# Prophylactic HPV Vaccination in Gynaecological Practice: Recommendations, Practices, and Challenges Reported in the ESGO-PERCH HPV Survey

## TL;DR

This study explores how gynecological oncologists recommend and practice HPV vaccination for cancer patients, revealing a gap between clinical practices and scientific evidence.

## Contribution

The paper provides insights into clinicians' perspectives and barriers to HPV vaccination in oncologic care, highlighting discrepancies between practice and evidence.

## Key findings

- Most clinicians support HPV vaccination for cervical precancer patients under 45, but recommendations vary by cancer type and age.
- Barriers to HPV vaccination include misinformation, lack of educational materials, and time constraints.
- There is no evidence supporting HPV vaccination for invasive gynecological cancers, yet it is often recommended beyond evidence-based guidelines.

## Abstract

Background/Objectives: HPV vaccination is highly effective in preventing HPV-related cancers when administered before viral exposure. However, vaccination practices for patients already diagnosed with gynaecological cancers remain poorly characterized. Understanding clinicians’ perspectives and barriers is essential for optimizing preventive strategies in oncologic care. Methods: We conducted an international, web-based survey among members of the European Society of Gynaecological Oncology (ESGO) and the European Network of Young Gynaecological Oncologists (ENYGO). The questionnaire explored clinicians’ attitudes, practices, and perceived obstacles regarding HPV vaccination in patients with gynaecological cancer or pre-invasive disease across multiple clinical scenarios and age groups. Results: A total of 149 respondents from 33 countries completed the survey. Most clinicians supported HPV vaccination for patients treated for cervical precancer (78–82% for patients under 45 years), and even for invasive cervical cancer (57–62%). Recommendations varied by patients’ age, cancer type, and treatment status. For endometrial and ovarian cancer, endorsement ranged from 16% to 53%, depending on patient age. Timing of vaccination was a point of divergence: some clinicians favoured vaccination immediately after treatment for CIN2+, while others recommended delaying vaccination depending on HPV test results. Reported barriers discouraging HPV vaccination recommendations included misinformation (69.8%), lack of patient education materials (52.3%), and time constraints (48.3%), alongside economic factors and uncertainty about efficacy in oncologic settings. Conclusions: The survey shows that HPV vaccination is often recommended beyond evidence-supported indications. Randomized trials have not demonstrated a reduction in CIN2+ recurrence with adjuvant vaccination, and no evidence supports vaccination in women with invasive gynaecological cancers. These findings reveal a gap between clinical practice and available evidence, highlighting the need for clearer, evidence-based guidance.