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Contemporary Perceptions of Human Papillomavirus and Penile Cancer - Perspectives from a National Survey
Michael Zavaski, MD1, Mark Preston, MD1, Jairam Eswara, MD1, Julian Hanske, MD2, Bjoern Loeppenberg, MD2, Alexander P. Cole, MD1, David Friedlander, MD1, Philip J. Cheng, MD1, Nawar Hanna, MD2, Quoc Trinh, MD1, Christian P. Meyer, MD2.
1Brigham & Women's Hospital, Boston, MA, USA, 2Center for Surgery and Public Health (CSPH), Harvard Medical School, Boston, MA, USA.

Background:
Penile cancer is a deadly yet rarely discussed genitourinary cancer with more than half of cases in the United States (US) associated with HPV (Human Papillomavirus). Our goal was to investigate contemporary knowledge of HPV and its association with penile cancer in a nationwide cohort from the US.
Methods:
We utilized the 2014 Health Information National Trends Survey (HINTS), a cross-sectional telephone survey performed in the US initiated by the National Cancer Institute. Our primary endpoints included knowledge of HPV and its causal relationship to penile cancer. Baseline characteristics included sex, age, education, race & ethnicity, income, residency, personal or family history of cancer, health insurance status, and internet use. Adjusted analyses were used to identify predictors of HPV and penile cancer knowledge.
Results:
An unweighted sample of 3,376 respondents was extracted from HINTS. Whereas 65.0% of respondents had heard of HPV, only 29.5% of these were aware that it could cause penile cancer. Men were significantly less likely to have heard of HPV than women (OR 0.32 95% CI 0.24-0.43). Older age; African-American, Asian, and “other race”; being married; from a lower education bracket; having a personal cancer history; and those without internet were significantly less likely to have heard of HPV. We did not identify any independent predictors for the knowledge of the association of penile cancer and HPV.
Conclusions:
A large, nationally representative survey demonstrates that the majority of the American public is familiar with HPV but lack a meaningful understanding between this virus and penile cancer. Urologists and primary care providers should be encouraged to intensify counseling about this significant association as a primary preventive measure of this potentially fatal disease.
Table I: Baseline Survey Characteristics, Health Information National Trends Survey 4, Cycle 4, 2014
Gender
Male
Female
Age
<65
>/= 65
---
48.95
51.05
---
82.55
17.45
Race
White
Afr-Amer
Hispanic
Asian
Other
---
66.63
11.31
15.14
4.78
2.14
Marital Status
Married
Divorced, widowed, Separated
Single, Never Married
---
53.72
31.47
14.81
Children in Household
No children
>/= 1 child
---
64.04
35.96
Education
Some High School
High School Graduate
Some College
College Graduate
---
11.63
18.19
30.03
40.15
Income ($ USD)
</= 20,000
20,001-50,000
50,001-75,000
>/= 75,000
---
19.37
27.53
17.25
35.85
Residency
Urban
Rural
---
85.59
14.41
Insurance Status
No
Yes
---
12.68
87.32
Personal History of Cancer
Yes
No
Family History of Cancer
Yes
No
---
8.52
91.48
---
70.94
29.06
Internet Access
Yes
No
---
83.41
16.59


Table 2: Univariate responses to HPV questions/simple proportions, HINTS4
Survey Question
NoYesUnsure
Have you ever heard of HPV?35.6564.35--
Do you think HPV can cause penile cancer?15.3429.4755.18
Do you think HPV can cause cervical cancer?0.9777.9921.04
Do you think HPV is a STD?30.1569.85--
Do you think HPV needs medical treatment?10.7189.29--
Survey answers are based on percentages from weighted estimates


Table 3: Logistic Regression for predictors of Association between HPV and Penile Cancer
VariableOR (95% CI)P-value
Gender
Male
Female
Age
<65
>/= 65
---
1.11 (0.76-1.61)
Ref.
---
Ref.
0.93 (0.56-1.55)
---
0.606
-
---
0.790
Race
White
Afr-Amer
Hispanic
Asian
Other
---
Ref.
0.93 (0.49-1.75)
0.88 (0.44-1.78)
1.09 (0.39-3.04)
1.67 (0.59-4.69)
---
-
0.824
0.726
0.876
0.332
Marital Status
Married
Divorced, widowed, Separated
Single, Never Married
---
1.06 (0.72-1.58)
1.30 (0.78-2.18)
Ref.
---
0.760
0.308
-
Children in Household
No children
>/= 1 child
---
Ref.
1.47 (1.00-2.17)
---
-
0.052
Education
Some High School
High School Graduate
Some College
College Graduate
---
1.51 (0.51-4.41)
1.03 (0.57-1.87)
1.17 (0.75-1.82)
Ref.
---
0.456
0.921
0.487
-
Income ($ USD)
</= 20,000
20,001-50,000
50,001-75,000
>/= 75,000
---
Ref.
0.80 (0.39-1.65)
0.73 (0.33-1.59)
0.51 (0.22-1.16)
---
-
0.552
0.427
0.107
Residency
Urban
Rural
Insurance Status
No
Yes
---
0.90 (0.43-1.91)
Ref.
---
0.99 (0.48-2.06)
Ref.
---
0.787
-
---
0.988
-
Personal History of Cancer
Yes
No
Family History of Cancer
Yes
No
---
1.14 (0.64-2.03)
Ref.
---
0.91 (0.62-1.35)
Ref.
---
0.663
-
---
0.651
-
Internet Access
Yes
No
---
Ref.
0.92 (0.46-1.83)
---
-
0.811


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