More than half of Texas physicians do not follow HPV recommendations

Aug 6 2009

The Advisory Committee on Immunization Practices recommends the human papillomavirus vaccination for all 11- and 12-year-old girls, but results of a recent survey showed that more than half of Texas physicians do not follow these recommendations.

The survey was published in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research.

“Two years after the FDA approved the vaccine, the study suggests that additional efforts are needed to encourage physicians to follow these national recommendations,” said Jessica Kahn, M.D., M.P.H., associate professor of pediatrics at Cincinnati Children’s Hospital Medical Center.

The quadrivalent human papillomavirus (HPV) vaccine has been mired in controversy since it was approved in 2006. Texas placed itself at the center of that controversy early on with a mandate for universal vaccination from the governor’s office, followed by a swift rebuke of that mandate from the legislature.

Kahn said she was approached by the Texas Medical Association to assist them in conducting this survey as part of their efforts to assess educational needs related to HPV vaccination among Texas physicians. Kahn and colleagues surveyed 1,122 physicians.

Of the respondents, 48.5 percent said they always recommend the HPV vaccine to girls, 68.4 percent said they were likely to recommend the vaccine to boys and 41.7 percent agreed with mandated vaccination.

When the researchers assessed the predictors of vaccine recommendation, they found that those in an academic vs. non-academic practice were more than twice as likely to recommend the vaccine. Those who considered professional organizations or professional conferences an important source of information were almost twice as likely to recommend the vaccine than those who did not consider these sources valuable.

“Most physicians are aware of the vaccine and what it prevents, but they may lack knowledge about issues of safety and how to address parental concerns. That may be making them reluctant to deliver the vaccine,” said Kahn.

Although the study population was limited to Texas, Kahn said she believes that the views expressed by these physicians could be representative of physicians across the country. Nationally, vaccine rates for 11- to 12-year-old girls are between 6 percent and 25 percent.

“Physicians train all across the country using more or less the same curriculum, so as a group they tend to be fairly homogenous in their beliefs,” said Kahn.

Sally Vernon, Ph.D., director of the Division of Health Promotion and Behavioral Sciences in the University of Texas School of Public Health, said this study points to the need to further educate physicians about the HPV vaccine.

“Physicians are the gatekeepers for this vaccine and the studies have shown that one of the most important predictors of health behavior is what your physician recommends,” said Vernon, who is also an editorial board member of Cancer Epidemiology, Biomarkers & Prevention.