Laitman BM, et al. JAMA Otolaryngol Head Neck Surg. 2018;doi:10.1001/jamaoto.2017.3089.

February 08, 2018
2 min read

Medical students lack knowledge of HPV-positive cancers


Laitman BM, et al. JAMA Otolaryngol Head Neck Surg. 2018;doi:10.1001/jamaoto.2017.3089.

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Only about half of medical students graduated with knowledge about the association between HPV infection and head and neck cancer, according to results of a survey.

Conversely, almost all medical students demonstrated awareness about the risk for cervical cancer associated with HPV.

Researchers predict the rate of HPV-positive head and neck cancer will surpass cervical cancer rates by 2020. Despite this expectation, most adults are unaware of the association between HPV infection and head and neck cancer.

Data suggest the HPV vaccine prevents 93.3% of oral HPV infections, yet only 60% of teenagers in the United States have initiated the vaccination series.

Further, only 47% of pediatricians routinely discuss HPV-positive head and neck cancer.

“It becomes imperative to examine how we are training our next generation of physicians regarding this epidemic,” Benjamin M. Laitman, PhD, medical student at Icahn School of Medicine at Mount Sinai, and colleagues wrote.

Laitman and colleagues surveyed 707 New York state medical students regarding their knowledge about HPV-positive cancer.

Of the 617 students who completed the survey, 187 (30.3%) were in their first year of medical training, 132 (21.4%) were in their second year, 169 (27.4%) were in their third year and 129 (20.9%) were in their fourth year.

Ninety-nine percent (n = 511) of students correctly identified associations between persistent HPV infection and cervical cancer. A majority of students also had knowledge regarding HPV and genital warts (81.5%; n = 503), anal cancer (76.7%; n = 473) and genital cancers (75.9%; n = 468).

Researchers used the phi coefficient () to evaluate proportion differences between students’ knowledge of different associations.

Compared with cervical cancer, fewer students correctly selected recurrent respiratory papillomatosis (28.5%; = 0.733) or head and neck cancer (47.2%; = 0.585) as associated with HPV. A similar proportion of students incorrectly selected esophageal cancer (44.9%) as associated with HPV as the proportion who correctly selected head and neck cancer ( = 0.023) and recurrent respiratory papillomatosis ( = 0.17).

Knowledge of HPV-associated head and neck cancer appeared lowest among first-year medical students (32.6%) and highest among fourth-year students (56.6%; = 0.238), whereas rates regarding cervical cancer remained high throughout training (first year, 98.4%; fourth year, 99.2%; = 0.036).

Students also completed a self-assessment of their knowledge using a five-point Likert scale, where 1 represented no knowledge and 5 excellent knowledge. Researchers measured differences in these results using the Cohen d statistic.


Self-reported knowledge scores appeared lower for head and neck cancer (mean difference, 1.47; 95% CI, 1.36-1.58; Cohen d = 1.53) and recurrent respiratory papillomatosis (mean difference, 2.03; 95% CI, 1.93-2.12; Cohen d = 2.27) than for cervical cancer.

Although these findings are limited by the low participation rate, the results suggest an education gap among medical students regarding the risk for HPV-positive cancers, which may be generalizable to students nationally, the researchers wrote.

“To increase HPV vaccination rates and have an impact on the future of this epidemic, physicians must be informed; thus, head and neck manifestations of persistent HPV infection should be emphasized in medical school curricula,” the researchers wrote. – by Alexandra Todak

Disclosures: The authors report no relevant financial disclosures.