Knowledge and Awareness of Human Papillomavirus (HPV) Vaccine in Prevention of Cervical Cancer among Medical Students: A Cross-Sectional Study

 

Dr. Alnkrita Bansal¹^*, Dr. G. Indira², Dr. KSK Divya³, Dr. Mrudhula⁴ and Dr. Karisini⁵

Citation: Bansal A, Indira G, Divya K, Mrudhula, Karisini. Knowledge and Awareness of Human Papillomavirus (HPV) Vaccine in Prevention of Cervical Cancer Among Medical Students: A Cross-Sectional Study. Genesis J Gynaecol Obstet. 2(1):1-15.

Received: September 08, 2026 | Published: September 19, 2026

Copyright^© 2026 Genesis Pub by Bansal A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0). This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author(s) and source are properly credited.

Abstract

Background: Cervical cancer remains a leading cause of cancer-related morbidity and mortality among women in low- and middle-income countries, particularly India, which accounts for a substantial share of the global burden. Persistent infection with high-risk Human Papillomavirus (HPV) is the primary etiological factor, and HPV vaccination provides effective primary prevention — yet vaccine uptake remains low even among healthcare trainees who are expected to serve as advocates for preventive health.

Objectives: To evaluate the knowledge, awareness, attitudes, and vaccination status related to HPV and its vaccine among final-year medical students and house surgeons, and to examine the association between awareness and willingness to recommend vaccination to others.

Methods: A descriptive, cross-sectional study was conducted among 100 final-year MBBS students and house surgeons at GIMSR Hospital, Visakhapatnam, using a structured, self-administered questionnaire covering knowledge, awareness, vaccination status, and attitudes. Data were analysed using descriptive statistics and the chi-square test, with p<0.05 considered statistically significant.117 (51.5%) reported knowing two or more danger signs.

Results: Awareness of HPV as a causative factor for cervical cancer was reported by 95% of students, and 85% were aware of the HPV vaccine; however, only 40% had actually received the vaccine. Among the 60 unvaccinated students, exactly half (50%) expressed willingness to be vaccinated. Awareness of the vaccine schedule (80%) and cost (74%), and willingness to recommend vaccination to others (88%), reflected generally positive attitudes despite low personal uptake. A statistically significant association was found between awareness of the HPV vaccine and willingness to recommend it (p<0.05), while sex showed no significant association with vaccination status (p>0.05).

Conclusion: Medical students demonstrate strong awareness of, and positive attitudes toward, HPV vaccination, but this has not translated into adequate personal uptake. Strengthening practical, vaccine-focused medical education, facilitating affordable on-campus access, and supporting national vaccination strategies — including India's newly available, lower-cost indigenous vaccine — are crucial to closing this gap.

Keywords

Cervical cancer; Human papillomavirus; HPV vaccine; Medical students; Awareness; Vaccination uptake; Preventive health; Cross-sectional study.

Introduction

Cervical cancer continues to pose a major threat to women's health worldwide despite being one of the most preventable and treatable malignancies when detected early. According to the most recent Global Cancer Observatory (GLOBOCAN) estimates, cervical cancer accounted for approximately 662,301 new cases and 348,874 deaths worldwide in 2022, making it the fourth most commonly diagnosed cancer and the fourth leading cause of cancer death among women globally [1]. Nearly 90% of these deaths occur in low- and middle-income countries (LMICs), reflecting profound global inequities in access to preventive screening, vaccination, and timely treatment [1].

India shares a disproportionate share of this global burden. GLOBOCAN 2022 data place India second only to China in absolute case numbers, with an estimated 127,356 new cervical cancer cases that year — nearly one-fifth of the global total [1]. Cervical cancer is the second most common cancer among Indian women after breast cancer, and government surveillance data from the Indian Council of Medical Research–National Cancer Registry Programme (ICMR-NCRP) indicate that annual cervical cancer deaths in the country have risen steadily in recent years, from an estimated 32,246 in 2019 to 35,691 in 2023 [2].

