Human Papillomavirus Vaccination Prevalence and Disproportionate Cancer Burden Among US Veterans

Chidambaram, Smrithi; Chang, Su‐Hsin; Sandulache, Vlad C.; Mazul, Angela L.; Zevallos, José P.

doi:10.1001/jamaoncol.2022.7944

Cited by 3 publications

(2 citation statements)

References 5 publications

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“…Presently, the incidence of HPVrelated OPSCC within the U.S. Veteran population is estimated to be between 2-3-fold higher than the estimated rate of 45,000 incident cases/yearly in the U.S. general population [32][33][34] . Unfortunately, the prevalence of HPV vaccination among eligible U.S. veterans is roughly one-half that of their civilian counterparts.…”

Section: Burden Of Hpv-related Opscc In Veteransmentioning

confidence: 89%

“…Faraji et al [46] 2023 161 vets with HPV-related OPSCC treated with transoral robotic surgery (TORS) Survival outcomes for vets treated with TORS +/-adjuvant therapy equivalent to civilian population Feinstein et al [33] 2017 209 vets with HPV-related OPSCC within the VA Greater Los Angeles System Survival outcomes for vets with HPV-related OPSCC equivalent to civilian population Nelson et al [47] 2022 4,007 vets with HPV-related OPSCC treated with radiation within the VA CDW NRG Oncology nomograms effective for predicting recurrence and survival outcomes in vet populations…”

Section: Survival Outcomesmentioning

confidence: 99%

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Consideration of liquid biomarkers for surveillance of HPV-related oropharyngeal cancer in veteran populations

Smith,

Spector,

Brenner

et al. 2024

J Cancer Metastasis Treat

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The incidence of human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) will continue to rise in the United States over the next several decades. Thus, efforts to reduce treatment intensity, mitigate long-term physical and psychological sequelae of treatment, and simplify surveillance regimens for patients with HPV-related OPSCC are critical. Liquid biomarkers, namely plasma circulating tumor HPV DNA (ctDNA), have shown considerable promise for improvements in these domains by guiding personalized and adaptive treatment de-escalation paradigms and predicting disease recurrence in the survivorship period. Preliminary reports suggest an even broader impact of plasma HPV ctDNA assays for HPV-related OPSCC surveillance beyond the mere detection of cancer recurrence and metastasis. For instance, such assays may reduce the need for costly imaging studies, alleviate the financial toxicities of survivorship care, and improve care access and patient satisfaction. Currently, veterans and underserved populations are disproportionately affected by the financial burden of cancer surveillance and survivorship care. These disparities negatively impact oncologic outcomes, healthcare access, and utilization, specifically among veterans with HPV-related OPSCC. As such, we posit that HPV ctDNA monitoring may be of unique benefit and impact in the surveillance period for these patients specifically. Herein, we provide a narrative review of the current literature supporting the formal clinical evaluation of HPV ctDNA monitoring in veterans with HPV-related OPSCC.

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Section: Burden Of Hpv-related Opscc In Veteransmentioning

confidence: 89%

Section: Survival Outcomesmentioning

confidence: 99%

Consideration of liquid biomarkers for surveillance of HPV-related oropharyngeal cancer in veteran populations

Smith,

Spector,

Brenner

et al. 2024

J Cancer Metastasis Treat

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HPV Vaccine Usage Among the U.S. Military Academy Corps of Cadets (2018-2025)

