Knowledge That HPV Can Cause Oropharyngeal Cancer Increases Likelihood of Vaccination
Key findings
- 403 adults at an otolaryngology clinic, ages 18 to 45, were surveyed to assess whether knowledge of the link between human papillomavirus infection (HPV) and oropharyngeal squamous cell carcinoma (OPSCC) was associated with prior HPV vaccination
- Of the 271 patients who completed the survey, only 11% of men and 38% of women were fully vaccinated
- Only 23% of patients knew HPV infection may cause OPSCC; patients who did have knowledge of the association were 3.7 times more likely than others to be vaccinated
- At the same otolaryngology clinic visit where they completed the survey, 22% of patients indicated they were interested in receiving point-of-care vaccination that day, leading to 12% of men and 5% of women being vaccinated
- Educating unvaccinated adults in a clinical setting about the relationship between HPV and OPSCC, paired with point-of-care vaccination, may lead to improved HPV vaccination rates
Oropharyngeal squamous cell carcinoma (OPSCC) has surpassed cervical cancer to become the most common human papillomavirus (HPV)–associated cancer in the U.S., and the incidence is expected to rise through at least 2045. Since 2020, the HPV nine-valent vaccine has been approved for preventing HPV-associated cancers, including head and neck cancer, but vaccination rates in adults are low.
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Jacob C. Bloom, MD, a resident physician in the Department of Otolaryngology–Head and Neck Surgery at Boston Medical Center, and Daniel L. Faden, MD, a head and neck surgical oncologist and scientist who studies HPV at Mass Eye and Ear, recently assessed adults' knowledge and opinions of HPV and HPV vaccination as they pertain to HPV-associated OPSCC. They paired the survey with a novel point-of-care vaccination program housed within an otolaryngology clinic.
In JAMA Otolaryngology–Head & Neck Surgery, the researchers report only 23% of respondents understood the relationship between HPV infection and OPSCC. Those who did know the relationship were 3.7 times more likely than others to be vaccinated.
Methods
The research team developed a 17-item survey using questions from three existing surveys validated for gathering opinions about HPV and the HPV vaccine. Between September 1, 2020, and May 19, 2021, the survey was offered to 403 patients ages 18 to 45 while they waited for an appointment at the Boston Medical Center otolaryngology clinic.
Characteristics of the Cohort
271 patients completed or mostly completed the survey. The median age was 29 and 58% were female. 51% had at least a college degree. 0.8% were American Indian or Alaska Native, 10.0% were Asian, 24.7% were Black, 22.1% were Hispanic/Latino, 2.1% were Middle Eastern, 39.8% were white and 0.4% preferred not to respond. 27% were fully vaccinated (38% of women, 11% of men), 9% had an incomplete vaccination series and 58% were unvaccinated.
Knowledge
79% of participants said they had heard of HPV and 84% said they had heard of the HPV vaccine. 61% knew HPV is spread through sexual contact and 47% knew HPV can cause cancer. Only 23% of participants identified HPV as being a cause of throat cancer, and only 7% identified throat cancer as the most common HPV-associated cancer.
Disparities and Similarities in the Knowledge Gap
The odds of being vaccinated before the survey were higher among women than men (OR, 6.5). Women were also more likely than men to know HPV can cause cancer (OR, 3.7), but vaccinated women were not more likely than vaccinated or unvaccinated men to know HPV can cause throat cancer.
Participants who identified as white had higher odds of being vaccinated than participants from racial/ethnic minority groups (OR, 2.6) and were more likely to know HPV can cause cancer (OR, 3.3). However, they were not more likely to know HPV can cause throat cancer.
Multivariate Analyses
After adjusting for race/ethnicity, gender, educational level, and age, patients were significantly more likely to be vaccinated if they:
- Had been previously educated about the vaccine (OR, 3.8)
- Knew HPV can cause cancer (OR, 4.1)
- Knew HPV can cause throat cancer (OR, 3.7)
Patients were significantly less likely to be vaccinated if they said their physician did not recommend it (OR, 0.1). 94 participants were unvaccinated and interested in being vaccinated, and in that group the most cited reason for being unvaccinated was "doctor did not recommend" (24%).
Point-of-Care Vaccination
35 unvaccinated participants indicated on the survey they might be interested in HPV vaccination that day. A practitioner determined 26 were eligible, and 19 proceeded with vaccination after a shared decision-making conversation. That number included 12 of the 98 unvaccinated men (12%) and seven of the 131 unvaccinated women (5%).
The other patients said they had no time to stay for vaccination (n=1), were attempting to get pregnant (n=1), wanted to perform more research (n=1) or gave no reason for declining vaccination (n=4).
An Innovative Strategy
Otolaryngologists are well positioned (perhaps best positioned) to educate adults about the relationship between HPV infection and OPSCC and offer vaccination in their clinics. These findings suggest the paired approach is both effective and efficient.
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