Consideration for HPV vaccination recommendations in patients with vulvar dysplasia and malignancy following resection: A retrospective study investigating rural-urban vaccination practices in patients served by an academic medical center in the heartland

Abstract

Objectives

The American College of Obstetricians and Gynecologists (ACOG) recommends the HPV vaccine for unvaccinated or incompletely vaccinated individuals as an adjuvant treatment for cervical intraepithelial neoplasia (CIN) 2 + . Due to no such recommendation for adjuvant HPV vaccination for patients with vulvar intraepithelial neoplasia (VIN) 2 + after resection, and due to the large catchment area of our institution comprising rural and urban patient populations, which are disproportionately affected by HPV-associated cancers, we examined HPV vaccination uptake in patients with VIN2 + and vulvar malignancy and assessed relationships between social vulnerability and rurality.

Methods

We performed a retrospective analysis of patients treated between 2018 and 2023 at a single Midwestern academic medical center. The study analyzed clinical and demographic data along with the associated social vulnerability index (SVI) and Rural-Urban Commuting Area (RUCA) codes.

Results

Two hundred three unique patients met inclusion criteria. Of these, 36.5% (n = 74) lived in non-urban areas and 63.5% (n = 129) lived in urban areas. In the population of patients younger than 45 years of age who were not vaccinated for HPV prior to their VIN2 + diagnosis and treatment (n = 31), only 19.4% (n = 6) received at least one dose of the HPV vaccine in the adjuvant setting. Social vulnerability in housing and transportation was greatest in those living in rural areas.

Conclusions

Extending the ACOG 2023 practice advisory recommendation for adjuvant HPV vaccination after excisional procedures for CIN2 + to encompass patients treated for VIN2 + may help reduce the burden of HPV-associated cancers.