Pre-cervical cancers have plummeted for Kaiser Permanente members in Northern California in their early 20s, and there’s a clear reason why.

Rates for human papillomavirus (HPV) vaccination have soared.

That’s a sea change from 10 years ago when the region’s HPV vaccination rates were only slightly better than the low national average.

After addressing numerous barriers with innovative efforts, the improvement in vaccination was dramatic.

Today, with its HPV vaccination rates of 72% for girls and 70% for boys ages 9 to 12, Kaiser Permanente in Northern California is a national leader.

Back in 2015, those rates were 39% for girls and just 33% for boys by age 13.

Higher vaccination rates mean fewer cancer cases. In Kaiser Permanente Northern California, pre-cervical cancer rates for those ages 20 to 24 have decreased a whopping 90% since 2014.

“It’s an incredible feeling to know that we all contributed individually to this collective success,” said Donna Hong, MD, regional clinical lead for pediatric and adult immunization, and chief of Pediatrics at Kaiser Permanente in Pleasanton. “Every patient we vaccinate adds up to a future with less cancer.”

A vaccine to prevent cancer

The HPV vaccine protects against a sexually transmitted virus that causes the majority of cervical cancer cases, as well as other cancers and genital warts.

The vaccine was first recommended in the United States in 2006 for girls ages 9 to 12. The recommendation for boys followed in 2011. While the vaccine is recommended up to age 26 and FDA-approved up to age 45, it’s considered best by the medical community to receive the 2-dose vaccine between the ages of 9 and 13.

“Our goal is to do everything we can to create a blanket of protection over the entire patient population, well in advance of any exposures,” said Kenneth Hempstead, MD, a Roseville pediatrician and regional vaccine communications lead.

Since the vaccine was first introduced, HPV infections that cause most HPV-related cancers and genital warts have dropped 88% among teen girls and 81% among young adult women in the United States, according to the Centers for Disease Control and Prevention. Vaccinations, even at lower levels, in combination with routine cervical cancer screening, have led to a decline in cervical cancer in the United States.

When physicians in Kaiser Permanente Northen California set out to improve our vaccination rates, a team examined what might be preventing patients and their caregivers from saying “yes” to the vaccine. They began by tracking which patients needed vaccination, where in a medical center the vaccine was being given, and how physicians were talking to families about it.

What they uncovered became their roadmap to success.

First, they learned if patients had to go to another room, even next door, to receive the shot, they were less likely to get vaccinated. So, the team made it easier to offer the vaccine in the exam room.

They also discovered that many patients weren’t receiving the second dose. The team modified the scheduling system to enable parents to immediately book an appointment for the second dose, which needs to be done at least 6 months after the first. They also made it easier for parents to see online reminders about a second dose.

Finally, physicians were trained on “Communicating Without Confrontation,” a curriculum that goes beyond the traditional approach of trying to persuade parents with studies and science, which can be counterproductive.

Dr. Hempstead, who pioneered the curriculum with others, explained, “What works much better is coming together with parents, building trust, and helping them understand that we have the same goal: safeguarding their children’s health now and into the future.”

This story was adapted from an article originally appearing in “Permanente Excellence,” a publication of the Permanente Medical Group.