Fortunately, the most recently approved vaccine for HPV, Gardasil 9, protects against nine of the 13 different types of cancer-causing HPV strains. This vaccine has been extremely effective in reducing the incidence of cervical cancer among 20- to 24-year-old women, the first group to become eligible after the U.S. approval of the vaccine in 2006. The most recent data show that between 2012 and 2019, rates of cervical cancer declined by 65 percent among U.S. women in their early 20s, compared to only a 33 percent reduction in the previous decade (2005-2012) (28). The HPV vaccine is approved for males and females ages nine to 45, with recommendations for the first doses beginning at age 11 to 12 (see Sidebar 16, p. 50). Despite the positive impact of the vaccine on reducing cervical cancer incidence, the uptake of the HPV vaccine has been suboptimal in the United States. In 2021, only 76.9 percent of adolescents ages 13 to 17 had received one dose of the HPV vaccine and only 61.7 percent had received the recommended two doses (215). This stands in sharp contrast to other countries, such as the United Kingdom, where high uptake of HPV vaccination among 12- to 13-year-old girls has led to an 87 percent reduction in cervical cancer among women in their 20s (216). Programs designed to increase rates of HPV vaccination in the U.S., such as The Healthy People Initiative, which aims to vaccinate 80 percent of the eligible population, using strategies, including the implementation of vaccination information systems, patient reminders, and vaccination programs in schools can have immense public health benefit (217). Chronic infection with HBV and HCV, viruses that cause liver inflammation and damage, can lead to liver cancer and other malignancies including non-Hodgkin lymphoma (NHL), if left untreated (218,219). After new reported cases of HBV remained stable through 2013 until 2019, there was an abrupt decrease of 32 percent reported cases in 2020, potentially attributable to the COVID-19 pandemic, which may have led to reduced testing but not necessarily reduced infections (220). In contrast, cases of HCV have doubled since 2013, with an increase of 15 percent between 2019 and 2020 (220). These numbers are concerning, as HBV is preventable with vaccination and HCV can be cured using antiviral medications. To eliminate viral hepatitis as a public health threat, the U.S. Department of Health and Human Services released the Viral Hepatitis Strategic Plan for the United States: A Roadmap to Elimination (2021-2025). The primary goals listed in the report are to prevent new infections, improve hepatitis-related health outcomes for infected individuals, reduce disparities and health inequities related to hepatitis, improve surveillance of viral hepatitis, and bring together all relevant stakeholders in coordinating efforts to address the hepatitis epidemic. Individuals infected with human immunodeficiency virus (HIV) have an elevated risk of Kaposi sarcoma, NHL, and cervical cancer; these are called AIDS-defining cancers because they are HPV Vaccination Recommendations Thirteen strains of human papillomavirus (HPV) can cause cancer: HPV16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 66. U.S. Centers for Disease Control and Prevention (CDC) and Advisory Committee on Immunization Practices (ACIP) recommend: • Two doses of HPV vaccine, given at least six months apart, for adolescents younger than age 15 (except immunocompromised persons). • Three doses of HPV vaccine for adolescents and young adults ages 15 to 26 and for people with weakened immune systems. • Shared decision-making through discussion with health care providers for adults ages 27 to 45; if an individual chooses to be vaccinated, three doses of HPV vaccine. Adapted from (1). Although there are three FDA-approved HPV vaccines, Gardasil (first approved in 2006), Cervarix (first approved in 2009), and Gardasil 9 (first approved in 2014), only one (Gardasil 9) is currently being distributed in the United States. Gardasil 9 Protects against infection with 9 strains of HPV: HPV6, 11, 16, 18, 31, 33, 45, 52, and 58. FDA approved for: • Preventing anal, cervical, head and neck, vaginal, and vulvar cancers and precancers, as well as genital warts. • Vaccination of males and females ages 9 to 45. SIDEBAR 16 Globally, 5 percent of all cases of cervical cancer are attributable to HIV (53). AACR Cancer Progress Report 2023 Reducing the Risk of Cancer Development 50
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