1. Learning Collaborative #6 October 2016
National Immunization Partnership with the Academic Pediatric Association (NIPA) Wave 2
CDC Grant # 1H23IP000950

2. Agenda Attendance Review CORNET Data Oropharyngeal Cancer
Data Collection Reminder
LC schedule & Data Submission Dates
Any questions?
Contact Information

3. CORNET Data

4. Intervention: Prompts

5. Intervention: Standing Orders

6. Intervention: Reminder-Recall

7. Total Missed Opportunities

8. Missed Opportunities by Dose
- Ask Rachel

9. Missed Opportunities by Gender

10. Missed Opportunities by Visit Type

11. Reason Not Vaccinated

12. Oropharyngeal Cancer

13. HPV Cancer Survivor Videos
Head & Neck Surgeon
Other Survivor Videos

14. HPV Types Differ in their Disease Associations
Mucosal
sites of infection
Cutaneous
~ 80 Types
“Common” Hand and Foot
Warts
~40 Types
Genital Warts
Laryngeal Papillomas
Low Grade Cervical Disease
Low risk (non-oncogenic) HPV 6, 11 most common
High risk (oncogenic) HPV 16, 18 most common
Cervical Cancer Anogenital Cancers Oropharyngeal Cancer Cancer Precursors
HPV types differ in their tendency to infect cutaneous and mucosal or genital epithelium. More than 150 HPV types have been identified, including approximately 40 that infect the genital area. Genital HPV types are categorized according to their epidemiologic association with cervical cancer. High-risk types (e.g., types 16 and 18) can cause low-grade cervical cell abnormalities, high-grade cervical cell abnormalities that are precursors to cancer, and cancers. In addition to cervical cancer, HPV infection also is the cause of some cancers of the vulva, vagina, penis, and anus, as well as cancer of the oropharynx.
Low-risk types like 6 and 11 can cause benign or low-grade cervical cell changes, genital warts, and recurrent respiratory papillomatosis.

15. Cancers Caused by HPV, U.S.
Cancer site
Average number of cancers per year probably caused by HPV
Percentage per year
Male
Female
Both Sexes
Anus
1,600
3,000
4,600
91%
Cervix
10,700
Oropharynx
9,100
2,000
11,100
70%
Penis
700
63%
Rectum
200
500
Vagina
600
75%
Vulva
2,400
2,200
69%
TOTAL
11,600
19,200
30,800
Here you can see the distribution of HPV cancers at the various anatomic sites, with about 11,600 HPV cancers occurring in men, and 19,200 HPV cancers occurring in women, in the US, annually.
CDC, United States Cancer Statistics (USCS),

16. New Cancers Caused by HPV per Year United States 2008-2012
Rectum n=500 3%
Men (n = 11,600)
Anus n=1,600 14%
Oropharynx n=9,100 78%
Penis n=700 6%
Rectum n=200 2%
Anus n=3,000 16%
Cervix n=10,700 56%
Vagina n=600 3%
Vulva n=2, %
Oropharynx n=2,000 10%
This is another way of looking at the same information, and we can clearly see that the predominant HPV cancer in women is cervical cancer and the predominant HPV cancer in males is oropharyngeal.
Women (n = 19,200)
CDC, United States Cancer Statistics (USCS),

17. Number of HPV-Associated Cancer Cases Probably Caused by HPV per Year in the United States, 2008–2012
Data are from population-based registries participating in CDC’s National Program of Cancer Registries or NCI’s Surveillance, Epidemiology, and End Results Program, meeting USCS publication criteria quality for all years 2008–2012, and cover about 99% of the US population. HPV-associated cancers were defined as cancers at specific anatomic sites with specific cellular types in which HPV DNA frequently is found. All cancers were confirmed histologically. Cervical cancers (ICD-O-3 site codes C53.0–C53.9) were limited to carcinomas (ICD-O-3 histology codes 8010–8671, 8940–8941). Vaginal (ICD-O-3 site code C52.9), vulvar (ICD-O-3 site codes C51.0–C51.9), penile (ICD-O-3 site codes C60.0–60.9), anal (ICD-O-3 site code C21.0–C21.9), rectal (ICD-O-3 site code C20.9) and oropharyngeal (ICD-O-3 site codes C01.9, C02.4, C02.8, C05.0, C05.1, C05.2, C05.8, C05.9, C09.0, C09.1, C09.8, C09.9, C10.0, C10.1, C10.2, C10.3, C10.4, C10.8, C10.9, C14.0, C14.2 and C14.8) cancers were limited to squamous cell carcinomas (ICD-O-3 histology codes 8050–8084, 8120–8131).
Adapted from: Viens et al. Human Papillomavirus- Associated Cancers—United States, 2008–2012. MMWR 2016;65(26):

18. Rates of HPV-Associated Cancer and Median Age at Diagnosis Among Males in the United States, 2008–2012
Rates are per 100,000 persons and age-adjusted to the 2000 US standard population. Data are from population-based registries participating in CDC’s National Program of Cancer Registries or NCI’s Surveillance, Epidemiology, and End Results Program, meeting USCS publication criteria for all years 2008–2012, and cover about 99% of the US population. Rates are not shown for some cancer sites and age groups because there were fewer than 16 cases. HPV-associated cancers were defined as cancers at specific anatomic sites with specific cellular types in which HPV DNA frequently is found. All cancers were confirmed histologically. Cervical cancers (ICD-O-3 site codes C53.0–C53.9) were limited to carcinomas (ICD-O-3 histology codes 8010–8671, 8940–8941). Vaginal (ICD-O-3 site code C52.9), vulvar (ICD-O-3 site codes C51.0–C51.9), penile (ICD-O-3 site codes C60.0–60.9), anal (ICD-O-3 site code C21.0–C21.9), rectal (ICD-O-3 site code C20.9) and oropharyngeal (ICD-O-3 site codes C01.9, C02.4, C02.8, C05.0, C05.1, C05.2, C05.8, C05.9, C09.0, C09.1, C09.8, C09.9, C10.0, C10.1, C10.2, C10.3, C10.4, C10.8, C10.9, C14.0, C14.2 and C14.8) cancers were limited to squamous cell carcinomas (ICD-O-3 histology codes 8050–8084, 8120–8131). Adapted from: Viens et al. Human Papillomavirus- Associated Cancers—United States, 2008–2012. MMWR 2016;65(26):

19. Notice: Overdue Data All overdue data must be submitted ASAP.
Overdue Data includes:
- Baseline Chart Reviews
- Prior Monthly Chart Reviews
- PDSA Self-Assessments
- Baseline and Monthly Tally Forms
In order for your study team members to receive MOC credit and the participation stipend, all data must be submitted by the end of day, November 5th.

20. Next Learning Collaboratives: October 2016
Data Due:
October Monthly Chart Review Data is due November 5th!
Final Learning Collaborative Call Schedule:
Tuesday 8am ET/ 7am CT/ 6am MT/ 5am PT
Tuesday Noon ET/ 11am CT/ 10am MT/ 9am PT
Friday Noon ET/ 11am CT/ 10am MT/ 9am PT
**If you would like calendar appointments for the final LC calls, please send Holly your preferred date.

21. Any questions?

22. Contact Information
Please contact:
Holly Tyrrell, MSSW
Phone: 703/ x113 I Fax: 703/