Asian Paciic Journal of Cancer Prevention, Vol 13, 2012 897 DOI:http://dx.doi.org/10.7314/APJCP.2012.13.3.897 Knowledge and Attitude of Female Students towards Cervical Cancer Prevention Asian Paciic J Cancer Prev, 13, 897-900 Introduction Cervical cancer is the second most common malignancy among women worldwide and is especially common in developing countries; India, Bangladesh and Nepal have the highest incidence in the Asia Paciic region (Garland et al., 2008). The incidence of cervical cancer in Japan is relatively low, at 6.7 per 100,000; nevertheless, each year more than 15,000 new cases, including both in-situ and invasive forms, are diagnosed and about 2,500 women die because of cervical cancer (Konno et al., 2008). Cervical cancer used to be common among Japanese women in their 50s, but in recent years the incidence of cervical cancer has been increasing among younger women (25~34 years old). The most important risk factor for cervical cancer, in more than 90% of cases, is prior infection with Human Papillomavirus (HPV). There may be up to 30 HPV types that can infect the genital system but only about a dozen are associated with a high risk of malignancy. HPV types 16 and 18 may be responsible for about 70% of all cervical cancers, worldwide. The most common HPV types associated with cervical cancer in Japan are types 16, 18, 31, 33, 35, 52, and 58 (Miura et al., 2006). HPV Infection results from sexual contact with an already infected person, similar to 1 Graduate School of Asia Paciic Studies, Ritsumeikan Asia Paciic University, 2 Department of Preventive and Environmental Medicine, Faculty of Life Science, Kumamoto University, Japan *For correspondence: nader@apu.ac.jp Abstract Cervical cancer resulting from prior infection with human papillomavirus (HPV) is a signiicant public health threat against young Japanese women. A national immunization plan to vaccinate 13~16 year old female students against HPV infection has been started in Japan since 2010, and may reach almost full coverage by the end of 2012. Older age females who may already be sexually active are not targeted by this plan but should follow safer sex practices as well as periodic screening of the cervix cytology to reduce their risk of developing cervical cancer. HPV vaccination alone does not offer full protection either, because only some HPV types are covered by the vaccines and the long-term eficacy of the vaccines has not been determined yet. Therefore, we did a survey at an international university in Japan to study the knowledge and attitude of female college students towards prevention of cervical cancer, to examine the age when they start sexual activity and other related attributes that may inluence the risk of cervical cancer. We discuss the results of our survey and what they imply for the possible impact of an HPV immunization plan on the risk of cervical cancer in Japan, and conclude by an emphasis on the need to increase awareness among Japanese female adolescents and to enhance the cervical screening rates among older females who are already sexually active. Keywords: Cervical cancer - HPV - immunization - Japanese women’s health - periodic Pap screening RESEARCH COMMUNICATION Assessment of the Knowledge and Attitude of Female Students towards Cervical Cancer Prevention at an International University in Japan Nader Ghotbi 1 , Akane Anai 2 * other sexually transmitted diseases (STD). Primary prevention of cervical cancer is thus possible by avoiding infection with HPV through abstinence from sex. Early immunization of female adolescents with a vaccine which is effective against a few signiicant HPV types, mainly type 16 and 18, together with adherence to safer sex practices such as a consistent use of latex condoms, may also be very effective. It is believed that the use of the vaccine can help prevent from 44% of intraepithelial neoplasia and 71% of invasive cervical cancers in Japan (Onuki et al., 2009). However, a sexually active woman may have already been exposed to HPV infection and thus will probably not beneit from vaccination. The risk of HPV infection and the ensuing cervical cancer, from 5 to 20 years later, are higher among those who start sexual activity at an earlier age, and have multiple partners. The only HPV independent risk factor for cervical cancer is smoking (Konno et al., 2008). Secondary prevention of cervical cancer is also possible through periodic (annual) screening of sexually active females by Pap-smear; a cotton swab is used to take exfoliates of cervical cells for observation under the microscope. It can diagnose early forms such as in-situ malignancy which can thus be treated before changing into invasive cancer. Pap-smear screening can help reduce