Awareness on etiology and preventive measures of cancer cervix among female medical students in Rajarajeswari Medical College, Bengaluru

INTRODUCTION

Cervical cancer remains one of the most common cancers affecting women worldwide and continues to be a major public health concern. According to global cancer statistics, cervical cancer ranks as the fourth most common cancer among women globally, with a substantial burden observed in low- and middle-income countries.¹ Persistent infection with high-risk types of HPV, particularly HPV-16 and HPV-18, is recognized as the primary etiological factor responsible for the development of cervical cancer.² Human papillomavirus is one of the most common sexually transmitted infections worldwide and most sexually active individuals are exposed to the virus at some point in their lives.³ Although many HPV infections resolve spontaneously, persistent infection with oncogenic HPV types may lead to the development of cervical intraepithelial neoplasia and eventually cervical cancer.² Early identification of risk factors and preventive measures is therefore essential for reducing cervical cancer incidence and mortality. Cervical cancer is largely preventable through effective preventive strategies such as HPV vaccination and regular cervical cancer screening. Screening methods such as the Pap smear test have been widely used for the early detection of precancerous lesions and early-stage cervical cancer.⁴ Countries that have implemented organized screening programs have shown a significant reduction in cervical cancer incidence and mortality.⁵ HPV vaccination is another important preventive strategy that protects against high-risk HPV types responsible for the majority of cervical cancer cases.⁶Several studies have demonstrated that HPV vaccination can significantly reduce the incidence of HPV-related cancers and genital warts.⁷ Despite the availability of these preventive measures, awareness regarding HPV infection, cervical cancer risk factors and vaccination remains inadequate in many populations.⁸ Previous studies conducted among university and medical students in different countries have reported varying levels of knowledge regarding HPV infection and cervical cancer prevention. Some studies have shown relatively good awareness among healthcare students, while others have identified gaps in knowledge regarding screening guidelines and vaccination practices.^9,10 Furthermore, even when awareness is high, the uptake of HPV vaccination often remains low due to barriers such as cost, safety concerns and lack of accessibility.¹¹ Medical students represent an important group in cervical cancer prevention efforts because they are future healthcare providers who will play a key role in educating the community about cancer prevention strategies. Adequate knowledge among medical students regarding HPV infection, cervical cancer screening and vaccination is essential for effective health promotion and disease prevention.¹²

METHODS

Study design

This was a cross-sectional study.

Study setting

The study was conducted at Rajarajeswari Medical College and Hospital, Bengaluru.

Study population

Female medical students including undergraduates, interns and postgraduate students were included in the study.

Sample size

A total of 150 female medical students participated in the study.

Study duration

The study duration was of 3 months from June 2025–August 2025).

Study tool

Data were collected using a pretested semi-structured questionnaire consisting of sections on sociodemographic characteristics, knowledge on HPV transmission, cervical cancer risk factors and symptoms, pap smear screening, HPV vaccination awareness and acceptance.

Data collection

Participants completed the questionnaire after informed consent. The questionnaire assessed knowledge related to HPV infection, cervical cancer, screening methods, vaccination awareness and barriers to vaccination.

Statistical analysis

Data were entered into Microsoft Excel and analysed using SPSS software. Descriptive statistics were expressed as frequencies and percentages. The association between educational level and knowledge variables was analysed using the Chi-square test. A p value<0.05 was considered statistically significant.

RESULTS

A total of 150 female medical students participated in the study.

Sociodemographic characteristics

Most participants were between 20–30 years (96%), while only 4% were above 30 years of age. Equal distribution of participants was observed across educational levels, with 33.3% each belonging to postgraduate, intern and undergraduate categories.

Awareness of human papillomavirus and cervical cancer

All participants reported that they had heard of HPV and cervical cancer.

Regarding HPV-related health conditions, 76% identified cervical cancer, while 31% recognized genital warts and 27% identified penile cancer as HPV-related diseases. About 87% correctly identified genital contact as the primary mode of HPV transmission.

Knowledge of cervical cancer risk factors and symptoms

A majority of participants recognized sexually transmitted diseases (84%) as a risk factor for cervical cancer, while 30% identified HPV infection as a risk factor.

Regarding symptoms, 75% reported postcoital bleeding, 74% irregular vaginal bleeding and 68% vaginal discharge as symptoms associated with cervical cancer.

Awareness of preventive measures

Approximately 87% of students were aware that cervical cancer can be detected at an early stage. Nearly 69% believed that cervical cancer can be cured when detected early.

Knowledge of pap smear screening

Most participants (98.7%) had heard about the Pap smear test. However, only 28% correctly identified 21 years as the recommended age for the first Pap smear. About 41.3% reported that Pap smear screening should be done every three years.

Human papillomavirus vaccination awareness

Awareness regarding the HPV vaccine was high, with 98.7% of students reporting that they had heard about it. Approximately 80.7% correctly stated that the cervical cancer vaccine contains HPV antigens. About 66.7% knew that the HPV vaccine also prevents genital warts.

