
Human papillomavirus, or HPV, a common sexually transmitted infection that spreads through sexual contact, can lead to cervical, vaginal, vulvar, anal, and head and neck cancer, and is estimated to cause about 36,000 cases of cervical cancer in the United States each year.
The HPV vaccination, approved by the Food and Drug Administration in 2006, is widely available and provides safe and lasting protection against the HPV infections that can cause cancer. The vaccine is highly effective; the Centers for Disease Control estimates it has the potential to prevent more than 90% of cancers caused by HPV.
However, significant disparities in HPV vaccination among lower-income individuals and certain racial and ethnic groups persist in Oregon and around the country.
To address this, Oregon Health & Science University clinicians and researchers are working to improve communication around HPV and HPV-related diseases, and are implementing targeted interventions to expand vaccine access and cervical cancer screenings among underserved and at-risk populations.
Reaching patients where they are
The HPV vaccination is recommended to be given at age 9 through 12 and is recommended up to age 45. However, HPV vaccination rates are low among women aged 18 to 26 because if individuals were not vaccinated during adolescence, many believe they have missed their vaccination window.
Researchers at OHSU’s Center for Women’s Health are investigating how to improve the rates of HPV vaccination among this age group. A recent study found that the postpartum period is an ideal opportunity for individuals to be vaccinated.
The study identified patients who were less likely to be vaccinated prior to their child’s delivery, as well as patients who are more likely to accept vaccinations postpartum. After engaging in HPV-focused counseling and education, patients were offered the first dose of their vaccine after delivery, the second dose at their first postpartum visit and the third and final dose at a later scheduled visit.

“New parents understandably have a lot on their plate, so it’s important to be able to meet patients where they are and create opportunities for discussion, and vaccination if they choose, during existing healthcare visits,” said Christine Nguyen Dawson, M.D., a resident-physician in obstetrics and gynecology, who led the study alongside Amanda Bruegl, M.D., gynecologic oncologist and associate professor of obstetrics and gynecology, both in the OHSU School of Medicine.

Looking forward, Nguyen Dawson and colleagues are exploring additional opportunities to educate about vaccination at patients’ in-hospital visits, including lactation counseling sessions and well-child appointments. The team is also conducting a knowledge-based assessment and qualitative study to better understand the OHSU patient population’s knowledge of HPV and HPV-related diseases, to help improve patient-provider counseling and inform future interventions.
Addressing population-based disparities
A key part of preventing cervical cancer is the administering of the HPV vaccine: It protects against most forms of the cancer, whereas lower vaccination rates paired with decreased screenings in underserved communities often cause cervical cancer rates to spike. This is especially true among Native American and Latinx communities, who face disproportionate rates of cervical cancer due to social, economic and environmental barriers to health.

Cirila Estela Vasquez Guzman, Ph.D., assistant professor of family medicine in the OHSU School of Medicine, is bridging the gap in education and awareness through her research, which involved driving nearly 2,000 miles across Oregon and Washington to collect the lived experiences of older Latina women diagnosed with cervical cancer. Her hope is that these women’s testimonies will give providers and health care systems a better understanding of the barriers for these communities so action can be taken to improve their diagnosis and treatment experiences.
Next in her research, Vasquez Guzman will begin interviewing providers and health care systems and aims to develop a clinical intervention that leverages community-based research.
“There are a lot of misconceptions about the risks of HPV and who can be affected. But even if you’re educating an older woman, she has the power to communicate that information to her daughter or her granddaughter, which can improve a whole family’s understanding of this disease,” Vasquez Guzman said. “Our goal is to arm communities with information, so they feel educated and empowered to protect themselves and their loved ones against this highly preventable disease.”
Providing care in the community
Despite the survival benefits associated with cervical cancer screening, preventable cervical cancer deaths persist in part due to distrust, anxiety and misinformation around gynecologic procedures. In the U.S., Asian American women have the lowest rates of screening.
Since October, the OHSU Department of Pathology and Laboratory Medicine has partnered with community organizations to provide free HPV screening through self-collection vaginal swabs and community-based cervical cancer education to medically underserved Asian and Latina women.

“It’s been effective doing this work outside traditional health care settings because we can meet individuals at cultural centers that they would be frequenting, and offer services after hours and on weekends, when many clinics aren’t open,” said Vanderlene Kung, M.D., Ph.D., assistant professor of pathology and laboratory medicine in the OHSU School of Medicine, who leads a team of pathologists and researchers who are expanding cervical cancer education and screening in the Portland-Metro area.
“Most critical to our work, though, is partnering with organizations who have built trust within their communities,” she said. “Those community-based relationships have made all the difference.”
One such organization is the Chinese Friendship Association, a nonprofit group dedicated to supporting immigrants and fostering a greater cultural understanding among people in Oregon.
“This partnership is great, because information can be provided in the language of the community and services are offered in a location that’s comfortable and convenient,” said Iris Zhao, program director of the Chinese Friendship Association of Portland. “If we can bring health services closer to the community, it’s beneficial for everyone. I hope these types of efforts in the future will be more community-focused and mobile.”