Cervical cancer: Awareness and misconceptions of risk factors among lay persons and physicians

Abstract

Background: Cervical cancer (CC) is the fourth most common cancer in women worldwide. Human papillomavirus (HPV) subtypes 16 and 18 account for 70% of cases of CC. 80% of sexually active French women are infected by HPV at least once in their lifetime. Vaccination and screening are the main weapons against CC. This branch of the EDIFICE survey focuses on awareness of CC risk factors among the lay population and physicians. Methods: The 4th nationwide observational survey was conducted by phone interviews using the quota method. A representative sample of 737 women (age, 40-75 yrs) was interviewed between June 12 and July 10, 2014. A mirror survey on a representative sample of 105 female physicians was conducted between July 9 and August 8, 2014. Interviewees were asked to cite the five main risk factors for CC. Results: For 30.3% of lay population participants, heredity/family history was the main CC risk factor while 39.0% of physicians (non-significant difference, NS) ranked it second after other factors related to sexually-transmitted infections (STI) and risky sexual behavior. STI were cited by 85.7% of the physicians; notably, 76.2% also mentioned HPV whereas these risk factors were cited by only 21.7% and 8.0% of the lay population (P < 0.01). Sexual practices were cited by 81.9% of physicians and 18.5% of the lay population (P < 0.01), including multiple partners (70.5% vs. 9.7%, P < 0.01) and unprotected sexual activity (35.2% vs. 9.8%, P < 0.01). Tobacco was cited by 23.8% of physicians and 6.6% of the lay population (P < 0.01). Other known risk factors were cited at very low rates (differences between physicians and lay persons, NS): contraceptive pill (3.8% vs 6.2%) and multiple pregnancies (1.9% vs. 0.5%). Conclusions: Although not a recognized risk factor for CC, heredity/family history was ranked first by lay persons and second by physicians. Physicians were largely aware of HPV as a major risk factor for CC. They also widely cited notorious risky sexual behavior associated with the risk of contracting HPV, and tobacco, a known cofactor. Lay persons however, were inadequately aware of these risk factors. Other recognized cofactors such as the pill or multiple pregnancies were cited far less frequently both by physicians and lay persons.