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By Amanda S. Bruegl, MD, MCR, Oregon Health & Science University

In Oregon, there we 2,533 HPV cancers diagnosed between 2018-2021 with oropharyngeal (42.9%), cervix (22.3%), and anal (18.5%) being the most common. The rates of HPV cancers in the American Indian/Alaska Native (AI/AN) population vary, but the incidence of cervical cancer is 1.5 times the rate of the Non-Hispanic White population and mortality is 2 times the rate demonstrating a preventable disparity.

The Oregon Health & Science University Knight Cancer Institute and Northwest Portland Area Indian Health Board (NPAIHB) joined forces to create a toolkit for providers of AI/AN patients regarding HPV vaccination. NPAIHB is a non-profit tribal advisory organization serving the 43 federally recognized tribes of Oregon, Washington, and Idaho with delegates from each tribe who direct and oversee the activities of NPAIHB.

A joint publication between NPAIHB investigating the rates of HPV vaccination have been increasing steadily over time but remained well below the national Healthy People 2030 goal of 80% with an overall rate of 58.6%. We found that individuals assigned female at birth had higher rates of HPV vaccination initiation and completion than those assigned male at birth, and the age group of 13-17 years had the highest rates of HPV vaccination for all sexes.

Increasing HPV vaccination rates includes a multi-pronged approach with education of healthcare providers, patients, and caregivers. NPAIHB and the Knight Cancer Institute co-developed a resource for providers of AI/AN patients with materials for both general and AI/AN specific messaging around HPV vaccination. Our literature review specific to AI/AN individuals revealed four factors associated with higher rates of HPV vaccination: HPV knowledge, HPV education, provider trust, and cultural practices. The most common barriers to HPV vaccination identified in this population were concerns regarding safety, lack of knowledge about the vaccine, and concerns about its association with sexual activity.

To date, our HPV toolkit has been presented to several AI/AN serving clinics in the Pacific Northwest and the International Indigenous Women’s Health Meeting in New Mexico.

 About Amanda Bruegl, MD, MS

Dr. Amanda Bruegl, MD, MS, is a citizen of Oneida Nation and descendent of Stockbridge-Munsee. She grew up in Wisconsin and went to medical school at University of Washington. She originally thought she wanted to be a Family Medicine Physician and work for her tribe. During clinical rotations, she fell in love with Women’s Health and matched to an OB/Gyn residency at the University of Wisconsin – Madison. After residency, she extended her training and pursued a fellowship in gynecologic oncology. She is currently an Associate Professor and Vice Chair of Diversity, Equity, and Inclusion in the department of OB/Gyn. She enjoys mentoring Indigenous medical students and residents in the field of women’s health and leads faculty development for the Northwest Native American Center of Excellence.