briefs

In this HINTS Brief, we explore women's awareness of HPV and knowledge of the 

HPV-cervical cancer link in 2005, before the introduction of the HPV vaccine.

In 2005, 61 Percent of

American Women Had

Never Heard of HPV

Since the 2006 FDA approval of GardasilTM, a vaccine to prevent

cervical cancer, news stories and advertisements have penetrated print,

broadcast, and online communication channels with information about

human papillomavirus, more commonly known as HPV. Communication

researchers do not yet know how this influx of information has shaped

knowledge, attitudes, or opinions about HPV and cervical cancer

prevention. However, in 2005, 61 percent of American women aged 18

and older had never heard of HPV, even though it is the leading cause

of cervical cancer. Of those who had heard of HPV, 44 percent did not

know that it causes cervical cancer. (These percentages are unadjusted

for other factors that may predict awareness and knowledge.)

Cervical cancer screening using the Pap test is widely accepted and

integrated into the U.S. health care system. Newer HPV-based

technologies such as the HPV test and vaccine give women and health

care providers options for complementing the Pap test to prevent and

control cervical cancer more effectively. Current guidelines

recommend using the HPV test in women 30 and older for primary

screening, and in women of all ages to follow up an abnormal Pap test.

In addition, the Centers for Disease Control and Prevention’s Advisory

Committee on Immunization Practices recently recommended routine

HPV vaccination for girls aged 11 and 12.The vaccine protects against

two types of HPV that cause 70 percent of all cervical cancers. Not all

cervical cancers can be prevented with the vaccine; therefore, it is

essential that even vaccinated women continue to receive Pap and

HPV tests at the recommended intervals.

Quick Facts:

• Persistent HPV infection causes most cervical cancers. It also plays

a role in cancers of the anus, vulva, vagina, and oropharynx.

• HPV is a very common infection.About 20 million people are

currently infected and at least 50 percent of sexually active men

and women get an infection at some point in their lives.

• There are 100 types of HPV. Most infections go away on their own;

some persistent high-risk infections can lead to cervical cancer.

• The Pap test is used to detect abnormal cells in the cervix.Women

should begin having Pap tests within three years of first having

sexual intercourse, and no later than age 21. Healthy women

should repeat the test at least every three years.

• For women age 30 and older, the HPV test can be used for general

screening. For women of all ages, it is approved as a way to followup an abnormal Pap test.The HPV test can detect 13 of the highrisk types of HPV associated with cervical cancer, even before

there are visible changes to cervical cells.

• In June 2006, the FDA approved GardasilTM, the first vaccine to

prevent two types of HPV infection that cause 70% of all cervical

cancers.The vaccine is approved for girls and young women aged 9

to 26; routine vaccination is recommended for girls aged 11 and 12.

• Although males can also contract HPV, there is no approved test

to detect HPV infection in males, and no approved vaccine to

prevent HPV infection in males.

How Can This Inform Your Work?

HINTS 2005 does not tell us where women get information about

HPV and cervical cancer, nor does it capture the likely increase in

awareness of HPV since the 2006 introduction of GardasilTM and its

associated campaigns. Nonetheless, HINTS tells us that in 2005,

American women were largely unaware of the virus that causes the

majority of cervical cancers.There are several tasks that health

educators and health communication practitioners can take on to

increase the likelihood that women have accurate awareness of HPV

and its relationship to cervical cancer.

• Efforts are needed to increase recognition of the name of the virus,

human papillomavirus, and its acronym, HPV, especially among older

women, less educated women, and those not being screened

regularly for cervical cancer.

• Efforts are needed to increase the depth of accurate knowledge

about HPV and its link to cervical cancer.This information should

be shared with women before they are at risk for contracting and

suffering adverse consequences from an HPV infection.

• Women who are vaccinated against HPV must understand that

regular Pap or HPV tests are still needed to screen for the types of

cervical cancer not covered by the vaccine.

Have You Ever Heard of HPV Do You Think HPV Causes 

(Human Papillomavirus)? Cervical Cancer? 

2005 Estimated U.S. Population 2005 Estimated U.S. Population

Percentage Percentage among Women Who Had

among Women Heard of HPV

Yes 38% Don’t Know 0.5% Yes 47% Don’t Know 43.7%

No 61% Refused 0% No 8.8% Refused 0.3%
References Used in This HINTS Brief

Tiro JA, Meissner HI, Kobrin S, Chollette V. What do women in the U.S. know about human

papillomavirus (HPV) and cervical cancer? Cancer Epidemiology, Biomarkers, and Prevention, 16(2), 2007.

