Awareness and attitudes toward the Human papilloma virus and the HPV vaccine
Cervical cancer is the second most common cancer in women. Every year approximately 450 000 women are diagnosed with the disease and 200 000 die. In Sweden 500 women are diagnosed each year and approximately 150 die from the disease.
The major cause of cervical cancer is a sexually transmitted virus called Human papilloma virus (HPV). Already in 1842, long before HPV was identified, sexual activity was correlated to cervical cancer, but it was first in 1970`s the actual virus was related to the disease. Since then many studies have confirmed that HPV is a necessary cause to develop the cancer.
HPV is a very common virus that most people have been infected with at some point in their life. More than 100 types have been identified. These types have different routes of transmission and can cause both common warts on hands and feet, and various cancers. Approximately 30 of these types are sexually transmitted and can cause both genital warts and cervical cancer. The most common types discovered in cervical cancer biopsies are HPV 16, 18, 33 and 45. The prevalence of HPV in the cervix increases rapidly after sexual debut and it peaks around 20-25 years before a decrease is seen. Even though a HPV-infection is common it usually clears it self. Within a year 70% of infected have cleared the virus and within 18 months 80%. If the virus does not clear precursor stages of cancer might occurs and cancer and in less than 1 % of infected women, cervical cancer will develop.
Through the introduction of gynecological screening, a decline has been observed in the last three decades. In Sweden mortality rate decreased with 60% between the years 1986-1995. However, cervical cancer incidence is now increasing again. This is probably due to a change in sexual habits and that women do not attend the gynecological screening as frequently as before.
Recently a vaccine against four HPV types has been introduced on the market. The vaccine protects against HPV 6 and 11 (causing genital warts) and HPV 16 and 18 (causing 80% of cervical cancer cases). If one could introduce this vaccine in combination with gynecological screening, we would see a significant decrease in cervical cancer cases the coming years. For optimal efficiency the vaccine is recommended for girls between 12-15 years who have not initiated sexual contact.
For a successful introduction of the vaccine on the market people has to understand the cause of cervical cancer what the vaccine is for. Therefore it is important that those who will receive the vaccine understands the message given by an information campaign or their GP. And to achieve this one has to know the target population. We would like to perform a study on the Swedish population, men and women (18-30 years) and parents to boys and girls (12-15 years), examining the attitudes and awareness toward HPV and the vaccine. The study will be conducted through sending out a questionnaire to 40 000 participants asking about what they know about HPV, the vaccine and their sexual habits.
This is an important study for investigating and understanding attitudes and knowledge about HPV related disease, and a coming HPV vaccine, both among adults that are targeted for vaccination, and among parents to teenagers who will be targeted for vaccination programs. It also gives the possibility to understand how factors like education, income, and (among adults) sexual habits might influence attitudes and knowledge. A correct introduction of the vaccine and a sufficient coverage among target groups is necessary for the vaccine to prevent HPV related disease in the population. The results from this study will influence marketing and introduction of the vaccine in Sweden and other countries.
- Attitudes to HPV vaccination among parents of children aged 12-15 years-a population-based survey in Sweden.
Dahlström L, Tran T, Lundholm C, Young C, Sundström K, Sparén P
Int. J. Cancer 2010 Jan;126(2):500-7