The Cancer Plan

Expand Access to Palliative  and Support Care 

 

Cancer prevention starts long before a diagnosis—with the choices we make, the environments we live in, and the policies we support. In Georgia, we’re focusing on two of the most powerful tools to reduce cancer before it begins: reducing tobacco use and increasing HPV vaccination.

This priority area of the Georgia Cancer Plan aims to reduce the number of Georgians who develop cancer in the first place—especially in communities where risk is highest.

Background – HPV

High-risk types of HPV have been linked to six HPV-related cancers, which include cervical, vulvar, vaginal, penile, anal, and oropharyngeal cancers. 1 Overall, in the U.S., there are about 37,300 cancer cases attributable to HPV each year.2

It is estimated that 70% of oropharyngeal cancers can be attributed to HPV.2 In women with a cervix, cervical cancer is the most common cancer linked to HPV; in fact, almost all cervical cancers are caused by HPV.2 HPV vaccines were developed in 2006 and serve as cancer prevention against the six HPV- related cancers. The CDC’s Advisory Committee on Immunization Practices recommends HPV vaccination for all adolescents and adults from ages 9 to 26 and for some adults between ages 27 to 45.3

The HPV vaccination series is a 3-part series for those who start the series at 15 years of age or older. Only two doses are required for those starting the series under 15 years of age unless the adolescent is considered immunocompromised. Since the HPV vaccines have been in place, HPV infections, associated genital warts, and cervical precancers have decreased. Studies have found that more than 98% of recipients develop an antibody response to HPV types included in the respective vaccines once a month after completing a full vaccination series.4 Healthcare providers who provide clear, strong recommendations for HPV vaccination among their adolescent patients play an important role in promoting HPV vaccination.5 In Georgia, HPV vaccination among adolescents is lower than the national rate. There is also a significant disparity when comparing vaccination rates for HPV to the vaccination rates for other routinely recommended adolescent vaccinations (>90%). According to the 2022 CDC National Immunization Survey, NIS, 90% of U.S. adolescents aged 13-17 received one or more HPV vaccination doses, and 62.6% completed the HPV vaccination series.5 In Georgia, the rate of HPV vaccination among adolescents is 70.8% for one or more doses and 61.5% for up to date (UTD).5 Among adults aged 18-26, 44.7% reported having had an HPV vaccination in their lifetime; of those vaccinated, 51.6% completed the HPV vaccination series.6

    Background – Tobacco

    Tobacco use causes at least 12 types of cancer and is linked to 40% of all cancer diagnoses. Overall, about 3 in 10 cancer deaths are caused by cigarette smoking, and lung cancer is the leading cause of cancer death for both men and women nationally. Additionally, cancers of the cervix, colon, and rectum can also be linked to tobacco-related cancers. 7

    In Georgia, approximately 18% of adults smoke cigarettes, 87% of lung cancer deaths for men, and 70% of lung cancer deaths for women are due to smoking. 8

    Each year, Georgia spends approximately $1.8 billion in healthcare costs and $3.2 billion in lost productivity costs due to cigarette smoking among adults. 9

    If the current adult smoking prevalence persists, 219,000 Georgia Residents who were between 0-17 years of age in 2010 could die prematurely due to smoking-related illnesses during adulthood. 9 If the current prevalence of smoking continues, 219,000 Georgians who are currently 15-32 years old could die prematurely due to smoking- related illnesses. 9

    Georgia has a statewide Tobacco Use Prevention Program Comprehensive Plan that establishes goals, objectives, and tobacco prevention and control strategies. Additionally, the Georgia Tobacco Use Prevention Program, along with the Georgia Tobacco Quit Line, are free health services available to Georgians who want to quit smoking, vaping, and using other forms of tobacco.

      Objectives

      Objective 1 - HPV

      To increase the percentage of vaccine-eligible individuals in Georgia, starting at age 9 and up to 26 years old, who have completed the HPV vaccination series.

      Objective 2 - HPV

      To raise awareness and education on HPV vaccination as cancer prevention for six HPV-related cancers.

      Objective 1 - Tobacco

      Support statewide efforts aimed at tobacco use and control to reduce the incidence and prevalence of cancer.

      Strategies

       

      Strategy

      Strategic Actions

      Target Populations

      Key Collaborators

      Ensure Quality Data and Continuous Learning

      Develop a provider survey to better understand provider perspectives and current practices regarding HPV vaccination.

      Describe HPV vaccination coverage rates by race/ethnicity by country to identify HPV vaccination disparities.

      Healthcare providers, such as pediatricians, physicians, pharmacists, and dentists.

      State and local health department officials who are responsible for data collection and management systems.

      • American Cancer Society
      • Emory University Augusta University & University of Georgia Medical Partnership
      • Georgia Department of Public Health
      • Hispanic Health Coalition of Georgia
      Improve Provider Education, Clinical Training and Practice

      Develop and distribute a 1- pager educational piece with HPV guidelines for providers.

