Human Papillomavirus-Related Oral Cancer: Knowledge and Awareness Among Spanish Dental Students Alejandro Ismael Lorenzo-Pouso 1,2 & Pilar Gándara-Vila 1,2 & Cristina Banga 1 & Mercedes Gallas 1,2 & Mario Pérez-Sayáns 1,2 & Abel García 1,2 & Ellen M. Daley 3 & Iria Gasamáns 4 # American Association for Cancer Education 2018 Abstract Human papillomavirus (HPV) infections are responsible for a significant part of the global burden of cancer. Epidemiologic studies have shown increasing trends of HPV-related oral cancers worldwide. Dental professionals need comprehensive up-to- date HPV-related information to be able to provide correct advice to their patients. The aim of this paper is to describe knowledge and awareness levels of dental students from Spain on HPV infection, HPV vaccination, oral cancer prevention, and HPV-related oropharyngeal cancer. A survey was distributed to 240 dental students, of which 158 returned it. Most students reported not been vaccinated against HPV (n = 81, 51.3%) and believed that HPV infection was linked to oropharyngeal cancer (75%). Overall, advanced students showed better knowledge, attitudes, and perceptions regarding this issue while novice students showed relevant shortcomings. However, their attitudes in relation to the diagnosis of oral cancer were adequate. These results suggest that there are important HPV-related knowledge deficits among Spanish dental students, which hinders their interventions in oropharyngeal primary prevention efforts. Findings of this study suggest the inclusion and standardization of HPV-related educational information to the dental curriculum. Keywords HPV . Oral cancer . Health literacy . Vaccine . Dental education Introduction Worldwide HPV-attributable oropharyngeal cancer represents about 4.5% of all cancers with an estimated 630,000 new cases diagnosed annually [1]. Historically, the causes of oropharyn- geal cancer have been closely related with modifiable risk fac- tors such as tobacco or alcohol use. Recent evidence has corre- lated oropharyngeal cancer with other risk factors such as the human papillomavirus (HPV), a sexually transmitted infection [2, 3]. Despite the decline in the incidence of oral squamous cell carcinoma (OSCC) experienced in the last 30 years, probably due to the awareness of harmful effects of tobacco and alcohol use, the incidence of OSCC in the oropharynx associated to HPV has increased [4–7]. Numerous studies have estimated that the DNA-HPV prevalence oropharyngeal cancer tumor biopsies might be up to 75% [8]. Currently, oropharyngeal cancer patients are predominant- ly younger men who have minimal or no exposure to tobacco and/or alcohol. Regardless, they have an increased number of risky sexual behaviors, especially unprotected oral sex. Studies have found evidence that having more than nine life- time sexual partners increases the risk of having oropharyn- geal cancer by 34 times [9], and usually presents higher risk HPV genotypes (HR-HPV) in their tumor cells, predominant- ly HPV 16 and 18 [7, 9]. Moreover, patients with HPV-related oropharyngeal carcinomas seem to have a better response to treatment and better survival rates. For example, a 2011 study found that the survival rate after 3 years was 82.4% for the HPV-positive cancer patients group and 57.1% for the patients with HPV-negative cancer group [10]. Given the association between HPV 16 and 18 and oropha- ryngeal cancers, it has been suggested that the use of available HPV vaccines may decrease the incidence of these carcinomas. * Alejandro Ismael Lorenzo-Pouso alexlopo@hotmail.com 1 Oral Medicine, Oral Surgery and Implantology Unit, Faculty of Medicine and Odontology, University of Santiago de Compostela, Rúa Entrerríos S/N, 15782 Santiago de Compostela, Spain 2 GI-1319 Research Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain 3 College of Public Health, University of South Florida, Tampa, Florida; The Chiles Center, College of Public Health, University of South Florida, Tampa, FL, USA 4 Amsterdam, Netherlands Journal of Cancer Education https://doi.org/10.1007/s13187-018-1373-1