Most American Adults Are Unaware of HPV-Related Cancers, Indicating Need for Heightened Awareness

Human papillomavirus (HPV) is the most common sexually transmitted infection, yet many individuals are unaware of its associating cancers and subsequent need for vaccination. In a study published this week in the journal JAMA Pediatrics, researchers from The University of Texas Health Center Science Center at Houston (UTHealth) School of Public Health reported that more than 70% of US adults across 3 age groups were unaware that HPV causes anal, penile, and oral cancers.¹

In the study, 2564 men and 3697 women were split into 3 age groups of 18-26 years, 27-45 years, and 46 years and older:

• In people aged 18-26 years, 92.2% of men (95% CI, 87.1%-97.3%) and 79.4% of women (95% CI, 68.6%-90.3%) were unaware that HPV causes anal, penile, and oral cancers
• In people aged 27-45 years, 89.0% of men (95% CI, 82.7%-95.4%) and 77.8% of women (95% CI, 66.5%-89.1%) were unaware that HPV causes anal, penile, and oral cancers
• In people aged 46 years and older, 84.7% of men (95% CI, 74.1%-95.2%) and 77.6% of women (95% CI, 66.8%-88.4%) were unaware that HPV causes anal, penile, and oral cancers

A lack of HPV awareness was shown throughout the study, with men exhibiting diminished knowledge of HPV and the HPV vaccine when compared with women. Lead study author Ashish Deshmukh, PhD, MPH, assistant professor at UTHealth School of Public Health in Houston, attributed current HPV advocacy campaigns as an underlying cause of the gap in knowledge.

“HPV vaccination campaigns have focused heavily on cervical cancer prevention in women. Our findings demonstrate a need to educate both sexes regarding HPV and HPV vaccination,” said Deshmukh in a statement.

Lack of Recommendations

HPV awareness is an issue that has a myriad of contributing complications. Findings presented at the Society of Gynecologic Oncology 2018 Annual Meeting on Women’s Cancer revealed that a common reason parents may not get their sons vaccinated is because their family doctors do not recommend it.² Parents of boys were found to be significantly more likely to cite lack of HPV vaccine recommendation from a provider for their reported reasoning behind not initiating the HPV vaccine (19% in boys, 10% in girls, P<.001).

Physician recommendations play a vital role in combating stigmas related to vaccinations. In the study from UTHealth, only 19% of men and 31.5% of women who were vaccine-eligible or had vaccine-eligible family members received recommendations for the vaccine from a healthcare provider.

Co-lead study author Kalyani Sonawane, PhD, assistant professor at UTHealth School of Public Health in Houston, accentuated the lack of HPV knowledge for older generations in the study, which further inhibits vaccination numbers.

“Low levels of HPV knowledge in these older age groups is particularly concerning, given that these individuals are (or will likely be) parents responsible to making HPV vaccination decisions for their children,” said Sonawane in a statement. As physicians fail to recommend HPV vaccinations, and parents are unaware of their necessity, the benefit of HPV vaccinations remain concealed.

Handling Vaccination Stigma

The manner in which physicians recommend HPV vaccines is vital as well. In a study published this week in the journal Pediatrics,³ researchers found that while rates of vaccination refusal in parents remain high, utilizing a more presumptive style garnered higher acceptance rates. By pairing HPV with vaccinations such as meningitis or tdap, parents are more likely to understand its importance for their child. This approach has been growing in pediatrician practices as well, with the study detailing a significant 25% increase in strong recommendations for the vaccine between 2013 and 2018 for 11-12-year-old females and a 31% increase in boys of the same age.

Lead study author Allison Kempe, MD, MPH, professor of pediatrics at the University of Colorado School of Medicine, highlighted possible steps to improve HPV vaccination rates.

“The vaccine is underutilized, with less than half of American adolescents completing the vaccination. We need to maximize methods of introducing the vaccine that we know to be more effective, as well as the use of reminder and delivery methods at the practice in order to improve this rate,” said Kempe in a statement.

Necessity of HPV Vaccination

Currently, CDC recommends boys and girls ages 9-14 to receive a 2-dose immunization, with a 3-dose schedule recommended to adolescents who are given their first dose on or after 15 years of age. HPV is associated with numerous cancers, such as cervical, oral, anal, and penal, which stresses the need for vaccination.

"Rates of cervical cancer have declined in the last 15 to 20 years because of screening. On the other hand, there was a greater than 200% increase in oropharyngeal cancer rates in men and a nearly 150% rise in anal cancer rates in women," said Deshmukh.

As emerging studies are finding that HPV may not only be a sexually transmitted disease, and possibly able to spread through the blood, increased populations are at risk.

Reference

1. Suk R, Montealegre JR, Nemutlu GS, et al. Public knowledge of human papillomavirus and receipt of vaccination recommendations. [published online September 16, 2019]. JAMA Pediatrics. doi: 10.1001/jamapediatrics.2019.3105.
2. Caffrey M. Boys don’t get HPV vaccination because doctors don’t recommend it, study finds. The American Journal of Managed Care^® website. ajmc.com/conferences/sgo-2018/boys-dont-get-hpv-vaccination-because-doctors-dont-recommend-it-study-finds. Published March 25, 2018. Accessed September 19, 2019.
3. Kempe A, O’Leary ST, Markowitz LE, et al. HPV vaccine delivery practices by primary care physicians. [published online September 16, 2019]. Pediatrics. Doi: 10.1542/peds.2019-1475.