Awareness of human papillomavirus infection complications, cervical cancer, and vaccine among the Saudi population

Discussion

Worldwide, cervical cancer is a leading cause of morbidity and mortality, especially in developing countries because of ignorance about the disease and illiteracy.13 However, cervical cancer is a potentially preventable condition because cytological screening using the Pap smear helps to detect this disease in its early stages. Awareness of cervical cancer in Kingdom of Saudi Arabia is crucial and requires sound knowledge about the disease. Realisation and understanding are decisive elements that can prompt the adoption of healthy behaviours and increase advocacy for newly introduced preventive measures. Human papillomavirus infection is a well-known cause of cervical cancer, and there is evidence that HPV is a relevant factor in penile and other squamous cell carcinomas.14 This survey’s results should help increase awareness of HPV and its complications, cervical cancer, and vaccinations in the Saudi population. Among 676 (65.45%) females and 357 (34.55%) males who participated in this survey, poor awareness and various misconceptions regarding HPV and cervical cancer prevention were detected. Because only 10.9% (39/357) of males and 15.0% (102/676) of females had previous knowledge about HPV and cervical cancer, these results are consistent with a similar study by Naing et al15 in which they reported that among their study group, few participants had good HPV-related knowledge (14%) and vaccine-related knowledge (8%). Baloch et al16 determined that 37.9% of women knew about cervical cancer and 16% knew about the HPV vaccine, and Yuanyue et al17 showed that 13-25% of women knew about cervical cancer and the HPV vaccine, in 2 Chinese studies. Thus, the level of knowledge about HPV and the HPV vaccine was low, and this was comparable to our findings, but there was a difference in the targeted study population. Caution is required when comparing the results of the present survey with those student-based studies because students in general and specifically those in health sciences likely have more frequent access to the Internet and other media compared to the general population. Thus, it is possible that they have increased access to some of the websites that provide contradictory and potentially inaccurate information about the HPV vaccine. For example, in Nigeria, only 17.7% of female students were aware of HPV.18 Al-sheikh’s19 study and several others performed among students in many parts of the world reported an increase in HPV-related knowledge compared to our general population-based study group. Only 51.1% of Saudi students attending the Health Colleges of Princess Nora Bint Abdul Rahman University, Riyadh, Kingdom of Saudi Arabia, recognised cervical cancer as a preventable disease.19 A similar study conducted in Pakistan by Tahir Khan et al,20 in Lahore city to assess the HPV knowledge, attitudes, and perceptions among university students found that nearly 57% of these students had already heard about HPV, 55% of the participating students in Pakistan stated that HPV is not a rare disease, and nearly 68% of these students did not believe that HPV occurs without any symptoms. Saudi and Pakistani students had better HPV-related knowledge than Nigerian students. This comparatively better knowledge could result from a higher rate of participation in and use of HPV information by health sciences students in these different countries. However, a study conducted at Keele University, England, reported that nearly 75% of female participants had heard of HPV.16 Despite being aware of HPV, only 27% reported that HPV causes cervical cancer.16 Similarly, a Malaysian study reported that around 80% of healthcare students knew that HPV causes cervical disease, and nearly 54.6% reported that HPV infects both men and women equally.21 However, only 37% of them considered HPV to be a frequently occurring illness.21 These findings show that HPV knowledge gaps exist everywhere and that inadequacy of HPV knowledge is a global issue. Among our study group, 0.9% of male and 27.9% of female participants, had heard of the Pap smear test, and males were better informed about HPV transmission via sexual intercourse. Conversely, a population-based study in the United States of America showed that >90% of participants had heard of HPV, and 74% of them knew that it is sexually transmitted.22 Misconceptions regarding the nature of HPV were found in approximately 37.0% males. Females stated that HPV is a subtype of HIV; this finding may be explained because HIV may be equated with risky sexual behaviour. Our study group had limited knowledge regarding HIV and HPV infections and the relationship between them. In our survey, male participants (45.7%) appeared to be less aware of the HPV vaccine compared to the female group (61.0%). A similar study reported that 75% of the females were aware of the HPV vaccine compared to only 57% of males.23 Overall, >88% of males and females agreed to the statement that HPV vaccines should be added to premarital tests. When participants were asked questions regarding their awareness about HPV diagnosis, availability of HPV vaccine, the capability of the immune system to remove HPV infections, and its association with penile cancer, a severe lack of knowledge was noted. For example, 4.2% of the males and 11.8% of the females, do not understand the diagnostic method, and 45% of the males and 61.0% of the females, were aware that cervical cancer is preventable by vaccination. This finding was much higher than that found by Touch et al,24 who showed that only 35% of women were aware that the vaccine prevents cancer; however, there was poor awareness of the HPV vaccine among participants since only 9.5% of males and 21.0% of females were aware of the vaccine, and 19.4% of male compared to 16.5% of females reported that the immune system cannot remove HPV infection. These findings are worse than those in studies performed in developed countries.