Health Promotion Journal of Australia 2010: 21(3) 202 Knowledge of cervical cancer, pap testing and the human papillomavirus among young Australian women Abstract Issue addressed: In 2007, the Australian Federal Government implemented an ongoing national human papillomavirus immunisation program for females aged 12 to 13 years. Those aged up to 26 years were able to receive the vaccine free of charge from their general practitioner until June 2009. The purpose of this study was to determine the level of participation in the national human papillomavirus vaccination and cervical cancer screening programs and knowledge of cervical cancer, Pap testing and the human papillomavirus within this at risk group. Methods: The sample comprised 274 women, mean age 21.75 (SD=2.14) years who were recruited using snowball sampling. Participants completed an online questionnaire between May and July 2008 that assessed knowledge, awareness and attitudes towards cervical cancer, Pap testing and the human papillomavirus vaccine, as well as participation in Pap testing and uptake of the vaccine. Results: Just over 84% of the participants reported receiving the human papillomavirus vaccine and 60% were following the national guidelines in relation to cervical cancer screening. Participants who reported screening correctly for cervical cancer were more likely to be sexually active compared to under-screeners, but under- screeners were more likely to be in a relationship. Overall, knowledge of cervical cancer, Pap testing and the human papillomavirus was good but some misconceptions were present. Conclusions: While knowledge of the human papillomavirus, cervical cancer and Pap testing was good, further education is required to correct common misconceptions about the human papillomavirus vaccine and to improve vaccination uptake in this population. Key words: human papillomavirus, vaccination, cervical cancer, Pap testing, knowledge and attitudes Health Promotion Journal of Australia 2010; 21:202-7 So What Health promotion campaigns need to ensure all women, and particularly young women, continue to be educated on cervical cancer and the human papillomavirus as well as the importance of having regular Pap tests. Understanding Health Behaviours Introduction Cervical cancer is the 16th leading cancer in Australian women, while worldwide it remains the second most common cancer in females. 1 Until recently, the prevention of cervical cancer has relied almost exclusively on detection of abnormal cell changes in the cervix through regular Papanicolaou (Pap) tests. 2 These malignant cells manifest from the abnormal development of cells caused by infection with the human papillomavirus. (HPV). 3-6 HPV is a sexually transmitted infection (STI) that typically occurs through skin to skin contact within several years of the onset of sexual activity. 2,4,7 While HPV infection is a necessary cause of cervical cancer, 1 infection with HPV does not always lead to development of the disease. The four most common strains of HPV are types 6, 11, 16 and 18, 4 with types 16 and 18 implicated in ~70% of cases of cervical cancer. 1,2 Symptoms associated with cervical cancer usually present in middle-aged women, 4,8 with progression from precancerous lesions to invasive cancer occurring over a period of 10 to 15 years. 8,9 Accordingly, cervical cancer is one of the most preventable and curable cancers. The development of prophylactic vaccines to prevent HPV infection has allowed for the primary prevention of the virus and subsequent cervical cancer. Gardasil™, licensed for use in Australia in June 2006, is a quadrivalent vaccine protecting against HPV types 6, 11, 16 and 18, 2,10 while Cervarix™, a bivalent vaccine protects against HPV types 16 and 18. 2 Presuming that the vaccine remains effective in preventing HPV infection, it is predicted that vaccination of all women aged under 25 years will lead to a 60-70% reduction in cervical cancer related mortality within 30 years. 11-13 There is no evidence to suggest that the vaccines prevent cervical cancer in women who have already been exposed to HPV. Therefore, the ideal time to vaccinate is prior to the onset of sexual activity and potential exposure to the virus. Lyndel Shand, Sue Burney and Jane Fletcher