Awareness of human papillomavirus, cervical cancer and its prevention among primigravid antenatal clinic attendees in a tertiary care hospital in Sri Lanka: A cross-sectional study

Background: Cervical cancer is the second commonest cancer amongst Sri Lankan women. With introduction of the human papillomavirus (HPV) vaccine to the national immunisation schedule, awareness and prevention of disease underpins vaccine uptake. Knowledge of HPV, HPV-related diseases and attitudes towards prevention and screening among urban women was assessed. Methods: Primigravids attending Colombo North Teaching Hospital antenatal clinics were recruited over 8 months as surrogates for women who have recently become sexually active. Data through a self-administered questionnaire on three domains were collected (cervical cancer, Pap testing, HPV and vaccine). Results: Of 667 participants (mean age 23.9 (s.d. = 4.4) years, 68.0% (n = 454) had >11 years of schooling), only 1.5% (n = 10) were aware of all three domains: 55.0% (370/667) had heard of cervical cancer, 19.0% of whom (70/370) knew it was sexually acquired, 9.0% (60/667) were aware of Pap screening, while 5.4% (36/665) had heard about HPV and <1.0% (5/667) knew it caused cancer. The total knowledge score ranged from zero (379/665) to nine (2/665), with a mean of 0.9 (s.d.-1.4), with awareness increasing with level of education (χ² = 18.6 P <0.001). Of those aware of Pap testing, 8.0% (5/60) were reluctant to undergo testing, while 46.6% (28/60) had no apprehension. Conclusions: Knowledge of cervical cancer, Pap testing, HPV and vaccine was low, especially in terms of HPV. Among those aware of Pap screening, generally there were favourable attitudes to having a test. These data have implications for acceptance of the vaccine and any future expansion of cervical screening with newer, more cost-effective technologies.