The near-universal cause of cervical cancer is persistent infection with high-risk, oncogenic genotypes of Human Papillomavirus (HPV). More than 200 HPV genotypes have been identified, of which approximately 12–14 are classified as high-risk; genotypes 16 and 18 alone are responsible for approximately 70% of cervical cancers worldwide [3]. HPV is transmitted predominantly through sexual contact and is the most common sexually transmitted infection among sexually active individuals. While most infections are transient and cleared spontaneously by the host immune system within one to two years, persistent infection with high-risk genotypes can progress through cervical intraepithelial neoplasia (CIN) to invasive carcinoma over a period of years to decades.

Preventive strategies against cervical cancer operate at two levels. Secondary prevention relies on the early detection of precancerous lesions through Papanicolaou (Pap) smear cytology, HPV DNA testing, and visual inspection with acetic acid (VIA). Primary prevention through HPV vaccination, however, has emerged as the single most effective long-term strategy, since it prevents infection before it can become established. Three prophylactic vaccines have historically been available in India: Cervarix (bivalent, targeting HPV 16 and 18), Gardasil (quadrivalent, targeting HPV 6, 11, 16, and 18), and Gardasil-9 (nonavalent, additionally targeting HPV 31, 33, 45, 52, and 58). More recently, India has developed its own indigenous quadrivalent vaccine, Cervavac, manufactured by the Serum Institute of India in partnership with the Department of Biotechnology; a randomised, active-controlled phase 2/3 trial demonstrated that Cervavac produces antibody responses non-inferior to Gardasil, and it received market authorisation from the Drugs Controller General of India in 2022 [4]. Because Cervavac is priced substantially lower than the imported vaccines, it holds considerable promise for improving affordability and access in a cost-sensitive setting such as India.

Despite these advances, HPV vaccine uptake in India remains low. Recognised barriers include limited awareness, misconceptions about vaccine safety and fertility effects, social stigma associated with a sexually transmitted infection, and the historically high cost of imported vaccines. In 2020, the World Health Organization (WHO) launched the Global Strategy to Accelerate the Elimination of Cervical Cancer as a Public Health Problem, which set the “90–70–90” targets to be achieved by 2030: 90% of girls fully vaccinated against HPV by age 15 years, 70% of women screened using a high-performance test by age 35 and again by 45, and 90% of women with cervical disease receiving appropriate treatment [5]. Achieving these targets will require the active participation of healthcare professionals at every level of the health system.

Medical students occupy a unique position in this effort. As future physicians, they will be responsible for counselling patients, dispelling myths, and driving uptake of preventive interventions such as HPV vaccination within their communities. Their personal knowledge, attitudes, and vaccination status are therefore not merely a matter of This study was therefore undertaken among final-year MBBS students and house surgeons at GIMSR Hospital, Visakhapatnam, to assess their knowledge, awareness, attitudes, and vaccination status with respect to HPV and its vaccine.

Review of Literature

The causal link between persistent HPV infection and cervical carcinogenesis was firmly established through epidemiological and molecular virology studies during the 1980s and 1990s — work recognised by the award of the 2008 Nobel Prize in Physiology or Medicine to Harald zur Hausen — and this understanding directly informed the global burden estimates and prophylactic vaccine development efforts that followed in the early 2000s [6].

