Carolann Risley is Women’s Health Nurse Practitioner and PhD Candidate at the University of Mississippi Medical Center. She graduated with honors from the
University of Pennsylvania and Temple University in the United States. Her focus is preventative health care. Her dissertation research surrounds vaccine hesitancy
and the HPV immunization. She has spoken at national conferences on HPV, cervical neoplasia, and vaccination and is passionate about preventing HPV-related
Background: Human papillomavirus (HPV) causes 100% of cervical cancer and vaccination can prevent it. Immunization is grossly underutilized. Cervical cancer screening guidelines have changed and Pap smears are not recommended for females under 21 yearsold. Therefore, adolescents have potentially fewer wellness visits and missed opportunity for immunization and cancer prevention.
Objective: The purpose of this study was to describe women below 21 years old who were diagnosed with premalignant cervical
neoplasia and correlate the types and frequency of vaccinations received before abnormal Pap smear results.
Method: A retrospective analysis of girls aged 14-20 years with high-grade Pap smears and cervical biopsy at State Health Departments in Mississippi, USA, between 2011 and 2014 were assessed for a history of vaccination. Descriptive statistics and a Chi-square analysis were conducted.
Results: 15,201 females aged 14-20 years received pap smears from 2011-2014. Of those, 179 (1%) of females had high-grade pap smears; only 1 had immunization at age 12. Biopsy confirmed 62% had high-grade dysplasia. Only 51 (28.5%) had documentation of one HPV shot at a mean age of 16. Only 1 of these 51 who were vaccinated received the dose at the recommended age of 9-12 ((χ2=48.000, df=3, p=0.001). Black females were significantly more likely to receive an HPV vaccine than whites ((χ2=12.166, df=2, p=0.002).
Discussion: Cervical cancer mortality is highest in Mississippi with the lowest rates of HPV vaccination. The American College of Obstetrics and Gynecology reports a lack of sufficient screening data in this age group contributed to changes in guidelines. The Center for Disease Control suggests further investigation of race and lack of vaccination to refine screening guidelines. Providing strong recommendations for vaccination at age 9-12 may decrease cervical cancer.