an issue."
Difficulties with access to care impacts rates of HPV vaccination in kids, too, Brubaker adds. "It’s a two- or three-shot series depending on the age at which a child receives it, and caregivers may not always be able to get the time off work for those appointments.”
The initial CU Cancer Center project goal was to recruit at least 200 participants and researchers are nearing that number.
“Our goal is to engage these communities and to answer any questions or address any fears about the HPV vaccine,” Barrón says. “Our goal is to get people vaccinated.”