Key takeaways:

• Many people remain unaware that HPV causes cervical cancer.
• People with a lot of trust in physicians and government health agencies had significantly higher awareness.

Improving trust in the health care system could have a significant impact on increasing HPV vaccination rates in the future.

A survey of nearly 4,000 people revealed that those with a lot of trust in physicians and health care agencies about cancer information had a significantly higher likelihood of being aware that HPV causes cervical cancer.

Data derived from Oladoyin OO, et al. JAMA Netw Open. 2026;doi:10.1001/jamanetworkopen.2026.20133.

Additionally, those with high trust that religious organizations provide credible cancer information had significantly lower awareness.

“In the U.S., millions of people are not trusting government agencies and their physicians for information about cancer,” Sanjay S. Shete, PhD, Betty B. Marcus Chair in Cancer Prevention at The University of Texas MD Anderson Cancer Center, told Healio. “It’s concerning.”

‘We could eliminate’ cervical cancer

About 13 million people are infected with HPV every year, and it causes roughly 36,000 malignancies annually in the U.S., according to CDC.

HPV is associated with approximately 90% of all cervical cancer cases, according to study background.

Less than 20% of adolescents aged 13 to 15 years had received two or three doses of the HPV vaccine in 2012. That rate increased to 57.3% in 2023, but it remains far below the Healthy People 2030 Target of 80%, according to NCI.

“Cervical cancer is one of the cancers, in theory, we could eliminate in the U.S. and around the world,” Shete said. “How is that going to happen? Getting girls the HPV vaccine.”

Shete and colleagues sought to understand how a person’s trust in the health care system impacted that knowledge.

“Trust in government agencies is going down in this country. Trust in health care professionals, doctors, is also going down,” Shete said. “We wanted to see how trust plays a role in awareness of HPV as a cause of cervical cancer. We believe if individuals trust their doctors, they’re more likely to have evidence-based information for cancer prevention.”

The researchers used the 2022 Health Information National Trends Survey to investigate.

They included 3,914 respondents (66.5% aged 30-65 years; 55.8% women; 65.2% white) who reported they had heard of HPV.

Awareness that HPV causes cervical cancer served as the primary endpoint.

‘Building trust is everybody’s responsibility’

Most respondents reported either a lot of trust in physicians (75.1%) or some trust (20.7%) regarding cancer information.

“I think 75% is good, but it has gone down in the last 5 to 7 years,” Shete said. “We would really like it to be much higher. These results mean 25% of people do not have a lot of trust regarding information about cancer from their physicians, which is a concern.”

Respondents had substantially lower trust in cancer information they received from government health agencies (a lot: 30.3%; some: 43.4%) and religious organizations (a lot: 3.5%; some: 20.1%).

“That’s really the biggest [concern],” Shete said about trust in government. “The CDC, FDA, those types of organizations should be the sources of information people get their cancer information from. Trust has gone down substantially compared to 10 years ago.”

Overall, 61.4% of respondents reported being aware that HPV causes cervical cancer, but researchers observed higher rates for people who had a lot of trust in government health agencies (70.2%) and physicians (64.8%) about cancer information, and those who had little or no trust in religious organizations about cancer information (63.8%).

Compared with individuals with a lot of trust, people with some trust in government agencies had significantly lower odds of being aware that HPV causes cervical cancer (adjusted OR = 0.71; 95% CI, 0.52-0.96), as did those with little or no trust (aOR = 0.68; 95% CI, 0.49-0.95).

“These data tell you if you don’t trust the government agencies for cancer information, you are less likely to be aware of the HPV’s role in causing cervical cancer, and in turn you’re less likely to get vaccinated,” Shete said.

Similarly, people with some trust in physicians for cancer information had significantly lower odds of being aware that HPV causes cervical cancer than those with a lot of trust (aOR = 0.71; 95% CI, 0.52-0.98).

“If they trust their physicians for cancer information, that means they will realize the important role of HPV in causing cervical cancer, leading to vaccination for themselves and their family members,” Shete said. “If they don’t trust it, then they’re less likely to follow evidence-based cancer preventive measures.”

Compared with individuals with a lot of trust in religious organizations about cancer information, those with little or no trust had significantly higher odds of awareness (aOR = 1.88; 95% CI, 1.1-3.24).

“I was glad that only 3.5% people trust religious organizations for cancer information,” Shete said. “The fact that those who have high trust are less likely to be aware tells me that there is a lack of discussion on this topic, that religious organizations focus more on abstinence than vaccination to reduce cervical cancer.”

Other demographics with lower odds of awareness that HPV causes cervical cancer included Asian respondents compared with white respondents (aOR = 0.31; 95% CI, 0.18-0.52), men (aOR = 0.62; 95% CI, 0.47-0.81), and those with a high school education compared with college or postgraduate degrees (aOR = 0.42; 95% CI, 0.3-0.6).

Respondents with a personal cancer history had a significantly higher likelihood of awareness (aOR = 1.49; 95% CI, 1.07-2.08).

Researchers acknowledged study limitations, including its cross-sectional nature, which cannot determine a causal relationship between trust and awareness.

Shete noted that automatic prompts about HPV vaccination could help clinicians improve uptake, but improving trust remains a barrier that must be addressed.

“People want to trust their clinicians, but building trust is everybody’s responsibility, including the health care professional,” Shete said. “They should probably see why 25% of their patient populations are not trusting them, and then how they can better provide this information in a way that will increase awareness and eventual uptake of the HPV vaccine. We know health care professionals’ recommendations for any vaccination increase the likelihood of getting the vaccine.

“There should be continued efforts to put the CDC and FDA in a positive light, too,” he added. “They are the ones with a lot more data- and evidence-based interventions to prevent cancers. We should continue to work on that, although that’s going to be an uphill battle.”

For more information:

Sanjay S. Shete, PhD, Betty B. Marcus Chair in Cancer Prevention and deputy division head of cancer prevention and population sciences at The University of Texas MD Anderson Cancer Center, can be reached at sshete@mdanderson.org.