Brief 5: Knowledge and Awareness of Human Papillomavirus (HPV)

In this HINTS Brief, we explore women's awareness of HPV and knowledge of the HPV-cervical cancer link in 2005, before the introduction of the HPV vaccine.

In 2005, 61 Percent of American Women Had Never Heard of HPV

Since the 2006 FDA approval of Gardasil™ a vaccine to prevent cervical cancer, news stories and advertisements have penetrated print, broadcast, and online communication channels with information about human papillomavirus, more commonly known as HPV. Communication researchers do not yet know how this influx of information has shaped knowledge, attitudes, or opinions about HPV and cervical cancer prevention. However, in 2005, 61 percent of American women aged 18 and older had never heard of HPV, even though it is the leading cause of cervical cancer. Of those who had heard of HPV, 44 percent did not know that it causes cervical cancer. (These percentages are unadjusted for other factors that may predict awareness and knowledge.)

Cervical cancer screening using the Pap test is widely accepted and integrated into the U.S. health care system. Newer HPV-based technologies such as the HPV test and vaccine give women and health care providers options for complementing the Pap test to prevent and control cervical cancer more effectively. Current guidelines recommend using the HPV test in women 30 and older for primary screening, and in women of all ages to follow up an abnormal Pap test. In addition, the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices recently recommended routine HPV vaccination for girls aged 11 and 12. The vaccine protects against two types of HPV that cause 70 percent of all cervical cancers. Not all cervical cancers can be prevented with the vaccine; therefore, it is essential that even vaccinated women continue to receive Pap and HPV tests at the recommended intervals.

Have You Ever Heard of HPV (Human Papillomavirus)?

d

Do You Think HPV Causes Cervical Cancer?

d

How Can This Inform Your Work?

HINTS 2005 does not tell us where women get information about HPV and cervical cancer, nor does it capture the likely increase in awareness of HPV since the 2006 introduction of Gardasil™ and its associated campaigns. Nonetheless, HINTS tells us that in 2005, American women were largely unaware of the virus that causes the majority of cervical cancers. There are several tasks that health educators and health communication practitioners can take on to increase the likelihood that women have accurate awareness of HPV and its relationship to cervical cancer.

• Efforts are needed to increase recognition of the name of the virus, human papillomavirus, and its acronym, HPV, especially among older women, less educated women, and those not being screened regularly for cervical cancer.



• Efforts are needed to increase the depth of accurate knowledge about HPV and its link to cervical cancer. This information should be shared with women before they are at risk for contracting and suffering adverse consequences from an HPV infection.



• Women who are vaccinated against HPV must understand that regular Pap or HPV tests are still needed to screen for the types of cervical cancer not covered by the vaccine.

The HPV-Cervical Cancer Connection: Do Women Understand the Link?

A recently published HINTS study revealed that awareness of HPV among American women in 2005 was low, and that accurate knowledge of the HPV-cervical cancer link is generally limited to women who have tested positive for HPV or who have had an abnormal Pap test. Therefore, educating women about persistent HPV infection and its relationship to cervical cancer is crucial.

The study used 2005 HINTS data to assess awareness and accurate knowledge of HPV and cervical cancer among American women. Researchers also examined whether variables for sociodemographics, access to health care, cervical cancer screening history, cancer history, and health information trust and attention were associated with accurate knowledge. The study found that awareness of HPV was significantly lower among women who are older, less educated, and less exposed to health information. Factors associated with having heard of HPV were being non-Hispanic White, getting regular Pap tests, and being aware of the change in cervical cancer screening guidelines.

Among those women who had heard of HPV, the multivariate analysis found that the only factors positively associated with knowing that HPV causes cervical cancer were having had an abnormal Pap or a positive HPV test result. It appears that education about the HPV-cervical cancer link is more likely to occur after a woman has experienced an adverse consequence from an HPV infection.

Investigators suggest that if HPV testing and vaccination represent the future of cervical cancer control, population-wide understanding of HPV and its relationship to cervical cancer is imperative.

HPV Awareness and Knowledge: Differences by Education and Cervical Cancer Screening History

Despite some key differences by level of education and cervical cancer screening history, it is important to remember that the majority (61 percent) of all female respondents to HINTS in 2005 had never heard of HPV, and that among those who had heard of the virus, less than half knew that it causes cervical cancer. Below, we provide associations identified in a recent HINTS 2005 publication by education and screening history, adjusting for other factors that predict HPV awareness and knowledge.

Education
In 2005, awareness of HPV was greater among respondents with some college (47%) or a college degree (61%) compared with respondents with a high school degree (27%) or less (16%).

Among those who had heard of HPV, accurate knowledge of the HPV cervical cancer link was highest among college graduates (54%) compared with those with less education.

Cervical Cancer Screening History
Awareness of HPV was greatest (100%) among women who said they had had a positive HPV test. HPV awareness also was higher among women who received Pap tests on a regular schedule. Women who reported having regular cervical cancer screening were more likely to say they had heard of HPV (45%) compared with women who only recently had a Pap test (26%) or women who never or had not recently had a Pap test (24%).

Among women who had heard of HPV, the multivariate analysis found only two factors associated with knowing HPV causes cervical cancer: positive HPV test and abnormal Pap test. Among women who reported having had a positive HPV test, 72% were aware that an HPV infection could cause cervical cancer while only 46% of women who had not had a positive HPV test were aware of this connection. Similarly, while 68% of women who had a previous abnormal Pap result knew that an HPV infection could cause cervical cancer, only 47% of women who had not had an abnormal Pap result were aware. Getting regular Pap tests was not associated with knowing about the HPV-cervical cancer connection.

References Used in This HINTS Brief

Tiro JA, Meissner HI, Kobrin S, Chollette V. What do women in the U.S. know about human papillomavirus (HPV) and cervical cancer? Cancer Epidemiology, Biomarkers, and Prevention, 16(2), 2007.

Human Papillomaviruses and Cancer: Questions and Answers, NCI Fact Sheet (2006), http://www.cancer.gov/cancertopics/factsheet/Risk/HPV

CDC Advisory Committee on Immunization Practices (2006), http://www.cdc.gov

NCI’s Cancer Trends Progress Report—2005 Update, http://progressreport.cancer.gov

American Cancer Society. Cancer Prevention & Early Detection: Facts and Figures 2006, http://www.cancer.org

For More Information on Cancer

• Call the NCI Cancer Information Service at 1-800-4-CANCER (1-800-422-6237)



• Visit http://cancer.gov



• Order NCI publications at http://www.cancer.gov/publications

March 2007