Global perspectives

Countries that achieved high, sustained HPV vaccination coverage have documented dramatic real-world reductions in HPV prevalence and cervical disease. In Australia, which became one of the first countries to introduce a national, school-based quadrivalent HPV vaccination programme in 2007, population-based surveillance found that the prevalence of vaccine-targeted HPV genotypes among women aged 18–24 years fell from 22.7% in 2005–2007 (pre-vaccine) to just 1.5% by 2015 — a relative reduction exceeding 90% — with similar declines and clear evidence of herd protection observed even among unvaccinated women [7]. In England, a population-based observational study linking vaccination, screening, and cancer registry data found that women offered the bivalent vaccine at age 12–13 years had cervical cancer rates 87% lower than earlier, unvaccinated cohorts, with corresponding reductions of 62% and 34% among those vaccinated at ages 14–16 and 16–18 respectively [8]. A pooled systematic review and meta-analysis of vaccination programmes across multiple high-income countries has confirmed that these gains are consistent and reproducible wherever coverage is high and sustained, with clear population-level herd effects extending to unvaccinated individuals [9]. Together, these findings provide direct, population-level evidence that HPV vaccination — particularly when delivered before the onset of sexual activity — can dramatically curtail the future burden of cervical cancer.

Indian studies

Vaccination coverage in India, however, remains far below these benchmarks, even among healthcare trainees who might be expected to be better informed than the general population. Radhika et al. found that only 55% of medical students in Mangalore were aware of the HPV vaccine [10]. Pandey et al., studying students at a premier Indian medical school, similarly reported moderate awareness coupled with very low uptake [11]. Aparna et al. reported comparable findings, with reasonable baseline knowledge failing to translate into vaccine acceptance [12]. This pattern has persisted in more recent cohorts: a 2025 cross-sectional study among female undergraduate medical students in Nagpur found that despite generally adequate awareness of HPV, only around 10% of participants had actually been vaccinated [13]; a similarly recent study from a medical college in Amritsar found that while more than three-quarters of undergraduate medical students were aware of the HPV vaccine, only 7% had received it [14].

A large multi-institutional survey of 1,210 health science undergraduates in central India found that fewer than 28% correctly identified vaccination as a preventive measure for cervical cancer, although medical students performed somewhat better on most parameters than students of other health science disciplines [15]. Taken together, these studies — spanning more than a decade and multiple regions of India — consistently demonstrate a persistent gap between awareness and actual vaccine utilisation among Indian medical trainees.

Barriers identified

Across these studies, recurring barriers to HPV vaccine uptake include the absence of a strong recommendation from healthcare providers or institutions, persistent myths linking the vaccine to infertility or the promotion of premarital sexual activity, the historically high cost of imported vaccines, and — until 2024 — the exclusion of HPV vaccination from India's Universal Immunization Programme [10–15]. Notably, even where knowledge and awareness are adequate, translation into actual vaccine uptake remains poor, mirroring the broader global observation that population-level impact is realised only where sustained, structured programmatic delivery — not awareness alone — drives high coverage [8,9].

Medical students as advocates

As future physicians, medical students are expected to act as both educators and vaccine advocates for their patients and communities. Consistent with this expectation, the present study found a statistically significant association between students' awareness of the HPV vaccine and their willingness to recommend it to others (see Results), reinforcing the notion that informed, personally engaged medical trainees are best placed to serve as credible advocates for vaccination — and underscoring the importance of addressing knowledge gaps and personal vaccine hesitancy at the trainee level.

Thus, the literature consistently demonstrates a paradox of high awareness but poor uptake, highlighting the urgent need for comprehensive, practically-oriented education, supportive institutional policy, and accessible vaccination programmes targeting medical trainees specifically.

Materials and Methods

Study design

This was a descriptive, observational, cross-sectional study designed to evaluate knowledge, awareness, attitudes, and vaccination status regarding HPV and cervical cancer among medical students.

Study setting and duration 

The study was conducted in the Department of Obstetrics and Gynaecology, GIMSR Hospital, Visakhapatnam — a tertiary care teaching institution with an annual intake of approximately 150 MBBS students, providing a representative cross-section of young medical trainees in coastal Andhra Pradesh. [Study period: to be inserted by authors, e.g., Month Year to Month Year.]

Study population

Participants comprised final-year MBBS students and house surgeons who had completed their core clinical rotations, including postings in Obstetrics and Gynaecology. This group was selected because sufficient clinical exposure was considered necessary to meaningfully evaluate awareness of, and attitudes toward, a clinically relevant preventive intervention. Students in the first, second, and third years of the MBBS programme were excluded on account of limited clinical exposure at the time of the study.

