The States Where Fewer Kids Get The HPV Vaccine Have Higher Rates Of Cervical Cancer

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The states with the lowest rates of HPV vaccination are the same ones with the highest rates of cervical cancer, according to a new study that was presented on Tuesday at a conference for the American Association for Cancer Research.

HPV, which stands for the human papillomavirus, is linked to several different types of cancer. In fact, an estimated 91 percent of cervical and anal cancers are probably caused by HPV, according to the Centers for Disease Control and Prevention. And HPV-related cancers have actually been on the rise over the past several years.

Rates of cervical cancer have always varied across the country — so when the HPV vaccine was introduced for widespread use in 2006, public health experts hoped that it would help even out some of those disparities. But that hasn’t been the case. The states with particularly high cancer rates aren’t vaccinating kids against HPV at very high rates.

For instance, according to the new study, 69 percent of the girls who live in Massachusetts get at least one HPV shot. The cervical cancer rate in that state is one of the lowest in the country, affecting just 6 women out of every 100,000. But in states in the South, where cancer is more common, fewer girls are initiating the vaccination process. There are 10.2 cases per 100,000 women in Arkansas, but only 41 percent of girls there get at least one HPV shot. In Mississippi, where there are 9.6 cases per 100,000 women, only 40 percent of girls get a shot.

“These states could really use some interventions to increase the rates of HPV vaccination now, and hopefully there will be big dividends in the coming decades in terms of cancer mortality,” Jennifer Moss, the study’s lead author and a doctoral student at the University of North Carolina Gillings School of Global Public Health, told TIME.

Previous research has found similarly low rates of HPV vaccination in the South, something that’s concerned researchers for years. “If a lower rate of HPV vaccine uptake in the South persists, it could contribute to the national burden of cervical cancer in the long run,” Dr. Abbey Berenson, a researcher at the University of Texas Medical Branch at Galveston, pointed out last year after publishing the results from a study that highlighted this discrepancy.

Moss and her team recommend some simple policies to encourage more girls to get vaccinated against HPV. Health care providers should be more intentional about recommending the shots and explaining their benefits, while state officials could implement programs to fund vaccines for low-income and uninsured families. Moss believes that could help start changing public opinion about the HPV shots.

Public opinion has historically been a big barrier to increasing HPV vaccination rates in the United States, which lag far behind the rates in other developed countries. Since HPV is a sexually transmitted disease, some parents are uncomfortable with the idea of giving their young daughters a vaccine for it — they worry the shot will encourage kids to have risky sex, even though there’s absolutely no link between the vaccine and promiscuous sexual behavior. Others still worry that the HPV shot isn’t safe, even though the CDC recommends it for both boys and girls.

Plus, many parents don’t understand why the vaccine matters in the first place. About 70 percent of U.S. adults don’t realize the HPV shot can protect against cancer, and about a quarter of parents surveyed by the CDC in 2013 said they don’t believe the vaccine is necessary for their kids.