University students training for careers in healthcare in Lahore, Pakistan, show surprisingly incomplete knowledge of cervical cancer and the human papillomavirus that causes most cases, according to a cross-sectional survey published in Discover Public Health. Among 163 students at the University of Lahore, only 42 percent recognized HPV infection as a risk factor for cervical cancer, and 34 percent did not know that the disease can be prevented through Pap smear screening. The findings come from a population that the study’s authors describe as relatively educated and medically oriented, suggesting that knowledge gaps in the wider Pakistani population may be even larger.
The survey, conducted between mid-May and mid-June 2025, used a structured online questionnaire in English administered through Google Forms. Approximately 300 students from the Allied Health Sciences faculty were approached, yielding a response rate of about 55 percent. After one participant declined to consent, the final sample comprised 163 respondents enrolled in Bachelor of Science programs in anesthesia technology, emergency and intensive care technology, respiratory therapy, and operation theater technology. Most participants were students, and the median age among the 79 respondents who reported their age was 20 years, with an interquartile range of 19 to 22 years. Of the total, 85 participants identified as female and 71 as male.
The questionnaire was adapted from previously validated instruments used in studies across Asia and was organized into eight sections moving from general questions about vaccination toward specific topics on cervical cancer, HPV, and HPV vaccination. Keywords such as cervical cancer and HPV were deliberately omitted from the introduction to avoid priming responses. The authors note that no formal psychometric validation of the adapted questionnaire was performed, and the survey relied entirely on self-reported knowledge, attitudes, and vaccination status, which may be influenced by guesswork or social desirability bias.
On basic awareness, roughly two-thirds of respondents had heard of uterine cervical cancer, with a gender difference: 72 percent of female participants had heard of the disease compared with 59 percent of males. Fewer than half reported knowing the main cause of cervical cancer. When asked to identify risk factors, most participants correctly pointed to sexually transmittable diseases such as HIV and Chlamydia trachomatis, and to having multiple sexual partners. Yet HPV itself, the leading cause of the disease, was recognized as a risk factor by fewer than half of the participants and ranked only third when respondents named the most important risk factor, behind sexually transmitted infections and smoking. Some participants even listed irrelevant factors such as not believing in God, or protective behaviors such as condom use and frequent visits to a health center, as risk factors.
Knowledge of prevention was similarly uneven. Just over half of those surveyed knew that cervical cancer is preventable through genital exams by health providers using Pap smears, and most correctly identified that early treatment can cure the disease. A majority, 71 percent, recognized that vaccinating girls can prevent cervical cancer, while 52 percent affirmed that vaccinating boys can do so as well. However, a clear knowledge gap emerged around the fact that cervical cancer is not typically hereditary but is instead associated with HPV infection. After being informed that HPV is associated with cervical cancer in 99 percent of cases, fewer than half of the participants said they had previously known that HPV can cause the disease.
Understanding of HPV vaccination was also limited. Only about 20 percent of respondents appeared aware of the vaccine’s range of protection, which covers two to nine HPV types. About half assumed the vaccine also protects against other kinds of cancer, such as pharyngeal cancer. Most participants were unclear about the timing of vaccination, including that no annual booster is required after completing the primary series in adolescence and that vaccination is most effective before the onset of sexual activity, since HPV vaccines are prophylactic rather than therapeutic. One-third of respondents believed the vaccine is only useful for girls or women, while another third considered it beneficial for people of all genders.
Risk perception was strikingly low. Of the 85 female respondents, only 10, or 11.8 percent, believed they were at risk of cervical cancer, and 51 women, or 60 percent, rejected the idea outright. Only 10 women reported ever having participated in cervical cancer screening, while 57 said they never had. Notably, six female respondents said they had not participated in screening because they do not have a uterine cervix, a result the authors describe as astonishing and warranting thorough discussion, since it points to uncertainty about basic reproductive anatomy. Participation in screening was significantly associated with awareness of personal risk for both cervical cancer and HPV infection, with p values below 0.001 for both comparisons. Nearly two-thirds of all participants believed they were not at risk of HPV infection, and men felt more at risk than women, a statistically significant difference.
Only 10 percent of participants reported being vaccinated against HPV, and 11 percent of the women surveyed said they were vaccinated. HPV vaccination was significantly associated with cervical cancer-related knowledge and risk awareness: vaccinated participants were more likely to report knowing the main cause of cervical cancer, to be aware that HPV causes the disease, and to have learned about it in school. Willingness to receive the HPV vaccine was moderate at 62 percent, below the World Health Organization’s target of 90 percent coverage, and consistently lower than the 68 percent who said they would accept a general cancer vaccine. The most common reason for not being vaccinated, reported by 60.7 percent of those answering the question, was simply not knowing the HPV vaccination existed. The authors interpret the lower willingness for HPV vaccination specifically, compared with vaccination against cancer in general, as possibly reflecting stigma around a vaccine tied to a sexually transmitted infection, along with low perceived susceptibility.
The survey also mapped where students obtain health information. Educational institutions were the most common source, followed closely by social media platforms such as TikTok, Facebook, and X, which were used about as frequently as healthcare professionals. Health professionals were identified as the most trusted source, followed by educational institutions and social media. Only about a quarter of respondents had learned about cervical cancer or HPV in school, a gap the authors say underscores the potential of educational systems to strengthen health literacy and counter misinformation. Information on cervical cancer and HPV specifically was less widely and diversely available than general health information, with the largest shortfalls reported for parents, relatives, and friends, a pattern the authors suggest may reflect sociocultural factors around sex education.
The study’s context matters. Pakistan faces significant challenges in women’s healthcare, including limited access to services, low health literacy, and high out-of-pocket expenditures. Although HPV vaccination was introduced in 2019, a nationwide program has yet to be implemented, and cervical cancer screening is severely limited, with only 1 percent of women aged 30 to 49 screened in the past five years. Cervical cancer has a crude incidence rate of 4.67 per 100,000 in Pakistani women, with 3,197 deaths per year. In September 2025, Pakistan launched its first national campaign to vaccinate girls aged nine to 14 against HPV, confronting significant challenges and vaccine hesitancy. The authors caution that their sample, drawn from a single private university and surveyed in English, is not representative of Pakistan’s general population, and that the study did not collect data on sexual behavior, socioeconomic status, or prior health education, limiting interpretation of perceived risk and vaccination willingness. Still, they argue, if this relatively privileged group shows such gaps, the need for targeted educational interventions, culturally sensitive communication, and organized vaccination and screening programs is urgent, in line with the WHO’s 90-70-90 elimination targets for 2030.
Subject of Research: Knowledge and awareness of cervical cancer prevention and HPV vaccination among university students in Pakistan
Article Title: Awareness and knowledge of cervical cancer prevention and HPV vaccination among university students in Pakistan: a cross-sectional study
Article References: Wieneke, M., Bonk, M., Schild-Suhren, M., & Shabaz, S. (2026). Awareness and knowledge of cervical cancer prevention and HPV vaccination among university students in Pakistan: a cross-sectional study. Discover Public Health, 23(1), Article 1728. https://doi.org/10.1186/s12982-026-03225-x
Image Credits: AI Generated
DOI: 10.1186/s12982-026-03225-x
Keywords: cervical cancer, HPV, HPV vaccination, Pakistan, cross-sectional study, university students, Pap smear screening, health literacy, vaccine hesitancy, public health, Lahore, WHO 90-70-90 targets
News Source: Nathaniel Bowman. (October 29, 2026). Cervical Cancer Knowledge Gaps Persist Among Pakistani Medical Students, Survey Finds. Scienmag.