Vaccine acceptance and barriers

A large majority (94.7%) expressed willingness to receive the HPV vaccine. However, only 38.7% of participants had actually received the vaccine. The most commonly reported barriers to vaccination were high cost and fear of side effects.

Association between educational level and knowledge

Educational level showed a statistically significant association with knowledge of the primary target age group for HPV vaccination (p=0.035) and knowledge of the recommended age for the first Pap smear test (p=0.030).

Note: P value<0.05- Significant.

DISCUSSION

The present study assessed awareness regarding cervical cancer etiology and preventive strategies among female medical students. The findings demonstrated a high level of awareness about HPV infection, cervical cancer and screening methods among the participants.

In the present study, all participants had heard about HPV and cervical cancer, indicating a high level of general awareness among medical students. Similar findings have been reported in studies conducted among university students in different countries. For example, a study conducted among university students in Qatar reported that a majority of participants had some level of knowledge regarding HPV infection and vaccination, although detailed understanding varied among students.¹ Similarly, research conducted among female university students in Ethiopia found that awareness regarding HPV infection existed among many students, but only a proportion demonstrated good knowledge regarding its prevention and vaccination.²

Knowledge regarding HPV transmission was relatively high in the present study, with most participants identifying genital contact as the primary mode of transmission. This observation is consistent with previous studies among healthcare students where sexual transmission was commonly recognized as the major route of HPV infection.³ Medical education likely contributes to better awareness of sexually transmitted infections and their associated risks. Regarding cervical cancer risk factors, a majority of participants recognized sexually transmitted diseases as an important risk factor. However, fewer students correctly identified HPV infection itself as a direct etiological factor. Similar knowledge gaps have been observed in other studies conducted among healthcare students. Research conducted among medical, dental and nursing students in South India reported that although many participants were aware of cervical cancer, detailed knowledge about HPV as the causative agent remained incomplete.⁴

In the present study, awareness of cervical cancer symptoms such as postcoital bleeding, irregular vaginal bleeding and vaginal discharge was relatively high. Early recognition of these symptoms is important because cervical cancer can often be detected and treated effectively when identified at an early stage. Awareness regarding pap smear screening was also high in the present study, with nearly all participants having heard about the test.

However, knowledge regarding the correct age to initiate screening and recommended screening intervals was comparatively lower. Similar findings have been reported in studies conducted among university students in Saudi Arabia and Pakistan, where general awareness about cervical cancer screening existed but knowledge about specific screening guidelines was limited.^5,6 HPV vaccination awareness in the present study was also very high. Nearly all participants reported that they had heard about the HPV vaccine. This level of awareness is higher than that reported in many studies conducted among general populations. For example, a study conducted among women in North India reported that awareness of HPV vaccination was relatively low and vaccination coverage was minimal.⁷ These differences may be explained by the medical background of the participants in the present study. Despite high awareness and willingness to receive the vaccine, the actual vaccination coverage among the participants was relatively low. Only about one-third of participants reported being vaccinated. Similar gaps between awareness and vaccine uptake have been reported in several studies worldwide. A study conducted among university students in the United States found that although many students expressed willingness to receive the HPV vaccine, actual vaccination rates remained low due to various barriers.⁸

Cost and fear of side effects were reported as the most common barriers to vaccination in the present study. These findings are consistent with previous research conducted among university students in Morocco and Italy, where vaccine cost, safety concerns and lack of accessibility were identified as major barriers to HPV vaccine uptake.^9,10 Educational level was significantly associated with knowledge regarding HPV vaccination target age and Pap smear screening age. Students at higher academic levels demonstrated better knowledge compared to junior students. Similar findings have been reported in studies conducted among medical students in China and nursing students in India, where academic progression was associated with improved knowledge and awareness regarding HPV vaccination and cervical cancer prevention.^11,12 Overall, the findings of the present study highlight that although awareness among medical students is relatively high, gaps remain in detailed knowledge and preventive practices such as vaccination uptake. Strengthening educational interventions and improving vaccine accessibility could play an important role in enhancing cervical cancer prevention strategies among young women.

Strengths

The study included participants from different levels of medical education, allowing comparison of knowledge across academic levels. The use of a structured questionnaire enabled systematic assessment of awareness regarding cervical cancer and preventive measures.

Limitations

The study was conducted in a single medical college, which may limit the generalizability of the findings to other populations. In addition, the study relied on self-reported responses, which may be subject to reporting bias.

CONCLUSION

The study demonstrated high awareness regarding HPV infection, cervical cancer and preventive measures among female medical students. However, despite high levels of awareness and willingness to receive the HPV vaccine, actual vaccination coverage remained relatively low. Strengthening educational initiatives and improving accessibility and affordability of HPV vaccination may help bridge the gap between awareness and preventive practices, ultimately contributing to cervical cancer prevention.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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