Feature Articles

On 2 March 2009, FPAHK announced the findings of a public survey that revealed the public’s need for more information about Human Papillomavirus (HPV) vaccine. The Association appealed to healthcare providers to step up public education on cervical cancer prevention so as to enhance the awareness and practice of effective preventive methods among women and mothers of young girls and help them make informed choice.

The Public Survey on HPV Vaccine and Cervical Cancer Screening, conducted in October 2008, interviewed 500 mothers of young daughters (aged 9 to 16) to gauge their understanding of cervical cancer prevention, prevalence of HPV vaccination among their daughters and their opinions on the vaccine.

Only 30% of the respondents correctly pointed out“infection with HPV” as the main cause of cervical cancer. 43% thought that “having too many sex partners” and “smoking”were the main cause. Almost one-fifth (19%) erroneously considered that “heredity” was the main cause.

When asked what thoughts they associated with cervical cancer, 63% of the respondents perceived that cervical cancer is “one of the common cancers among women in Hong Kong”. 39% thought that “promiscuous women are at higher risk of cervical cancer” but only 32% were aware that “all sexually-active women are exposed to the risk of the cancer”. The impression that cervical cancer was preventable by pap test came to the mind of only 30% of respondents. Even fewer (22%) had the idea that “it is preventable by HPV vaccination”.

Presenting the survey findings, Dr. Susan Fan, Executive Director of FPAHK, said the results reflected that many mothers had inadequate knowledge about the main cause of cervical cancer, mistaking “having too many sex partners” or “smoking” as the main cause, whereas they were only risk factors. “Heredity” as a cause of cervical cancer was certainly a misconception. Mothers who mistakenly think that “women who are monogamous, non-smoking, with no family history of cervical cancer will not get the disease”, not recognizing that “all women who have ever had sex have a chance of getting cervical cancer”, may have a false sense of security and be less vigilant in cervical cancer prevention practices for themselves and their daughters.

Dr. Fan said, “Cervical cancer is a preventable disease. In the past, regular pap tests were the best way to prevent cervical cancer by detecting and treating pre-cancerous cell changes before they develop into cancer. It is now understood that cervical cancer is associated with HPV. With the development of the HPV vaccine, prevention of cervical cancer can be made more effective. Administering the vaccine to girls and young women before they are infected by HPV will reduce their risk of cervical cancer.”

The survey found that only 4% of the respondents had their daughters vaccinated, 38% said they were considering to let their daughters have the vaccination and the remaining 59% said their daughters did not have the vaccination. Among those whose daughters have been vaccinated and those who said they were considering letting their daughters have it, 71% said it was because “parents are responsible for protecting their daughters’ health” and 70% said that they hoped “to reduce their daughters’ risks of cervical cancer and other HPV associated diseases”. Conversely, among those whose daughters have not been vaccinated 46% said “more information about HPV vaccine is needed before making a decision”, 41% had “concerns about the vaccine’s side effects”; and 30% cited “cost concern” and 29% cited “the vaccine is not 100% effective in preventing cervical cancer” as the reasons for not having their daughters vaccinated.

Dr. Fan said, “The results reflect that despite their concern about their daughters’ health and willingness to take effective preventive methods to protect them from cervical cancer, many mothers wished to have more information about the vaccine to help them decide whether or not their daughters should be vaccinated. Therefore, we call on healthcare providers to step up public education about the HPV vaccine in order to facilitate people to make informed decisions.”

The survey also found 45% of the respondents answered correctly that the effectiveness of HPV vaccine could reach 70%, while about 34% of respondents mistakenly thought its effectiveness was higher. 58% of the mothers knew that even after receiving HPV vaccination, women still needed to have regular pap tests. Among this group, 68% said it was because “the vaccine is not 100% effective in preventing cervical cancer” and 64% pointed out that “Pap tests can help detect cervical abnormalities early”. Nevertheless, 88% of all mothers polled said they would suggest their daughters to have regular pap tests after they were 25 years old and started sexual activities.

Dr. Fan stressed that all women who had ever had sex, irrespective of whether they had received HPV vaccination or not, should have regular pap tests, and the survey results highlighted the need to promote awareness of this among mothers. She also called on parents to start sexuality education to their children when young, and particularly to teach their daughters about cervical cancer and its prevention.

According to Dr Shum Po Ying of FPAHK’s Youth Health Care Service, a total of almost 6,000 unmarried women under the age of 26 had Pap tests at FPAHK’s three Youth Health Care Centres last year. Since the availability of the HPV vaccine in 2007, 364 and 768 young women received it in 2007 and 2008 respectively. Sharing her experience, Dr. Shum said common concerns about HPV vaccine raised by parents were its side effects, effectiveness, duration of protection, cost and the time schedule of getting the second and third injections.

Dr Shum said that at FPAHK, doctors would assess the suitability of HPV vaccination for individual clients and explain in detail the vaccine’s effectiveness, side effects, injection schedule, duration of protection and cost, etc. Moreover they would remind clients that even after the vaccination, they still needed to have regular pap tests once they reached 25 years old and started sexual intercourse in order to effectively prevent cervical cancer.