This research highlight focuses on Lyn Robertson, DrPH, MSN, BSN — Director of Cancer Screening and External Partnerships for Health Equity and Community Outreach and Engagement at UPMC Hillman Cancer Center.
One of Dr. Robertson’s main areas of interest is in decision-making related to cancer prevention, early detection, and preventative vaccines. In this article, Dr. Robertson discusses her work regarding the Human Papillomavirus (HPV) vaccine and cervical cancer. This Q&A has been lightly edited for length and clarity.
In your own words, can you describe your work related to the HPV vaccine?
First, I’m very interested in vaccines in general, but the HPV vaccine is a particular interest of mine because over the years I’ve given many lectures with people asking when we’re going to cure cancer. And we currently have two vaccines that can prevent certain types of cancers — HPV and Hepatitis B. Yet, individuals remain hesitant to receive these vaccines. My interest is why and how can we use this information to increase vaccine rates.
Because there are a considerable number of individuals who are reluctant or on the fence about getting vaccinated or getting their children vaccinated, my work is centered around education. Not just about why people should be vaccinated for HPV, but also delving into the reasons why they’re hesitant. In other words, what are the things that we need to be doing to increase vaccine uptake for HPV?
I’ve been the recipient of funding to increase HPV vaccination across southwestern Pennsylvania. Most recently, my team’s focus has been on the use of social media and its potential impact on HPV vaccine uptake. Our goal is to use the findings to develop interventions that address specific concerns and to ultimately increase HPV vaccination rates across the state and country.
How has the national conversation around COVID-19 affected HPV vaccine hesitancy?
In addition to my work at UPMC Hillman Cancer Center, I am also a co-chair of the Pennsylvania Immunization Coalition. Our team has seen a tremendous decrease in childhood vaccination overall since the COVID pandemic. Partially because there was a significant amount of time that access was not available, and currently, there are fewer resources to play catch-up for all the children who were not able to receive vaccinations during the shutdown.
Although there is a great deal of effort to make childhood vaccines easy to access, such as through events like parking lot clinics or at the pediatrician’s office, there remains a significant number of children who have not received their standard childhood vaccines, let alone their COVID or HPV series.
In my view, there has been an increase in vaccine hesitancy — not necessarily unwillingness but hesitancy since the pandemic. I’ve noticed that people have more questions about vaccines now and possibly are even more reluctant to receive some vaccines. It seems they have less trust, and for a health care provider, trust is very important. If you aren’t trusted by your patients and their parents, they aren’t as likely to ask you questions or share their concerns.
How has and can adoption of the HPV vaccine impact cervical cancer incidences?
The vaccine has greatly decreased the incidence of cervical cancer. For example, researchers in Sweden conducted a study involving over 1.7 million women who had received the HPV vaccination. Over an 11 year period, there was a 90% reduction in cervical cancer rates in women who were vaccinated compared to those who were not vaccinated.
The more individuals we get vaccinated, particularly young individuals prior to sexual activity, the more successful we’ll be in decreasing the number of cervical cancer cases, as well as, other HPV-related cancers such as cancer of the throat. And while the conversation around HPV usually revolves around women, HPV can be transmitted to partners — both male and female. Everyone needs to be vaccinated so the transmission doesn’t continue.
What things have you discovered that can help the adoption of the HPV vaccine?
Include HPV Into the List of Other Required Childhood Vaccines
We’ve heard this directly from advocates and parents. Their physicians need to say these are the recommended vaccines at this time in the child’s life. While other childhood vaccines such as measles, mumps, and DTaP are presented to parents as a given, the HPV vaccine often remains an option. When HPV is included into the list of other accepted vaccines, it often removes the questioning and doubt.
Make It About Cancer Prevention
Through interviews with parents and others, we found that HPV vaccine education often revolves around sexual activity rather than cancer prevention. When you shift the conversation to cancer prevention, parents are more accepting of the vaccine.
Train Confident and Educated Providers
Most recently we’ve found that seasoned health care providers are much more comfortable talking to parents and children about HPV vaccines. Newer physicians may be more hesitant, not wanting to disrupt the patient-physician relationship, so they either back off more easily or don’t bring up the HPV conversation at all. As a part of physician education, we heard that there should be an emphasis on how they communicate with parents and patients about vaccines.
It is also critical that everyone in the physician’s office be on the same page. If the providers recommend the vaccine, but a member of the health care team or office staff doesn’t support the HPV vaccine, the efforts won’t work as well. Without consensus, patients may not trust your expertise.
In addition, when patients or parents ask questions about the vaccine, it’s important that their question be answered in a way that is easy to understand. In our experience, parents appreciated their question being addressed but did not appreciate additional information that they had not requested, as it often confused them.
What is the role of cancer centers in providing education on HPV vaccinations and cancer prevention generally?
As an NCI-designated comprehensive cancer center, it’s important for the UPMC Hillman Cancer Center to be available and accessible to patients for education and screening, particularly for vulnerable populations.
We are available to anyone and do our best to navigate clients through the process to remove as many barriers as possible, including helping to provide access to screenings for the most common cancers. UPMC Hillman can provide service when patients have no or limited coverage.
With our network facilities across multiple states, we can more easily provide screenings to patients in areas outside of Pittsburgh or help them find the best provider for the care they need, wherever they live. Without the passion that UPMC Hillman has for outreach and education, none of this would be possible.
How has UPMC Hillman’s work affected HPV rates in the Western PA region? Cervical cancer rates?
UPMC Hillman’s work has been able to assist in increasing the HPV vaccine rate within our 29-county catchment area. In addition to that, with efforts from all health systems, we are seeing the HPV vaccine uptake increase across all of Pennsylvania, slowly but steadily.
In general, we’ve seen cervical cancer rates decrease, however, there are some counties where there remains work to be done, particularly in the more rural areas. These are areas of focus, but it is important that we determine the reason why. There could be women that aren’t being screened for cervical cancer, or they weren’t of age to receive the HPV vaccine. There may be access issues or lack of knowledge, which means that care is more likely to fall off the radar for them.
Can you describe how cervical cancer screening and prevention efforts differ from other cancer types? How are efforts similar?
Cervical cancer screening requires that the individual be seen by a health care provider. If an individual doesn’t have a health care provider or what we often call, a medical home, they may not routinely be screened for cervical cancer. There are other cancers, such as colorectal cancer, where individuals can have access to at-home screening kits that they obtain at a health fair. However, it is important to note, that all cancer-related screening tests should involve a health care provider, as follow-up is extremely important, especially for positive results.
At the end of the day, if a patient calls us to get more information about cervical cancer or any type of cancer screening, we also discuss with them the other cancer screenings that they may be eligible to receive. The importance of working with individuals does not change based on the type of cancer screening. We do our best to identify barriers that any individual may face that could potentially interfere with their complying with a recommended or requested cancer screening. Our goal is to work with the individual to help them remove barriers and ensure compliance. Everyone is navigated through the screening process by a member of our team.
For more information about screening, educational efforts, and community outreach regarding HPV and cervical cancer, please call 412-623-1266.
Written by: Lyn Robertson
Edited and Published by: Annaliese Daniels