Knowledge and intention to participate in cervical cancer screening after the human papillomavirus vaccine
Introduction
The first human papillomavirus (HPV) vaccine was introduced in the United States in 2006. Both that quadrivalent vaccine, and the bivalent vaccine approved by the FDA in 2009, protect against HPV 16 and 18, two carcinogenic strains of HPV responsible for approximately 70% of cervical cancers [1], [2], [3]. However, neither vaccine confers broad protection against all high risk types of HPV. In addition, vaccine recipients may have been exposed to carcinogenic types of HPV before vaccination. Consequently, routine cervical cancer screening is recommended for both vaccinated and unvaccinated women [4]. Some have expressed concern that women will believe that the vaccine confers complete protection against cervical cancer, and therefore, not know about or participate in required continued screening [5]. Such misperceptions could be particularly harmful among women of lower education and income and less generous insurance coverage, who underutilize cervical cancer screening [6], [7], [8], [9], [10], [11], [12], [13], and for racial and ethnic minorities and those of lower socioeconomic status, who experience a disproportionate burden of cervical cancer mortality [14], [15].
In the present study, we assess whether adult women in the general population know about cervical cancer screening requirements after the HPV vaccine; whether women who received the HPV vaccine in 2007 and 2008 intend to receive Pap tests in the future; and whether knowledge and intention vary across groups at greatest risk for poor screening adherence and cervical cancer.
As no single data source examines both knowledge and behavior related to HPV vaccination and cervical cancer screening, we conducted separate analyses of data from two national surveys, the National Cancer Institute's Health Information National Trends Survey (HINTS), which examines cancer knowledge and communication, including knowledge of cervical cancer screening guidelines; and the National Center for Health Statistics’ National Health Interview Survey (NHIS), which assesses cancer-related behaviors and intentions, including both HPV vaccination and cervical cancer screening. We hypothesized that knowledge of screening requirements would vary by socioeconomic status and race/ethnicity, as previous reports have shown lower awareness of HPV among Black and Hispanic women and those of lower income and education than among White women and those with higher income and education [16]. Consistent with research showing an association between HPV vaccination and health care utilization [17], [18], [19], [20], we further hypothesized that adult women who received the HPV vaccine in 2007 and 2008 would report higher intended Pap test participation than their unvaccinated peers.
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Data
Study samples and outcomes for the two datasets analyzed here are described in Table 1. Data on women's knowledge of cervical cancer screening requirements were from the HINTS 2008, a cross-sectional survey of the US adult population on health communication topics, conducted from January through April 2008. The survey sample is nationally representative, with oversampling of Hispanics and African Americans to ensure adequate representation and stable estimates. Further details regarding the
Knowledge of cervical cancer screening requirements
In the HINTS sample of 1586 women ages 18 through 74 who 150 had heard of HPV and had no history of cervical cancer, 95.6% of 151 respondents knew that women who receive the HPV vaccine should 152 continue to receive Pap tests (Table 2). This high level of knowledge did not vary significantly by race or ethnicity, education, income, health insurance, presence of a usual health care provider, or previous cancer diagnosis. Women who had a history of HPV infection or had a Pap test in the previous
Discussion
Our analysis of a nationally representative sample from the 2008 Health Information National Trends Survey found that the vast majority of women are aware of the need to continue cervical cancer screening with Pap tests after receipt of the HPV vaccine. We found higher levels of knowledge regarding the need for screening after vaccination than a national survey conducted in late 2007 [17]; this may reflect differences in question wording and research methods between the two surveys, or slight
Conclusions
Our study provides encouraging preliminary evidence that adult women are knowledgeable about the importance of continued cervical cancer screening after receipt of the HPV vaccine and that those vaccinated in young adulthood are likely to continue to participate in Pap testing. As time elapses, further studies will be needed to monitor cervical cancer screening knowledge and behaviors among adult women who are later adopters of the vaccine and to examine whether vaccinated adolescent females
Acknowledgements
The authors gratefully acknowledge Nancy Breen for her insightful comments on an earlier version of the manuscript, and Timothy McNeel and William Waldron of Information Management Services for their programming support.
This project has been funded in whole or in part with federal funds from the National Cancer Institute, National Institutes of Health, under Contract No. HHSN261200800001E. The content of this publication does not necessarily reflect the views or policies of the Department of
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