Many Unaware of Link between HPV and Some Cancers

Awareness of the link between the human papillomavirus (HPV) and cervical cancer has declined over the past several years, according to a study presented at the American Association for Cancer Research Annual Meeting 2023, held April 14–19 in Orlando, FL. The analysis of a nationwide survey also revealed a limited understanding of HPV's connection with anal, oral, and penile cancers, signaling an urgent need for public education.

The results may explain why vaccination rates remain low more than 15 years after the FDA approved the first HPV vaccine, said the study's lead author Eric Adjei Boakye, PhD, of Henry Ford Health in Detroit, MI, who presented the findings. Currently, only 54.5% of adolescents in the United States have received all recommended doses of the vaccine, well short of the government's goal of 80%.

Adjei Boakye and colleagues analyzed between 2,000 and 2,350 survey responses, depending upon the year, from the Health National Trends Survey at each of five intervals between 2014 and 2020. Respondents were prompted to answer “yes,” “no,” or “not sure” as to whether they thought HPV causes anal, cervical, oral, or penile cancers.

The percentage of respondents ages 18 and older who knew that HPV could cause cervical cancer dropped from 77.6% to 70.2% between 2014 and 2020, researchers reported. Respondents were even less likely to know of HPV's links with anal, oral, and penile cancers, with awareness levels at around 30% for all three cancer types throughout the study period.

The findings probably represent a best-case scenario, noted Adjei Boakye, because only people who had heard of HPV were asked to take the full survey.

“The decline seen for cervical cancer is especially concerning,” said Robert Bednarczyk, PhD, of Winship Cancer Institute of Emory University in Atlanta, GA, whose research focuses on the use of vaccines to prevent HPV-related diseases. “This report should give us pause and prompt us to revisit what we're doing in terms of public education.”

Awareness about HPV's link to cervical cancer was higher among females than males (76% vs. 64%), pointing to a need for more effective public messaging, said Adjei Boakye. The vaccine, approved in 2006, was initially recommended for girls to help protect against cervical cancer, then updated in 2009 to include boys and girls to protect against cervical, anal, oral, and penile cancers. The Centers for Disease Control and Prevention recommend generally starting at age 11 or 12 (see https://www.cdc.gov/vaccines/vpd/hpv/hcp/recommendations.html).

Medical professionals are in the best position to lead public education efforts, Adjei Boakye said. People more readily trust information offered by their physician or nurse practitioner than advertising campaigns on TV or social media.

Public health officials must do a better job of reaching out to pediatricians, in particular, said Bednarczyk. Since HPV-related diseases aren't typically diagnosed in children, the vaccine may receive less attention from pediatricians compared with other vaccines recommended for adolescents, such as bacterial meningitis and pertussis.

The survey highlights the challenge of communicating a clear, concise public message about the HPV vaccine and its related diseases, he added.

“Some of our efforts to normalize the vaccine by calling it the HPV vaccine may be backfiring in that people are viewing it as a vaccine against a virus while not necessarily knowing all the different secondary diseases that can arise,” said Bednarczyk. “It's really important to get the message out that this is a virus that causes six different types of cancer, adding up to about 40,000 diagnoses a year.” –Janet Colwell