Article Text
Abstract
Introduction HPV vaccination reduces recurrence of HPV-related gynecologic dysplasia but utilization rates of HPV vaccination for secondary prevention in gynecologic oncology have not been described. Our objective was to assess secondary vaccination practice patterns in an academic, tertiary gynecologic oncology center.
Methods Retrospective cohort study (10/1/2018-4/1/2024) of patients aged ≥18 with ICD10 diagnosis of moderate-to-severe dysplasia of the cervix, vulva, or vagina (CIN, VIN, or VAIN) treated by gynecologic oncologists. Exclusion criteria included diagnoses of carcinoma, HIV, or contraindications to vaccination (pregnancy or allergy). Appropriate statistics were used to determine if vaccination varied by diagnosis or demographics.
Results 84 patients were included; 41.7% CIN, 51.2% VIN, 7.1% VAIN/VAIN w/CIN or VIN. Patients with CIN were younger (40.6 vs 60.8 vs 50.0 years respectively; p<0.05) and more likely to have documented history of vaccination (34% vs 4.7% vs 16.7%; p=0.08). Race/ethnicity were similar across groups, though >90% were non-Hispanic White. Privately-insured patients were more likely to have documentation of history of vaccination or vaccination for secondary prevention (62.4% private vs 34.1% Medicaid/Medicare and 3.5% none/self-pay; p=0.003). Rates of documentation of completed vaccination series for secondary prevention were low (8.6%, 7.0%, and 0% VAIN).
Conclusion/Implications The cohort reflects low overall HPV vaccination rates (for both primary and secondary prevention) and suggests the presence of socioeconomic barriers (i.e. insurance type). Gynecologic oncology encounters may represent an underutilized opportunity to advocate for HPV vaccination for secondary prevention of preinvasive disease. Additional research with diverse cohorts and formal QI processes may standardize care and increase vaccination rates.