Knowledge, attitude and practice towards cervical cancer screening and human papilloma virus vaccine at a tertiary care facility in North India

Devyani Misra, Charu Mahajan, Bhumika Bansal


Background: Cervical cancer continues to be a major health care problem and most common cause of cancer deaths. Many screening methods are available to detect the disease in precancerous stage. Cervical cancer is the only cancer that is preventable with HPV vaccine against the causative agent responsible for this condition. Knowledge and attitude of women determine the likelihood of women undergoing screening procedures and HPV vaccination which will have implications for the future generations. This study was conducted to determine the knowledge, attitude and practice of women towards cervical screening and HPV vaccine.

Methods: This is a facility based observational cross-sectional study conducted at Dr. RMLIMS, Lucknow, over a period of 3 months - January 2019 to March 2019. Women attending gynecology OPD were enrolled after verbally consenting for the study and were required to fill a pre-structured questionnaire which was then analyzed and assessed.

Results: A total of 368 participants answered the questionnaire. Overall, 154 subjects (41.8%) had adequate knowledge regarding cervical carcinoma risk factors, symptoms, screening for cancer and HPV vaccine. Favorable attitude was seen in 315 (85.5%) participants. Ninety-six participants (26.0%) had ever had a cervical cancer screening and 23 participants (6.2%) had ever received HPV vaccine which was very low. Lack of knowledge and cost factors were the main reasons cited for these low screening and vaccination rates among the participants.

Conclusions: The study shows that knowledge was inadequate and screening and vaccination rates were very low in the study population. This highlights the need to educate the community regarding cervical cancer prevention and to make these services readily available at affordable costs to achieve the ultimate goal of elimination of cervical cancer.


Cervical cancer screening, Human papilloma virus vaccine

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Arbyn M, Weiderpass E, Bruni L, de Sanjosé S, Saraiya M, Ferlay J, et al. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. The Lancet Global Health. 2020;8(2):e191-203.

Singh N. HPV and Cervical cancer - prospects for prevention through vaccination. Indian J Med Paediatr Oncol. 2005;26:20-3.

Schiffman M, Castle PE, Jeronim J, Rodrigue AC, Wacholde S. Human papillomavirus and cervical cancer. Lancet. 2007;370:890-907.

de Sanjose S, Quint WG, Alemany L. Human papillomavirus genotype attribution in invasive cervical cancer: a retrospective cross-sectional worldwide study. Lancet Oncol. 2010;11:1048-56.

Bzhalava D, Guan P, Franceschi S, Dillner J, Clifford G. A systematic review of the prevalence of mucosal and cutaneous human papillomavirus types. Virol. 2013;445:224-31.

Dunne EF, Markowitz LE. Genital human Papillomavirus infection. Clin Infect Dis. 2006;43:624-9.

World Health Organization. HPV IARC monograph summary. Lancet Oncol. 2005;6:204.

Castellsague X, Munoz N. Cofactors in human papillomavirus carcinogenesis - role of parity, oral contraceptives, and tobacco smoking. J Natl Cancer Inst Monogr. 2003;31:20-8.

Arbyn M, Ronco G, Anttila A, Meijer CJ, Poljak M, Ogilvie G, et al. Evidence regarding human papillomavirus testing in secondary prevention of cervical cancer. Vaccine. 2012;30:F88-99.

Kaarthigeyan K. Cervical cancer in India and HPV vaccination. Indian J Med Paediatr Oncol. 2012;33(1):7-12.

Gupta RK, Singh P, Langer B, Kumari R, Sharma P, Gupta RK. Cervical cancer: a hospital based KAP study among women aged 18 years and above in Northern India. Int J Community Med Public Health. 2019;6:1628-33.

Narayana G, Suchitra MJ, Sunanda G, Ramaiah JD, Kumar BP, Veerabhadrappa KV. Knowledge, attitude, and practice toward cervical cancer among women attending obstetrics and gynecology department: a cross-sectional, hospital-based survey in South India. Indian J Cancer. 2017;54(2):481-7.

Bansal AB, Pakhare AP, Kapoor N, Mehrotra R, Kokane AM. Knowledge, attitude, and practices related to cervical cancer among adult women: A hospital-based cross-sectional study. J Natural Sci Biol Med. 2015;6(2):324.

Tran NT, Choe SI, Taylor R, Ko WS, Pyo HS, So HC. Knowledge, attitude and practice (KAP) concerning cervical cancer and screening among rural and urban women in six provinces of the Democratic People's Republic of Korea. Asian Pac J Cancer Prev. 2011;12:3029-33.

Van Dyne EA. Establishing baseline cervical cancer screening coverage-India, 2015-2016. Morb Mortal Weekly Report. 2019;68:14-9.

Chawla PC, Chawla A, Chaudhary S. Knowledge, attitude and practice on human papillomavirus: A cross-sectional study among healthcare providers. Indian J Med Res. 2016;144:741-9.

Mehta S, Rajaram S. Awareness about human papilloma virus and its vaccine among medical students. Ind J Comm Med. 2013;38(2):92-4.

Pandey S, Chandravati. Human papillomavirus-mediated cervical cancer awareness and Gardasil vaccination: a pilot survey among North Indian women. J Community Health. 2013;38:907-10.

Leung JTC, Law CK. Revisiting knowledge, attitudes and practice (KAP) on human papillomavirus (HPV) vaccination among female university students in Hong Kong. Hum Vaccin Immunother. 2018;14(4):924‐30.

Sankaranarayanan R, Basu P, Kaur P, Bhaskar R, Singh GB, Denzongpa P, et al. Current status of human papillomavirus vaccination in India's cervical cancer prevention efforts. The Lancet Oncol. 2019;20(11):e637-44.

Gaurav A, Bahadur A, Khoiwal K, Bhattacharya N, Chaturwedi J. Knowledge, attitude and practice towards HPV vaccine among medical and nursing students in AIIMS Rishikesh. Indian Obstet Gynaecol. 2019;9(4):34-7.

Hall MT, Simms KT, Lew JB, Smith MA, Brotherton JM, Saville M, et al. The projected timeframe until cervical cancer elimination in Australia: a modelling study. Lancet Public Health. 2019;4:e19-27.