Study: Most Americans Don’t Know HPV Is Linked to Multiple Types of Cancer

• New survey data found that most Americans don’t know that HPV can cause anal, oral, and penile cancers.
• HPV is responsible for about 37,300 cases of these cancers annually.
• Experts recommend healthcare workers prioritize HPV education for patients, starting with individuals’ eligibility for the HPV vaccine.

A majority of Americans don’t know that human papillomavirus (HPV) is linked to a number of cancers, new survey data shows.

Between 2014 and 2020, researchers discovered that a large majority of Americans don’t know that an HPV infection can cause anal, oral, and penile cancers. And though most knew that HPV could cause cervical cancer, levels of awareness dropped from 77% to 70% over the seven-year period.

The findings were presented at the American Association of Cancer Research’s annual meeting last week.

Experts are concerned that the low levels of awareness could hinder adolescent HPV vaccination efforts, which are already lagging.

“[The HPV vaccine has] been around for a long time and there’s been a lot of talk about it,” Eric Adjei Boakye, PhD, assistant scientist at the Department of Public Health Sciences at Henry Ford Health and lead study author, told Health. “So no one was expecting that awareness would be decreasing.”

Here’s what experts had to say about the link between HPV and cancer, why awareness may be trending downward, and what people should do to avoid HPV.

Awareness of HPV-Related Cancers Is Remaining Stagnant or Declining

HPV is a collection of over 200 viruses, which are spread through sexual activity. Infections are incredibly common—most HPV infections are low-risk and people’s bodies fight off the virus on their own.

But for others, the HPV infection may linger. If someone has a more severe strain of HPV, there is the potential for cancer.

“HPV first starts off causing precancerous changes in cells, and then over time if somebody’s immune system can’t clear the HPV virus on their own, then eventually it can cause cancerous changes in those cells,” Yasmin Lyons, DO, assistant professor of gynecologic oncology at the Mays Cancer Center at the University of Texas Health Science Center at San Antonio, told Health.

HPV can cause cervical, anal, penile, vaginal, rectal, vulval, and oropharyngeal (back of the throat) cancer. The virus is responsible for about 37,300 cases of these cancers annually.

Of these HPV-related cancers, the survey looked at just four to determine Americans’ level of awareness on the topic.

Adjei Boakye and his team took data from the Health Information National Trends Survey in 2014, 2017, 2018, 2019, and 2020. Over the years, between 2,000 and 2,350 people answered a survey question that asked them if they thought HPV caused anal, cervical, oral, and penile cancers. For each cancer type, participants could answer “yes,” “no,” or “not sure.”

The researchers found that awareness of HPV and cervical cancer was by far the highest—in 2014, 77.6% of survey respondents correctly said that HPV causes cervical cancer. By 2020, however, that number dropped to 70.2%.

Awareness levels for the three other HPV-related cancers—anal, penile, and oral, or back of the tongue and throat—was more concerning. In 2014, just 27.9% of survey respondents said that HPV can cause anal cancer, and that number stayed relatively stable—27.4% said the same in 2020.

The other two cancers—penile and oral—had similarly low awareness, which declined further over the seven-year period. About 31% of people knew HPV could cause oral cancer when the survey started, but by 2020, that dropped to 29.5%. And for penile cancer, 30.3% were aware of its link to HPV in 2014 as compared to 28.4% in 2020.

Adjei Boakye noted that as awareness is dropping, cancer rates are doing the opposite. Anal and oral cavity and pharynx cancers are both increasing in incidence. Rates of new cases of cervical cancer, in contrast, have plummeted since 1992.

“For some reason, there’s a drop in knowledge that HPV is linked to cancer,” Dr. Lyons said. “Awareness, again, is the biggest tool that we have because the virus is asymptomatic in a lot of cases.”

HPV Symptoms All Women Should Be Aware Of

Why Is This Lack of Awareness Such a Concern? 

Though knowledge about HPV-related cancers may not seem to correlate with health outcomes, experts agree that this dip in awareness is a concern. 

“The number one reason people get a vaccine is because a doctor recommended it or [told] them to,” Adjei Boakye noted. “Below that, one of the other main reasons is when people know the benefits of it. So when people know the vaccine prevents cancer, they tend to get it.”

If people don’t understand how dangerous HPV can be, and the consequential risks associated with it, they may not be as motivated to get themselves or their children vaccinated. The same could also go for screenings, Dr. Lyons added. For example, women may be more likely to go in for regular pap smears if they know about the link between HPV and cervical cancer, she continued. 

The U.S. has not yet reached its target vaccination rate for HPV, Adjei Boakye added. 

The HPV vaccine was first recommended in 2006, and it’s been primarily marketed toward adolescents. As of 2020, 75% of adolescents had received at least one dose of the HPV vaccine and 54% of adolescents had received all recommended doses. That’s still shy of the government’s original 80% goal.

How Can We Raise Awareness?

In order to increase awareness about HPV-cancers, researchers are looking into why awareness may be stagnating or declining in the first place. Unfortunately, there’s no one clear explanation as to why this is the case.

It could be due to the fact that more emphasis has been placed on healthcare providers educating their patients on HPV, rather than reaching out to the public itself, Adjei Boakye theorized. People may also think that since a majority of people have received the HPV vaccine, it’s not something that they need to worry about, he added, or they may be vaccine-hesitant in general.

The way that receiving news and information has changed since 2014 could also be playing a role, Leila Mady, MD, PhD, MPH, assistant professor of otolaryngology head and neck surgery at Johns Hopkins Medicine, told Health.

Gender may explain the low awareness of anal, penile, and oral cancers as compared to cervical cancer. The vaccine was first approved for women only, before being approved for men three years later. People may think that HPV only causes cervical cancer, and is therefore only a risk for those with a cervix.

Adjei Boakya emphasized the importance of getting information about HPV cancers to the general public. Making sure that patients have access to information about HPV and the HPV vaccine from their healthcare provider is a good place to start.

“Nurses actually have been shown to be the best people to talk to parents about HPV. And it doesn’t even have to be talking about [it]. It could just be having pamphlets in waiting rooms,” he said. “It could be adding it to people’s packet that they take home with them.”

It’s also important that health care providers who see a more general population—such as dentists or primary care doctors—are educating people about this too, said Dr. Mady.

As important as awareness is, however, it has to lay the foundation for healthy action, which means getting an HPV shot if you’re eligible.

“There’s actually something that we can do about prevention of a cancer, which is a really big thing,” Dr. Mady said. “Having the awareness that HPV is linked to this type of cancer, and that there’s a vaccine that can help prevent developing that cancer, I think is the biggest reason as to why it’s so important.”

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