Awareness of the link between HPV and cervical cancer has declined, finds research

Americans have become less aware that the human papillomavirus (HPV) causes cervical cancer in recent years, according to survey data presented at the AACR Annual Meeting 2023, held April 14-19. Survey respondents also showed low awareness that HPV can cause anal, oral, and penile cancer.

"Over 90% of HPV-associated cancers could be prevented with the HPV vaccination, yet vaccine uptake remains suboptimal," explained the study's lead author, Eric Adjei Boakye, Ph.D., assistant scientist in the Department of Health Sciences and the Department of Otolaryngology at Henry Ford Health in Detroit. Currently, about 54.5% of U.S. adolescents have received all recommended doses of the HPV vaccine, well short of the U.S. government's goal of having 80% of adolescents fully vaccinated.

Previous research has indicated that awareness that HPV can cause several types of cancer can increase a person's likelihood of getting vaccinated. To assess current awareness about HPV and cancer, Adjei Boakye and colleagues examined data from the Health Information National Trends Survey (HINTS) from five timepoints between 2014 (HINTS 4 cycle 4) and 2020 (HINTS 5 cycle 4). Each timepoint featured responses from between 2,000 and 2,350 individuals.

The survey asked respondents, "Do you think HPV can cause i) anal; ii) cervical; iii) oral; and iv) penile cancers?" Responses were "yes," "no," and "not sure."

In 2020, researchers found that 70.2% of respondents knew that HPV can cause cervical cancer, down from 77.6% in 2014.

Awareness that HPV can cause anal, oral, and penile cancers was low throughout the duration of the study. For anal cancer, awareness fell from 27.9% in 2014 to 27.4% in 2020. For oral cancer, awareness fell from 31.2% in 2014 to 29.5% in 2020. For penile cancer, awareness fell from 30.3% in 2014 to 28.4% in 2020.

Adjei Boakye said the results of the study suggest a significant need to educate the public that HPV can cause all four of the cancer types included in this study, plus vulvar and vaginal cancer.

"Given the connections between HPV-associated cancer awareness and HPV vaccination uptake, it is important we increase the population's awareness of this link, as it may help increase vaccine uptake," he said.

The U.S. Food and Drug Administration (FDA) approved the first HPV vaccine for girls and women aged 9 to 26 in 2006. In 2009, the FDA expanded the vaccine approval to boys and men, noting that the vaccine could protect against anal, oral, and penile cancers. Currently, the Centers for Disease Control and Prevention recommend that boys and girls receive the HPV vaccination at age 11 or 12. Two doses of the vaccine are recommended for those who begin the series before their 15th birthday. Three doses are recommended for those who start the series later.

Adjei Boakye said the initial public health campaigns surrounding the vaccine created strong associations with cervical cancer. "The talk about HPV was very female-centric when the vaccine was first approved and recommended. As a result, a lot of people know about HPV causing cervical cancer, but not the other cancers. Our results suggest that interventions to increase awareness of all HPV-associated cancers would benefit public health," he said.

Adjei Boakye said the decline in awareness about HPV and cervical cancer most likely has multiple causes and will require multiple strategies to reverse. He suggested one cause could be an increased focus in training health care providers to promote and administer the vaccine, which may have diverted resources from public information campaigns. Boosting awareness will require a concerted effort from health care providers and public health experts, he suggested.

"Research has shown a high degree of public trust in HPV information when received from health care providers; therefore, providers should use every clinical visit as an opportunity to educate patients about the causal link between HPV and HPV-associated cancers, and also about the cancer prevention benefits of the HPV vaccine," Adjei Boakye said.

Adjei Boakye said future research may assess public opinion on the vaccine in the wake of the COVID-19 pandemic.

Adjei Boakye noted that one potential limitation of the study is its cross-sectional design; the survey assessed different groups of people at each timepoint. Also, people who said they had never heard of HPV were not asked the follow-up questions; therefore, overall public awareness may be even lower, he added.