Educational intervention for women in Japan coming of age for cervical cancer screening who grew up during the suspended HPV-vaccination-program

Figures & data

Table 1. Content of the information sheet

Content of the Education Information sheet

1.Cervical cancer is caused by HPV, which 80% of women get through sexual relationship. 2. Cervical cancer screening is recommended for women 20 or more years old. It is free. 3. Cervical cancer screening can find cells which are becoming cervical cancer. If we find these pre-cancer cells, we can cure the cervical cancer without removing your uterus. 4. The HPV vaccination rate is less than 1% now, although the prevention of cervical cancer by the HPV vaccine is happening all over the would. If you have a sexual relationship without an HPV vaccination, cancer screening is the only way for prevention from cervical cancer. 5. Women born in 2000 are now defenseless against cervical cancer, 86% of them were not vaccinated because the Japanese Ministry of Health, Labor, and Welfare suspended its official recommendation for HPV vaccination as a consequence of reports of alleged adverse medical events. 6. Cervical cancer is the most common cause of death for women in their twenties, behind suicide. 7. The increase in the future incidence of cervical cancer in women born in 2000 is estimated to be about 3,600 more cases. One of 75 women will now be at a higher risk for acquiring cervical cancer, and one in 325 women will be newly at risk for future death from that disease in its progressive form. 8. The number of women acquiring cervical cancer is increasing; it is about two times of those who are of their mother’s age. 9. The number of women who die from cervical cancer is 1.7 times more than the number of women who die in traffic accidents.

Table 2. Characteristics of the internet survey responders

Responder Characteristics	Sheet-Education (+)	Non-Education (-)	p-value
Subjects	206	206
Employment status			n.s.
company employee (other)	11 (5.3%)	13 (6.3%)
stay-at-home	3 (1.5%)	2 (1.0%)
part-time staff	10 (4.9%)	8 (3.9%)
student	173 (84.0%)	177 (85.9%)
other	9 (4.3%)	6 (2.9%)
Having sex			n.s.
Yes	74 (35.9%)	53 (25.7%)
No	108 (52.4%)	131 (63.6%)
No Answer	24 (11.7%)	22 (10.7%)
Civil status			n.s.
unmarried	199 (96.6%)	204 (99.0%)
married	7 (3.4%)	2 (1.0%)
Have a child			n.s.
No	200 (97.1%)	204 (99.0%)
Yes	6 (2.9%)	2 (1.0%)
Household income			n.s.
<2 million yen	30 (21.9%)	21 (15.7%)
2–4 million yen	8 (5.8%)	9 (6.7%)
4–6 million yen	10 (7.3%)	9 (6.7%)
6–8 million yen	10 (7.3%)	9 (6.7%)
8–10 million yen	5 (3.6%)	8 (6.0%)
>10 million yen	4 (2.8%)	6 (2.9%)
unknown	70 (51.1%)	72 (53.7%)

Table 3. Health consciousness of the survey responders and their family

	Sheet-Education (+)	Non-Education (-)	Total
Status of HPV vaccination
Positive	35 (17.0%)	34 (16.6%)	69 (16.8%)
Negative	127 (61.7%)	140 (68.0%)	267 (64.8%)
NA	44 (21.4%)	21 (15.5%)	76 (18.4%)
			n.s.
Have you ever had cervical cancer screening?
Yes	24 (11.7%)	37 (18.0%)	61 (14.8%)
No	182 (88.3%)	169 (82.0%)	351 (85.2%)
			n.s.
Has your anyone in your family ever had cervical cancer screening?
Yes	60 (29.1%)	42 (20.4%)	102 (24.8%)
No	146 (70.9%)	164 (79.6%)	310 (75.2%)
			n.s.
Did you ever talk with your family about cervical cancer?
Yes	60 (29.1%)	80 (38.8%)	140 (34.0%)
No	111 (53.9%)	95 (46.1%)	206 (50.0%)
No Answer	35 (17.0%)	31 (15.9%)	66 (16.0%)
			n.s.

Table 4. Intention to have cervical cancer screening

	Positive	Negative	Do not know about cervical cancer screening	Total
Total p < .0001
Education (+)	155 (75.2%)	51 (24.8%)	0 (0.0%)	206 (100%)
Education (-)	132 (64.1%)	38 (18.4%)	36 (17.5%)	206 (100%)
Total	287 (69.6%)	89 (21.6%)	36 (8.7%)	412 (100%)
Not-vaccinated women p < .0001
Education (+)	130 (76.0%)	41 (24.0%)	0 (0.0%)	171 (100%)
Education (-)	106 (61.6%)	31 (18.0%)	35 (20.4%)	172 (100%)
Total	236 (68.8%)	72 (21.0%)	35 (10.2%)	353 (100%)
Vaccinated women p = .228
Education (+)	25 (71.4%)	10 (28.6%)	0 (0.0%)	35 (100%)
Education (-)	25 (73.5%)	7 (20.6%)	2 (5.9%)	34 (100%)
Total	50 (72.5%)	17 (24.6%)	2 (2.9%)	69 (100%)

Table 5. Multivariate with Cox proportional hazards regression analysis on intention to have cervical cancer screening

Covariate	Hazard ratio	95% CI	p-value
Sexual relationship	0.189	0.758 to 1.546	0.663
HPV status	0.443	0.431 to 1.514	0.506
Family cancer screening	9.679	1.502 to 6.003	<0.001
Talks with her family	1.4626	0.812 to 2.410	0.227

Table 6. Attitude toward HPV vaccination

Do you think you need an HPV vaccination?
	Needed	Not needed	Not-answered
Education(+)	46 (26.9%)	17 (9.9%)	108 (63.2%)	171 (100%)
Education(-)	31 (18.0%)	17 (9.9%)	124 (72.1%)	172 (100%)
Total	77 (22.4%)	34 (9.9%)	232 (67.6%)	343 (100%)
				p = .134

Table 7. Multivariate analysis of attitude about HPV vaccination

Covariate	Hazard ratio	95% CI	p-value
Sexual relationship	2.100	0.817 to 3.862	0.147
Having cancer screening	1.027	0.493 to 9.233	0.311
Family cancer screening	0.230	0.477 to 3.388	0.632
Conversation with family	9.782	0.094 to 0.581	<0.01