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.

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.