Human Papillomaviruses and Cancer: Questions and Answers, NCI Fact Sheet (2006),

http://www.cancer.gov/cancertopics/factsheet/Risk/HPV 

CDC Advisory Committee on Immunization Practices (2006), http://www.cdc.gov 

NCI’s Cancer Trends Progress Report—2005 Update, http://progressreport.cancer.gov

American Cancer Society. Cancer Prevention & Early Detection: Facts and Figures 2006,

http://www.cancer.org

For More Information on Cancer

• Call the NCI Cancer Information Service at 1-800-4-CANCER

(1-800-422-6237)

• Visit http://cancer.gov 

• Order NCI publications at http://www.cancer.gov/publications

March 2007

About HINTS

The National Cancer Institute (NCI) fielded the first Health Information National Trends Survey (HINTS) in 2002 and 2003, surveying 6,369

Americans.The second survey was fielded in 2005, surveying 5,586 Americans. HINTS was created to monitor changes in the rapidly-evolving

field of health communication.The survey data can be used to understand how adults 18 years and older use different communication

channels to obtain health information for themselves and their loved ones, and to create more effective health communication strategies

across populations.

The Briefs are intended to highlight top-level findings and are not meant to be comprehensive reports. Conclusions drawn from the Briefs are

limited by their descriptive nature and are not intended to replace HINTS-related scientific publications from which inferences may be more

confidently derived.

The HPV-Cervical Cancer Connection: Do Women Understand the Link?

A recently published HINTS study revealed that awareness of HPV exposed to health information. Factors associated with having heard of

among American women in 2005 was low, and that accurate HPV were being non-Hispanic White, getting regular Pap tests, and being

knowledge of the HPV-cervical cancer link is generally limited to aware of the change in cervical cancer screening guidelines.

women who have tested positive for HPV or who have had an Among those women who had heard of HPV, the multivariate analysis abnormal Pap test.Therefore, educating women about persistent HPV found that the only factors positively associated with knowing that infection and its relationship to cervical cancer is crucial. HPV causes cervical cancer were having had an abnormal Pap or a

The study used 2005 HINTS data to assess awareness and accurate positive HPV test result. It appears that education about the HPVknowledge of HPV and cervical cancer among American women. cervical cancer link is more likely to occur after a woman has

Researchers also examined whether variables for sociodemographics, experienced an adverse consequence from an HPV infection. access to health care, cervical cancer screening history, cancer history,

and health information trust and attention were associated with Investigators suggest that if HPV testing and vaccination represent the

accurate knowledge. The study found that awareness of HPV was future of cervical cancer control, population-wide understanding of

significantly lower among women who are older, less educated, and less HPV and its relationship to cervical cancer is imperative.

HPV Awareness and Knowledge: Differences by Education 

and Cervical Cancer Screening History

Despite some key differences by level of education and cervical cancer women who received Pap tests on a regular schedule.Women who

screening history, it is important to remember that the majority (61 reported having regular cervical cancer screening were more likely

percent) of all female respondents to HINTS in 2005 had never heard to say they had heard of HPV (45%) compared with women who only

of HPV, and that among those who had heard of the virus, less than recently had a Pap test (26%) or women who never or had not recently

half knew that it causes cervical cancer. Below, we provide associations had a Pap test (24%).

identified in a recent HINTS 2005 publication by education and Among women who had heard of HPV, the multivariate analysis found screening history, adjusting for other factors that predict HPV only two factors associated with knowing HPV causes cervical cancer: awareness and knowledge. positive HPV test and abnormal Pap test. Among women who reported

Education having had a positive HPV test, 72% were aware that an HPV infection

In 2005, awareness of HPV was greater among respondents with some could cause cervical cancer while only 46% of women who had not had

college (47%) or a college degree (61%) compared with respondents a positive HPV test were aware of this connection. Similarly, while 68%

with a high school degree (27%) or less (16%). of women who had a previous abnormal Pap result knew that an HPV

infection could cause cervical cancer, only 47% of women who had not Among those who had heard of HPV, accurate knowledge of the HPV- had an abnormal Pap result were aware. Getting regular Pap tests was cervical cancer link was highest among college graduates (54%) not associated with knowing about the HPV-cervical cancer connection. compared with those with less education.

Cervical Cancer Screening History

Awareness of HPV was greatest (100%) among women who said they

had had a positive HPV test. HPV awareness also was higher among