Sample size

The minimum required sample size was estimated using the standard formula for a single-proportion prevalence study:

n = Z²pq / d²

where Z = 1.96 (the standard normal deviate corresponding to a 95% confidence level), p = 0.5 (an expected awareness prevalence of 50%, used in the absence of prior local data to yield the most conservative, maximum sample-size estimate), q = (1 − p) = 0.5, and d = 0.1 (an acceptable margin of error of 10%). This calculation yielded a minimum required sample size of n = (1.96)² × 0.5 × 0.5 / (0.1)² ≈ 96.04, i.e., approximately 96 participants, which was rounded up to 100 to allow a margin for incomplete or non-usable responses.

Sampling technique and study tool

All eligible final-year MBBS students and house surgeons who were available and willing to participate during the study period were approached, and enrolment continued until the calculated sample size of 100 was reached. Data were collected using a structured, pretested, self-administered questionnaire comprising 10 multiple-choice questions, framed in simple language after review of the existing literature on HPV vaccine-related knowledge, attitudes, and practice. The questionnaire covered five principal domains:

1. Awareness of HPV infection as a causative agent of cervical cancer.
2. Knowledge of HPV vaccines and their availability.
3. Awareness of the recommended HPV vaccine schedule and cost.
4. Personal vaccination status of participants.
5. Attitudes toward HPV vaccination and willingness to recommend it to others.

 

Representative items included:

• “Do you know that HPV is a causative factor for cervical cancer?” (Yes/No)
• “Are you aware of vaccines available for HPV?” (Yes/No)
• “Have you received the HPV vaccine?” (Yes/No)
• “Would you recommend HPV vaccination to others?” (Yes/No)

 

Data collection

The objectives of the study were explained to all eligible participants prior to enrolment, and written informed consent was obtained. Questionnaires were distributed in classroom settings and collected immediately upon completion; responses were anonymised at the point of collection to protect participant confidentiality and encourage candid responses.

Ethical considerations

Ethical clearance was obtained from the Institutional Ethics Committee of GIMSR prior to commencement of data collection (Approval No.: [to be inserted by authors]). Participation was entirely voluntary, and participants were free to withdraw at any stage without any effect on their academic standing. Confidentiality of individual responses was maintained throughout data collection, entry, and analysis. 

Statistical analysis     

Completed questionnaires were coded and entered into Microsoft Excel for analysis. Descriptive statistics — frequencies and percentages — were calculated for all study variables. Associations between categorical variables (for example, awareness of the HPV vaccine and willingness to recommend it, and sex and vaccination status) were tested using the chi-square test, with a p-value <0.05 considered statistically significant.

Results

A total of 100 medical students — comprising final-year MBBS students and house surgeons — completed and returned the questionnaire. The study population was evenly split by sex, with 50 (50%) male and 50 (50%) female participants, and ages ranging from 21 to 25 years.

Knowledge and awareness (Table 1, Table 2; Figures 1, 2, 6, 7)

Awareness that persistent HPV infection is the causative agent of cervical cancer was high, reported by 95 of 100 students (95%) (Table 1; Figures 1 and 6). Eighty-five students (85%) were aware that vaccines against HPV are available (Table 2; Figures 2 and 7). Somewhat fewer — 70 students (70%) — were aware that HPV vaccination also protects against other HPV-associated malignancies, such as anal, penile, and oropharyngeal cancers.

Response	Number (n=100)	Percentage
Yes	95	95%
No	5	5%

Attitudes toward vaccination (Table 5; Figures 5, 10)

A large majority — 88 students (88%) — indicated that they would recommend HPV vaccination to others, including patients, friends, and family members (Table 5; Figures 5 and 10), reflecting generally positive attitudes toward the vaccine even among students who had not themselves been vaccinated.

Response	Number (n=100)	Percentage
Yes	88	88%
No	12	12%

Data availability: The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.

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