The bulk of resources devoted to cancer research is expended on either basic science efforts to better understand why cancer occurs or on the development of effective treatments for a specific neoplasm once it arises. Indeed, when considering the cancer research enterprise (often referred to as the “War Against Cancer”), attention too often is focused on the most recent basic science breakthrough regarding tumor genesis or the latest “cure” for cancer. Prevention and early detection of premalignant states and case finding of more readily treatable cancerous lesions represent critical aspects of a comprehensive strategy to battle cervical cancer effectively. With cervical cancer, effective screening for precancerous lesions currently exists, limited only by adherence to preventive guidelines and suboptimal accuracy of existing screening tests. Moreover, even for those willing to participate in screening, there is a wide variance in acceptance rates among proven screening tests, with cervical cancer screening rates in American women lagging compared with breast cancer screening.4
Primary prevention of cancer, clearly the most desirable option from a societal perspective, likely can be achieved for many common cancers with lifestyle choices such as smoking cessation and improved diet. As with other lifestyle choices, safer sex practices to reduce HPV infection and subsequent cervical cancer (eg, consistent condom use, fewer lifetime sex partners, and later age at sexual debut) can be difficult to implement and maintain. Scientific investment in cancer chemoprevention as an important adjunct to behavioral change recently has yielded HPV vaccines. These newly approved vaccines represent a major advance in our armamentarium for the reduction of cervical cancer.
The Centers for Disease Control and Prevention (CDC) has recommended universal administration of the quadrivalent HPV vaccine (Gardasil, Merck, Whitehouse Station, NJ) to girls 11 to 12 years old, with a comprehensive “catch up” strategy suggested for 13- to 26-year-old girls and women and vaccination allowable as young as age 9. On October 16, 2009, the U.S. Food and Drug Administration approved a second, bivalent HPV vaccine (Cervarix, GlaxoSmithKline, London, United Kingdom) for use in girls and women ages 10 through 25 to prevent cervical cancer. Within 1 week of U.S. Food and Drug Administration approval, the CDC’s Advisory Committee on Immunization Practices recommended Cervarix for routine administration in girls ages 11 and 12 as well as in girls and women ages 13 through 25 who have not been vaccinated. In addition, the Advisory Committee on Immunization Practices issued a permissive recommendation for the use of the quadrivalent HPV vaccine (Gardasil) for boys and men ages 9 through 26, which should serve to further interrupt the chain of HPV transmission to girls and women.
Introduction of new vaccines specifically targeting adolescents presents unique challenges for immunization delivery. People make fewer visits to physicians’ offices in their adolescent years than at any other time in their lives and are nonadherent to at least one recommended vaccine.5
The Healthy People 2010 report advocates coverage levels of 90% for any new universally recommended vaccine within 5 years of the recommendation, yet recent analysis of national adolescent-vaccination rates indicate that none of the recommended adolescent vaccines has reached this level of coverage.6
To achieve such high rates of coverage in adolescents will require novel strategies for improving vaccine uptake. In evaluating national patterns of adolescent health care visits, Rand et al conclude that vaccine provision to older adolescent girls requires the involvement of obstetrician– gynecologists in vaccine delivery,7
a position supported by the American College of Obstetricians and Gynecologists. This novel involvement of gynecologists leverages the potential existing relationship they have through provision of cervical cancer screening services to the adolescent and her mother. In fact, using maternal cancer-control behaviors as a teachable moment may represent one mechanism that may improve vaccine use among adolescents.