Knowledge about human papillomavirus (HPV) among people who are eligible for the HPV vaccine is critical to increasing vaccination update, but research shows this vaccination coverage is suboptimal in the United States. In 2017, only 50% of vaccine age-eligible adolescents were vaccinated, which is far from the Healthy People 2020 goal of 80%. Research also shows that a recommendation to receive an HPV vaccine from healthcare professionals (HCPs) can help parents in their decision-making to vaccinate children.

Considering these factors, Ashish A. Deshmukh, PhD, MPH, and colleagues recently had a study published in JAMA Pediatrics that evaluated knowledge of HPV, the HPV vaccine, and the relationship between HPV and cervical, anal, head and neck, and penile cancers. They also examined rates of receiving an HPV vaccine recommendation from an HCP. “We focused on knowledge and recommendations from HCPs as these key aspects can drive immunization decisions,” says Dr. Deshmukh.

The authors performed a cross-sectional analysis of the Health Information National Trend Survey for data obtained between January and May in 2017 and 2018. The survey obtained responses to HPV knowledge questions from 2,564 men and 3,697 women. The analysis focused on 3 age groups for both sexes: 1) ages 18-26 years (current vaccine eligible), 2) ages 27-45 years (newly eligible/approved age group), and 3) ages 46 years and older (not vaccine age eligible).

Knowledge Deficits Common

“Across the age groups assessed, men were significantly less knowledgeable than women about HPV, HPV vaccine, and the association between HPV and cancers,” says Dr. Deshmukh. “In addition, irrespective of age, over 75% of men and women did not know that HPV causes oral, penile, and anal cancers. This finding is particularly concerning because rates of anal cancer in women and oropharyngeal cancer in men are rapidly increasing in the U.S. Given that there is no alternative form of prevention for these diseases, rapid improvement in HPV vaccination rates is crucial to reverse rising rates of these cancers.”

Specifically, slightly over 50% of men aged 18 to 26 years who were vaccine-eligible were knowledgeable about HPV and the HPV vaccine, compared with a rate of about 80% for women. Overall, about 60% of men and 32% of women in this age category did not know that HPV causes cervical cancer. In addition, more than 84% of men and 77% of women did not know that HPV causes anal, penile, or oral cancers.

Among people aged 27 to 45 years, knowledge about HPV itself and HPV vaccination was lower for men than women, with 68% of men and 86% of women reportedly being aware of HPV and 56% of men and 81% of women being aware of HPV vaccination. More than 75% of both men and women did not know that HPV causes anal, penile, and oral cancers.

Similar levels of knowledge and significant sex differences were observed among people in the study aged 46 years and older. Of note, an overwhelming number of people in this age group were not knowledgeable about HPV and HPV vaccine.

A Recommendation Matters

A key finding from the study was that fewer vaccine-eligible men than women received an HPV vaccine recommendation from their HCP. Just 19% of men and 32% of women who were vaccine age-eligible or had vaccine-eligible family members reported that their HCP recommended the HPV vaccine to them in the last 12 months (Figure). “These findings highlight the need for improved and effective communication between clinicians regarding the benefits of HPV vaccination, says Dr. Deshmukh.

Dr. Deshmukh adds that clinicians must spread the word about the importance of HPV vaccination because it will prevent 1 out of 20 cancers in future generations. “Physicians must communicate the importance of the HPV vaccine rather than giving patients a choice to be vaccinated,” he says. “It is also important to convey that the HPV vaccine is a ‘cancer prevention vaccine’ that prevents 6 cancers—cervical, anal, vaginal, vulvar, penile, and oropharyngeal—and that it is equally important to vaccine both boys and girls.”

References

Suk R, Montealegre JR, Nemutlu GS, et al. Papillomavirus and receipt of vaccination recommendations. JAMA Pediatr. 2-19 Sept 16 [Epub ahead of print]. Available at: https://jamanetwork.com/journals/jamapediatrics/fullarticle/2749340.

Daley EM, Vamos CA, Thompson EL, et al. The feminization of HPV: how science, politics, economics and gender norms shaped U.S. HPV vaccine implementation. Papillomavirus Res. 2017;3:142-148.

Holman DM, Benard V, Roland KB, Watson M, Liddon N, Stokley S. Barriers to human papillomavirus vaccination among US adolescents: a systematic review of the literature. JAMA Pediatr. 2014;168(1):76-82.