The magic bullet of cancer prevention

In some cases, there is a magic bullet that can prevent cancer. Hollings Cancer Center (HCC) cancer prevention and control researcher Kathleen Cartmell knows all too well what that bullet is. The problem is, she’s in the minority in the state.

“I have just one question to ask. If you could prevent cancer, wouldn’t you do it?” she said. “Wouldn’t you want to protect your child?”

In South Carolina, that mission has reached a critical level, said Cartmell, who’s a health services researcher and assistant professor in the College of Nursing at the Medical University of South Carolina (MUSC). Cartmell studies ways to prevent human papillomavirus or HPV.

HPV is a strand of more than 150 related viruses, many of which can cause multiple types of cancers. According to the Centers for Disease Control and Prevention (CDC), nearly 80 percent of cancers diagnosed each year in parts of the body where HPV can occur are caused by the virus. Of the HPV-associated cancers, cervical and oropharyngeal (cancers of the back of the throat, including the base of the tongue and tonsils) are the most common.

They can be prevented, though, with what Cartmell calls a “magic bullet.”

That bullet is a U.S. Food and Drug Administration-approved vaccine recommended for boys and girls ages 11 and 12. Children up to the age of 15 are eligible for the two-dose series. Young adults can also be vaccinated with a three-dose series through age 26.

South Carolina has some of the highest rates of HPV-related cancers in the nation and is among those states with the lowest HPV vaccination rates. In South Carolina, HPV is estimated to cause more than 580 new cancers each year. Each year, the CDC conducts the National Immunization Survey-Teen to monitor vaccination rates among adolescents ages 13 to 17. Results show there’s a 50 percent vaccination rate for girls nationwide, compared to just 31 percent of girls in the state. For boys, it’s a 38 percent rate nationally, compared to 27 percent in the state.

“It’s just a pity. I’m a cancer prevention researcher, and I just feel like we can do so much better than that. We need to get the word out that people need to get the HPV vaccine to protect themselves,” Cartmell said.

"Diseases like cervical cancer, one of the top cancers caused by HPV, can be an indicator of a poor health system because they are very preventable. Each year 187 people are diagnosed with cervical cancer in South Carolina. With all the prevention methods for cervical cancer, including both cervical cancer screening and the HPV vaccination, the number of cases should be much closer to zero.”

Cartmell has spent the majority of her career dedicated to cancer prevention efforts. That work has included research in rural India, studying ways to increase cervical cancer screening and reduce barriers to HPV vaccination.

“While the HPV vaccine doesn’t protect against all cancers, it really provides a great basis of coverage.”

Cartmell has also been involved in leading research efforts at HCC, South Carolina’s only National Cancer Institute-designated cancer center. As part of a grant supplement from the National Cancer Institute awarded to HCC, Cartmell and her team conducted an environmental scan in South Carolina that polled community leaders regarding barriers to getting the vaccine. They met with 34 leaders across the state to discuss policy change and best practices to support HPV vaccination as a statewide initiative.

From the environmental scan, the research team learned that HPV vaccination just isn’t on the radar of family care providers and pediatricians at the level it should be. “Since the HPV vaccine isn’t mandatory, it’s often overlooked when adolescents receive the required childhood vaccines like Tdap and meningococcal,” said Cartmell of the study’s results, which were published in Papillomavirus Research.

These findings resulted in a recommendation to address the state’s low vaccination rates from two angles: top-down and bottom-up. 

From the top down, state leaders and health care providers, particularly pediatricians, need to be vocal. Cartmell says there are opportunities to talk to parents about the vaccine. "We just need to do a better job of having that conversation. Kids go to the doctor, they get sick and have well-child exams or sports physicals. If providers were recommending it, we’d see a major shift in vaccination rates. In order for us to change the state of this crisis, we need to make HPV vaccination for our children a top priority in the state.”

At the other end of the spectrum, though, are the stakeholders who have the most to lose, and that’s parents and community leaders. “It is just as important to address the issue from a grassroots level. By working with schools, PTAs, churches and community influencers, the hope is that people in communities across the state can hear about HPV vaccination from the people they trust the most – their health care providers, their schools and their churches.”

Cartmell urges parents of adolescent boys or girls to see their pediatricians or family providers and ask them to give their child the HPV vaccine that protects against cervical, oropharyngeal and numerous other cancers.

Cartmell, who serves as chair of the South Carolina Cancer Alliance’s Cervical Cancer South Carolina Workgroup, is helping to lead a statewide effort to engage key decision makers who can help change health policies to address the need. The workgroup is part of a new initiative led by the South Carolina Cancer Alliance and works with community members, health care providers, research experts and state leaders to decrease barriers to HPV vaccination. It also addresses major concerns around cervical cancer, including providing access to screening and support for follow-up exams.

In doing the study, Cartmell discovered a number of misconceptions that often are associated with the vaccine. Cartmell said it’s her mission to set the record straight. The HPV vaccine has been proven to be both safe and effective. The vaccine is not “live,” and there are no known links to autism or infertility, she said. The side effects that may occur are comparable to what a patient would have in getting any other shot, such as pain and swelling or redness at injection site.

Some people worry that the HPV vaccine, which protects against the sexually-transmitted HPV infection, may promote sexual activity – another common misconception. “However, studies have consistently shown that this is not the case. What happens is that doctors and parents often think the HPV vaccine can be delayed because the adolescent isn’t yet at risk, but what happens is that when the HPV vaccine isn’t given alongside other adolescent vaccines, HPV vaccination never happens. And that’s a shame.”

Cartmell wants parents to take this vaccine as seriously as any of the other immunizations their children receive.

“At the end of the day, it is a cancer prevention vaccine. That’s the beautiful thing about it. I’ve been doing cancer research for more than 12 years, and when we got a vaccine that prevents cancer, I thought to myself, ‘this is a magic bullet.’ There is nothing else available that you can use, and it will prevent cancer,” she said.

Cartmell, who is available for community talks, will continue her research and her advocacy role as a state HPV vaccine champion, but she knows it will take the efforts of many statewide partners to ensure the HPV vaccine becomes an essential tool for cancer prevention.

“We are all South Carolinians, and we have this problem that needs to be addressed. We need boots on the ground to fix it and to educate, provide access, and encourage use of the HPV vaccine. And so it begs the question again, “If you could protect your child against cancer, why wouldn’t you?”