      Collaborate with school- based health clinics to increase HPV vaccine awareness.

      Provide HPV vaccination requirements/education to staff of FQHCs.

      Target statewide organizations that have direct engagement opportunities for targeted HPV adolescent populations to address provider confidence and recommendations to start HPV vaccination series at age 9.

      Healthcare providers, such as pediatricians, physicians, pharmacists, and dentists.

      Healthcare organizations clinics, school-based health centers, health plans and payers, and other healthcare institutions.

      Healthcare and consumer advocacy and professional societies and organizations.

      • American Cancer Society Emory University
      • Augusta University & University of Georgia Medical Partnership
      • Hispanic Health Coalition of Georgia
      • Unified Healthcare for the Rural Underserved
      • CareSource
      Facilitate Policy Action and Advocacy – HPV

      Host Cervical Cancer and HPV Awareness Day events at the Capitol to expand public education and advocate for HPV vaccination among policymakers and healthcare providers.

      Build partnerships with healthcare organizations, school systems, and community-based organizations around increasing HPV vaccination rates and cancer prevention efforts.

      Utilize social media platforms, including Twitter, Instagram, Facebook, and LinkedIn, to create new partnerships and advocate for HPV vaccination.

      All individuals in the state of Georgia, particularly those affected by health inequities that negatively impact vaccination rates and health education, including low-income communities and racial/ethnic minority groups.

      Healthcare providers, such as pediatricians, physicians, pharmacists, and dentists.

      Healthcare and consumer advocacy and professional societies and organizations.

      • Augusta University &
      • University of Georgia Medical Partnership
      • Emory University American Cancer Society Cancer Pathways Hispanic
      • Health Coalition of Georgia Susan Jolly Awareness Program
      Facilitate Policy Action and Advocacy – Tobacco

      Actively participate in oversight, planning, and implementation groups in the DPH tobacco control accountability infrastructure.

      Enable and empower regional cancer coalitions to increase awareness, promote use cessation, and advocate for policy change to support tobacco control.

      Residents of rural health districts and communities

      Students at schools and universities

      Employees of health systems

      State and local policymakers

       

      • Augusta University &
      • University of Georgia Medical Partnership
      • Emory University American Cancer Society Cancer Pathways Hispanic
      • Health Coalition of Georgia Susan Jolly Awareness Program

       

      Measures

       

      5 Year Success Measure

      Baseline Values

      Target Values

      HPV vaccination rate among adolescents aged 13-17 in Georgia.61.5%70%
      HPV vaccination rate among adults aged 18-26 in Georgia.51.6%60%
      Several educational provider training sessions have been conducted on HPV vaccination in prioritized public health districts.None (New Measure)5
      Several HPV awareness initiatives and events were hosted. None (New Measure)5
      Several established commitments from regional cancer coaltions serve underserved communitites in Georgia.None (New Measure)5

       

      1. (2020, July 30). HPV and Cancer. Retrieved August 9, 2023, from American Cancer Society: https://www.cancer.org/cancer/risk-prevention/hpv/hpv- and-cancer-info.html
      2. (2022, October 3). How Many Cancers Are Linked with HPV Each Year? Retrieved August 9, 2023, from Centers for Disease Control and Prevention: https://www.cdc.gov/cancer/hpv/statistics/cases.htm
      3. (2021, November 16). HPV Vaccination Recommendations. Retrieved August 9, 2023, from Centers for Disease Control and Prevention: https://www.cdc.gov/vaccines/vpd/hpv/hcp/recommendations.html
      4. (2021, November 16). About HPV Vaccines. Retrieved August 9, 2023, from Centers for Disease Control and Prevention: https://www.cdc.gov/vaccines/vpd/hpv/hcp/vaccines.html
      5. (2021, May 14). Vaccination Coverage among Adolescents (13 – 17 Years). Retrieved August 9, 2023, from Centers for Disease Control and Prevention: https://www.cdc.gov/teenvaxview/interactive/?CDC_AAref_Val=https://www.cdc.gov/vaccines/imz-managers/coverage/teenvaxview/ data-reports/index.html
      6. (2023, July 21). 2021 BRFSS Survey Data and Documentation. Retrieved August 9, 2023, from Centers for Disease Control and Prevention: https://www.cdc.gov/brfss/annual_data/annual_2021.html
      7. Centers for Disease Control and Prevention (CDC). (2023). Tobacco and Retrieved from: https://www.cdc.gov/cancer/risk-factors/ tobacco.html
      8. Davis VN, Lavender A, Bayakly R, Ray K, Moon Using Current Smoking Prevalence to Project Lung Cancer Morbidity and Mortality in Georgia by 2020. Prev Chronic Dis 2013;10:120271. DOI: http://dx.doi.org/10.5888/pcd10.120271
      9. Georgia Department of Public Tobacco. Retrieved from: https://dph.georgia.gov/chronic-disease-prevention/tobacco