Brasko,

McClean,

Penick

et al. 2023

Military Medicine

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Introduction Human papillomavirus (HPV) is a common sexually transmitted virus that infects over 13 million people every year. Over 80% of sexually active adults will acquire HPV at some point in their lives, which is concerning since certain high-risk strains of HPV can cause six types of cancer. Vaccination against HPV is safe and effective, but despite high vaccine efficacy, vaccination rates are low among both service members and civilians. Materials and methods We conducted a retrospective, cross-sectional study to identify the percentage of United States Military Academy (USMA) Cadets who had received at least one HPV vaccine and those who completed the vaccine series. Deidentified vaccination and demographic data were retrieved from the Defense Health Agency Military Health System Data Repository (MDR) for all Cadets who were enrolled at USMA between January 2018 and May 2022 (graduating classes of 2018-2025). To identify the population of Cadets for our study and confirm presence of “any” vaccine in the MDR, Tdap vaccination information was also retrieved. The study population was defined as any Cadet who was enrolled at USMA between January 2018 and May 2022 (graduating classes of 2018-2025) and had record of an HPV and/or Tdap vaccine in the MDR. We compared demographic information between the identified population and known demographics of the USMA population to confirm that the retrieved data were consistent with population demographics. Descriptive statistics were performed to identify demographic differences based on vaccinated and unvaccinated Cadets and to determine the percentage of Cadets who received at least one HPV vaccine. Vaccine series completion was defined as the receipt of three HPV vaccine doses among those who reported receiving at least one dose of HPV vaccine or two doses if vaccinated before the age 15. Results A total of 9,567 Cadets were assessed for eligibility with 9,433 having Tdap and/or HPV vaccine on record. Of these Cadets, 5,738/9,433 (60.8%) had received at least one HPV vaccine. Of those starting the series, 4,492 completed the two- or three-dose series for a completion rate of 47.6%. We found HPV vaccine completion rate among female Cadets (55.6%) is higher than that of male Cadets (45.2%). More Cadets from minority groups received one vaccine; however, full completion rates were similar for both the groups (48.1%). In contrast, the percentage of Cadets vaccinated against Tdap was 97.2%. Most of those vaccinated received their first vaccine between the ages of 11 and 15 (53.0%) and their final vaccine after they turned 16 (68.9%). Conclusion Though the vaccination rate among the Corps of Cadets is comparable to the public, it is still less than the 80.0% goal set by the Healthy People 2030 objective. Based on these results, we recommend that the USMA modify its policy on HPV vaccine administration to encourage more vaccine uptake. We also conclude that further studies on the rationale for avoiding the vaccine are necessary to better inform educational campaigns and mitigate stigma.

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Human Papillomavirus (HPV) Vaccination Rates Among U.S. Military Veteran Females and Males and Non-Veterans in the National Health Interview Survey

Dubiel,

Vinekar,

Than

et al. 2024

Military Medicine

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Introduction Human papillomavirus (HPV) infection is a major risk factor for the development of multiple cancers. Active duty service members have higher rates of HPV infection than civilians, while Veterans are diagnosed with a disproportionately high burden of HPV-associated cancers compared to civilians without prior service. While a highly effective HPV vaccine has been available for over a decade, vaccination rates in the United States remain suboptimal. The objective of this study was to investigate HPV vaccination rates among male and female Veterans compared with their non-Veteran counterparts. Methods We performed a secondary analysis of cross-sectional National Health Interview Survey (NHIS) data pooled from 2015 to 2018 to analyze HPV vaccination rates for respondents aged 18–45 years. We used multivariable logistic regression to compare HPV vaccination rates between Veterans and non-Veterans stratified by sex while controlling for sociodemographic factors, including age, race/ethnicity, education level, income, insurance coverage, and VA coverage. All analyses used NHIS survey weights to produce national estimates. Results Among 45,493 respondents aged 18 to 45 years, vaccination rates were low across all groups: 9.6% of male Veterans and 8.4% of male non-Veterans (P = .21) had received at least one HPV immunization, whereas 32.0% of female Veterans and 25.1% of female non-Veterans (P = .02) were immunized. After controlling for sociodemographics, both male Veterans (AOR 1.79; 95%CI 1.31, 2.44) and female Veterans (AOR 1.56; 95%CI 1.1, 2.21) exhibited higher odds of HPV vaccination compared to their non-Veteran counterparts. VA coverage was also independently associated with higher odds of HPV vaccination among female Veterans (AOR 2.39; 95%CI 1.10, 5.21). Conclusions Veterans of both sexes are more likely to be vaccinated than their non-Veteran civilian counterparts. However, vaccination rates overall remain low. To our knowledge, ours is the first study of its kind to establish HPV vaccination rates among female Veterans. These findings underscore the important role of DoD and VA health care systems in improving HPV vaccine uptake and mitigating HPV-associated cancer risk among Veterans.

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Human Papillomavirus Vaccination Prevalence and Disproportionate Cancer Burden Among US Veterans

Abstract: This cross-sectional study examines the rate of HPV vaccination and the number eligible for this vaccination among younger veterans and civilians.

Cited by 3 publications

References 5 publications

Consideration of liquid biomarkers for surveillance of HPV-related oropharyngeal cancer in veteran populations

Consideration of liquid biomarkers for surveillance of HPV-related oropharyngeal cancer in veteran populations

HPV Vaccine Usage Among the U.S. Military Academy Corps of Cadets (2018-2025)

Human Papillomavirus (HPV) Vaccination Rates Among U.S. Military Veteran Females and Males and Non-Veterans in the National Health Interview Survey

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