U.S. could learn about cancer prevention—from Rwanda

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Dr. James Conway, right, leads immunization trainings in sub-Saharan Africa and sees lessons for the United States in Rwanda’s HPV immunization program.

Rwanda has lessons to offer the United States when it comes to vaccinating girls against human papillomavirus (HPV)—which can cause cervical and head and neck cancers, says Dr. James Conway, associate director for health sciences at the University of Wisconsin-Madison Global Health Institute.

Rwanda has vaccinated 95 percent of 12- to 15-year-old girls against HPV, the most common sexually transmitted disease. In the United States, less than 40 percent of 13- to 17-year-old girls receive needed doses of the vaccination.

“Rwanda is an example of the amazing things that can be done with collaboration, prioritization and removal of barriers,” says Conway, an international champion for the HPV vaccine. He is working to improve vaccination rates in Wisconsin and his team has trained immunization workers in many sub-Saharan African countries.

Rwanda began its HPV vaccine program in 2011 after recognizing the burden and suffering associated with cervical cancer and deaths from the disease. A collaboration of the Rwandan government, cancer control groups, community health workers and pharmaceutical companies resulted in a program to vaccinate girls in schools and reach out to girls not in school.

“If we follow Rwanda’s lead with collaboration and creative problem solving, we can reduce cancer rates in Wisconsin and the U.S. dramatically. We also have the opportunity to even broader in our impact, by immunizing both girls and boys. This could be a game-changer for an entire generation of individuals.”  Dr. James Conway, GHI associate director for health science.

While Rwanda’s school-based approach would not be practical here, the UW Health Immunization Task Force HPV Workgroup—Conway chairs the task force—has taken a page from the country’s program by collaborating with groups from across the UW Health system. This cooperative approach is striving to increase awareness among parents, patients and providers about the importance of routine HPV immunization for all pre-teen boys and girls. A similar collaboration organized by the Wisconsin chapter of the American Academy of Pediatrics (AAP), the Wisconsin Department of Health Services and the Wisconsin Comprehensive Cancer Coalition is working with 19 immunization coalitions, health systems and county health departments around the state to increase vaccination rates.

“It’s like a thousand-piece puzzle,” says Conway, who also chairs the Wisconsin AAP Committee on Immunizations and Infectious Disease. “We have all the pieces but we haven’t put them all together yet.”

Putting the puzzle together to save lives

IMG_0152One of the puzzle pieces is convincing primary care providers to give stronger recommendations to families of both girls and boys for the three-dose series. Conway says providers have little problem following the current recommendations for 11 to 12 year olds, for the meningococcal and tetanus, diphtheria and pertussis (T-dap) vaccines.

“Yet HPV is the most-common sexually-transmitted disease and meningococcal disease is very rare,” said Conway. “We have a vaccine to prevent this very common disease that causes a variety of cancers, but providers hesitate to strongly recommend it.”

HPV can be transmitted by a variety of activities like kissing, not just by sexual intercourse.

“People are still not connecting the dots that HPV causes cancer, and yet it is preventable.”Dr. James Conway

“In teens, the infection is likely to become more chronic, which is why early immunization is so critical,” Conway says. Chronic HPV infections are the eventual cause of pre-cancerous conditions and cancers.

Cervical cancer is most commonly associated with HPV infection. But Conway says HPV can also cause many head and neck cancers, and rates are rising steeply in the United States. In 2012, the Wisconsin Cancer Reporting System said there were nearly 800 new cases of oral cancers and 175 deaths. Cervical cancer was second with 191 new cases in Wisconsin and 54 deaths.

“If we follow Rwanda’s lead with collaboration and creative problem solving, we can reduce cancer rates in Wisconsin and the U.S. dramatically,” Conway says. “We also have the opportunity to be even broader in our impact, by immunizing both girls and boys. This could be a game-changer for an entire generation of individuals.”

By Toni Morrissey at UW Health/ July 14, 2015

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