Survey data presented during the AACR Annual Meeting 2023 revealed that Americans have become less aware of the link between human papillomavirus (HPV) and cervical cancer in recent years (Abstract 4210). Participants also demonstrated low awareness that HPV can lead to other malignancies, including anal, oral, and penile cancers.
In 2006, the first HPV vaccine for girls and women was approved by the FDA. This vaccine approval was expanded to boys and men in 2009. The CDC currently recommends that boys and girls receive the HPV vaccination at age 11 or 12. Those who begin the vaccination series before turning 15 should receive two doses, while those who start the series later should receive three doses of the vaccine.
"There are now over 45,000 HPV-associated cancers that are diagnosed in the U.S. every year," noted lead study author Eric Adjei Boakye, PhD, Assistant Scientist in the Department of Public Health Sciences and the Department of Otolaryngology at Henry Ford Health in Detroit. "It is estimated that over 90 percent of these cancers could be prevented with the HPV vaccination, yet vaccine uptake remains suboptimal.
"Currently, about 54.5 percent 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 percent of adolescents fully vaccinated," he noted in a press release.
Prior research has shown that awareness of HPV's link to several cancer types can improve HPV vaccination uptake, according to Adjei Boakye, who noted that several efforts to increase awareness have been made. However, it is unclear if these efforts have resulted in increased HPV-associated cancer awareness.
Study Methods
To better understand this issue, Adjei Boakye and colleagues examined current awareness regarding the association between HPV and cancer. They used Health Information National Trends Survey (HINTS) data from 2014 to 2020. HINTS is a nationally representative survey of adults 18 years and older in the civilian non-institutionalized U.S. population; therefore, Adjei Boakye noted the results are representative of the entire U.S. population.
HPV-associated cancer awareness was assessed with the question "Do you think HPV can cause 1) anal, 2) cervical, 3) oral, and 4) penile cancers?" Response options were "yes," "no," and "not sure."
"There were five time points included in the study: HINTS 4 Cycle 4 (2014, n=2,239), HINTS 5 Cycle 1 (2017, n=2,034), HINTS 5 Cycle 2 (2018, n=2,050), HINTS 5 Cycle 3 (2019, n=2,270), and HINTS 5 Cycle 4 (2020, n=2,340)," according to the study authors, who calculated weighted prevalence estimates and corresponding 95 percent CIs for all four HPV-associated cancer awareness questions at each time point.
Key Findings
The study included a total of 10,933 respondents. Fifty-eight percent were female and 68 percent identified as non-Hispanic White. Among study participants, 38 percent had a college degree or higher, 91 percent use the internet, and 89 percent reside in an urban area.
While awareness of the link between HPV and cervical cancer was high, the study authors observed a decrease from 77.6 percent in 2014 to 70.2 percent in 2020. Awareness that HPV can cause anal, oral, and penile cancers was low-around 30 percent for each cancer type-throughout the duration of the study, according to Adjei Boakye, but remained relatively stable between 2014 and 2020.
The study authors reported the following changes in awareness for each cancer type between 2014 and 2020: anal cancer (27.9% vs. 27.4%), oral cancer (31.2% vs. 29.5%), and penile cancer (30.3% vs. 28.4%).
"Awareness that HPV can cause anal, oral, and penile cancers has remained low since 2014," Adjei Boakye summarized during a press conference. "For cervical cancer, even though it has been high overall, [awareness] has been decreasing over time."
He acknowledged that the cross-sectional design of the study is a potential limitation. Another limitation is overestimation of awareness level. Individuals who said they had never heard of HPV were not asked the follow-up questions. As a result, overall public awareness may be even lower, he noted.
Study Implications
The results of this study underscore the need for implementing novel and targeted interventions to increase awareness, as well as counteract HPV vaccine disinformation, according to Adjei Boakye. Future research may assess public opinion on the vaccine following the COVID-19 pandemic.
"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 emphasized in a statement.
"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 recommended.
Catlin Nalley is a contributing writer.