Awareness of the link between the human papillomavirus (HPV) and HPV-associated cervical cancers has declined over time, and awareness of other HPV-associated cancers, such as oral, penile, and anal, remains low, according to a cross-sectional study of the U.S. population presented at the 2023 American Association for Cancer Research (AACR) Annual Meeting.¹ This is worrisome because these cancers are largely preventable with the HPV vaccine, which has been available since 2006 for females and 2009 for males.

Eric Adjei Boakye, PhD

“More than 90% of HPV-associated cancers could be prevented with the HPV vaccination, yet vaccine uptake remains suboptimal,” explained lead author Eric Adjei Boakye, PhD, Assistant Scientist at Henry Ford Hospital, Detroit.

“The incidence of HPV-associated cancers in the United States is more than 45,000 new cases annually. It is estimated that more than 90% of all cancers are preventable with the HPV vaccine. However, as of 2022, only about 60% of the target audience completed vaccination. This is short of the Healthy People 2020 goal of 80% completion,” Dr. Adjei Boakye said.

Study Details

Several efforts have been made to increase awareness of HPV-associated cancers and the ability to prevent them with a vaccine. Dr. Adjei Boakye and coauthors sought to study whether these efforts have led to improved awareness of the causal link between HPV and HPV-associated cancers from 2014 to 2020 in the United States.

To do this, they used the Health Information National Trends Survey (HINTS), which represents adults aged 18 or older in the civilian, noninstitutionalized United States. Five different time points were assessed between 2014 (HINTS 4 cycle 4) and 2020 (HINTS 5 cycle 5). At each time point, between 2,000 and 2,350 adults responded to the survey. These individuals were not necessarily the same, he explained.

The survey question read: “Do you think HPV can cause anal, cervical, oral, and penile cancers?” Responses were “yes,” “no,” and “not sure.”

Key Findings

Results showed that awareness of the link between HPV and cervical cancer decreased from 77.6% in 2014 to 70.2% in 2020, an absolute decrease of 7.4%. Awareness was low but consistent over time for the link between anal, oral, and penile HPV-associated cancers, about 30% for each cancer type. For anal cancer, awareness fell from 27.9% in 2014 to 27.4% in 2020. Awareness of oral cancer 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. Over the same period, there has been an increase in HPV-positive oral and anal cancers in the United States.

“Given the connection between HPV-associated cancer awareness and uptake of the HPV vaccine, it is important to increase the population’s awareness, as uptake of the vaccine could prevent HPV-
associated cancers,” commented Dr. Adjei Boakye. “Novel and targeted strategies are needed to counteract HPV vaccine information.”

During the discussion following his presentation at the AACR meeting, Dr. Adjei Boakye noted that when the vaccine was first approved in 2006 for girls and women aged 9 to 26, awareness was “female-centric.” In 2009, vaccine approval was expanded to include boys and men, when it became evident it could offer protection against anal, oral, and penile cancers. The current recommendation is for boys and girls to receive the HPV vaccine at age 11 or 12.

“Thus, a lot of people know about the link between HPV and cervical cancer, but people are much less aware that HPV can lead to anal, oral, and penile cancers,” he said.

More efforts need to be targeted to health-care providers, such as family physicians, internists, gynecologists, urologists, oncologists, as well as physicians and nurse practitioners. Also, improved public health education is needed.

Limitations of the study are that it is cross-sectional and may overestimate the level of awareness. “A different group of people were asked the question, and the question was asked only of those who had heard about HPV,” Dr. Adjei Boakye said. 

DISCLOSURE: Dr. Adjei Boakye reported no conflicts of interest.

REFERENCE

1. Adjei Boakye E, Nair M, Domgue J, et al: Over 10 years since HPV vaccine approval, awareness of the causal link between HPV and HPV-associated cancers remains low in the U.S. 2023 AACR Annual Meeting. Abstract 4210. Presented April 18, 2023.