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Knowledge Gap on HPV Testing Revealed

More should be done to explain to women the importance of testing for human papillomavirus (HPV), a cancer charity said, after survey results suggested that only around one in eight women understood the role of HPV testing within the cervical screening process.

HPV primary screening was fully rolled-out in Wales in 2018, England in 2019, and Scotland in 2020. "The cervical screening programme is estimated to save at least 2000 lives from cervical cancer every year in the UK and this number is likely to increase thanks to HPV testing," said Dr Julie Sharp, head of health and patient information at Cancer Research UK (CRUK).

However, there were still around 3300 new diagnoses of the disease, and around 850 deaths, every year in the UK. Moreover, latest figures from NHS England for cervical screening showed that around a third (30%) of eligible people were not up to date with their screening appointments.

More needs to be done to explain the importance of the HPV test and encourage screening attendance, CRUK urged.

The charity funded researchers at King's College London to explore HPV awareness and British women's knowledge about primary screening. The results, published in the Journal of Medical Screening, suggested that only three-quarters of women in Britain are aware of HPV, and knowledge of primary screening is "very low", even among screening-age women. The findings emphasised a need "for awareness-raising campaigns to ensure informed choice about screening and mitigate public concern when screening intervals are extended".

Study lead Jo Waller, who is now professor of cancer behavioural science at Queen Mary University of London, said improving awareness could help to "reduce feelings of uncertainty and confusion" about screening results. "It will also help people understand the reasoning behind any future updates to the screening programme, such as HPV self-sampling and changes to intervals between screening appointments."

Minority of Women Understand Role of HPV Testing

The cross-sectional, population-based online survey involved 1995 British women aged 18 to 70, with a mean age of 45 years, who were selected by YouGov in August 2022. Analysis of the results suggested that although 77.6% of women were aware of HPV, only one in seven (14%) recognised without being prompted that HPV was a risk factor for cervical cancer. 

Excluding those unaware of HPV, around two out of three participants had heard about the virus in the context of cervical screening (61.5%) or HPV vaccination (67.6%), and 23% were aware that most sexually active people will contract the virus at some point in their lives. 

Almost three out of four (72.8%) knew that an HPV-positive result did not mean a woman would definitely develop cervical cancer, but fewer than one in five (18.7%) were aware of the long timeline for HPV to develop into cervical cancer, alerted the authors.

However, only 12.2% of women understood the role of HPV testing within the screening process.

"While positive strides have been made to increase awareness of HPV, our research reveals major gaps in women's understanding of current approaches to cervical screening," Professor Waller said.

Raising Awareness an Urgent Priority

Awareness of the high prevalence of the virus was likely to "reduce stigma and adverse psychological outcomes" in women testing HPV-positive at screening, the authors pointed out. Receiving an HPV-positive result could "engender short-term anxiety, concerns about relationships and confusion" and this was likely to be more pronounced if women were not expecting to have an HPV test as part of screening, they explained. 

Although the researchers found that women's awareness of HPV had increased over the last decade — from 62% to 77.6% — there was less evidence of any increase in specific knowledge that might support understanding of the rationale for HPV primary screening or interpretation of an HPV-positive result, they pointed out. 

Part of the rationale for extended screening intervals was the long time it took for HPV to develop into cervical cancer, but this was poorly understood even by women who had heard of HPV, stressed the authors.

Although awareness of HPV was increasing in Britain, many women still "lack even a basic understanding" of the virus and the role of HPV testing in cervical screening, and raising knowledge and awareness should be an "urgent priority", the authors stressed.

The study findings provided "an opportunity to build on the public's understanding of how HPV testing and screening can prevent cervical cancer and stop the disease in its tracks", commented Dr Sharp.

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