INTRODUCTION: Many U.S. women continue to be screened annually for cervical cancer, despite current guidelines that recommend 3- or 5-year screening intervals depending on screening modality and patient age. METHODS: Data from 2012 and 2015 web-based surveys of U.S. adults were analyzed in 2017 to investigate U.S. women's cervical cancer screening preferences. The study was limited to women aged >/=18 years without a hysterectomy or cervical cancer diagnosis (2012 n=1,380, 2015 n=1,339). RESULTS: Women's preference for 3- or 5-year screening intervals doubled during the study period (2012: 31.2%, 2015: 64.2%, p<0.001). The most preferred screening options in 2015 were co-testing every 3 years with the Pap and human papillomavirus tests (34.0%) and annual Pap testing (30.4%)-neither of which were recommended at that time or currently. Use of 3- and 5-year Pap testing intervals increased during the study period (2012: 6.9%, 2015: 12.9%, p<0.001), whereas annual Pap testing declined (2012: 48.5%, 2015: 35.6%, p<0.001). Among women who were regularly screened and preferred 3- or 5-year screening intervals, the minority reported screening practices that matched this preference (2012: 24.1%, 2015: 29.3%, p=0.71). CONCLUSIONS: Women's preference for longer cervical cancer screening intervals has increased rapidly and outpaced utilization. At the same time, many women continue to be screened annually. Expanding appropriate screening may require increasing women's and providers' comfort with screening recommendations.

BACKGROUND: Primary HPV testing (without the Pap test) has recently been recommended as a cervical cancer screening option in the United States. U.S. women's awareness and acceptance of primary HPV testing were evaluated. METHODS: Data from a 2015 web-based survey of U.S. adults was examined. Analyses were limited to women who were >/=18years old, had not undergone a hysterectomy, had not been diagnosed with cervical cancer, and would accept cervical cancer screening (N=1309). Logistic regression was used to identify predictors of acceptance of primary HPV testing every 3years. RESULTS: Primary HPV testing every 3years was the least accepted cervical cancer screening option (13.5%), and annual Pap testing was the most accepted (41.2%). Most women (65.2%) reported that they were unsure how the HPV test is administered. HPV-vaccinated women were more likely to accept primary HPV testing every 3years than unvaccinated women (Adj OR=1.80, 95% CI=1.22-2.63, p=0.003). And, women who had participated in HPV testing at any interval were more likely to accept primary HPV testing every 3years than those who did not have regular HPV tests or were unsure how often they had HPV tests (Adj OR=1.74, 95% CI=1.20-2.52, p=0.003). CONCLUSIONS: Acceptance of primary HPV testing among U.S. women was low and associated with variables which may be indicative of general HPV awareness. Widespread adoption of primary HPV testing may require increasing women's familiarity with the HPV test and screening guidelines.

OBJECTIVE: To investigate the HPV testing recommendations of US physicians who perform cervical cancer screening. METHODS: Data from the 2015 DocStyles survey of U.S. health care providers were analyzed using multivariate logistic regression to identify provider characteristics associated with routine recommendation of primary HPV testing for average-risk, asymptomatic women ≥30years old. The analysis was limited to primary care physicians and obstetrician-gynecologists who performed cervical cancer screening (N=843). RESULTS: Primary HPV testing for average-risk, asymptomatic women ≥30years old was recommended by 40.8% of physicians who performed cervical cancer screening, and 90.1% of these providers recommended primary HPV testing for women of all ages. The screening intervals most commonly recommended for primary HPV testing with average-risk, asymptomatic women ≥30years old were every 3years (35.5%) and annually (30.2%). Physicians who reported that patient HPV vaccination status influenced their cervical cancer screening practices were almost four times more likely to recommend primary HPV testing for average-risk, asymptomatic women ≥30years old than other providers (Adj OR=3.96, 95% CI=2.82-5.57). CONCLUSION: Many US physicians recommended primary HPV testing for women of all ages, contrary to guidelines which limit this screening approach to women ≥25years old. The association between provider recommendation of primary HPV testing and patient HPV vaccination status may be due to anticipated reductions in the most oncogenic HPV types among vaccinated women.

The Centers for Disease Control and Prevention's Screen for Life: National Colorectal Cancer Action Campaign has operated continuously since 1999 to promote colorectal cancer screening. The campaign's most recent formative research cycle was conducted in 2015 and included 16 focus groups in four United States cities with adults aged 50-75 years who had not received colorectal cancer screening as recommended. The most common reason for screening nonparticipation was aversion to some aspect of colonoscopy, such as preparation, the invasive nature of the test, or the possibility of complications. Other reasons for screening nonparticipation were absence of symptoms, lack of screening awareness/provider recommendation, and lack of family history. Screening promotion messages that resonated with participants included the following: multiple screening tests are available; colorectal cancer may not cause symptoms; screening should begin at age 50; and most cases of colorectal cancer occur in individuals with no family history of the disease. Efforts to increase colorectal cancer screening participation may be supported by disseminating messages that counter common concerns about screening. Raising awareness of the range of colorectal cancer screening options may be especially critical given that many unscreened individuals were unwilling to undergo a colonoscopy.

To investigate U.S. women's intended care seeking for symptoms associated with ovarian cancer, data from the 2012 HealthStyles Fall survey of U.S. adults were examined. Analyses were limited to women with no history of gynecologic cancer (N = 1726). Logistic regression models for intended care seeking within 2 weeks of symptom onset were developed. A minority of women recognized that unexplained pelvic or abdominal pain (29.9%), unexplained bloating (18.1%), and feeling full after eating a small amount of food (10.1%) can indicate ovarian cancer, and 31.1% mistakenly believed that the Papanicolaou (Pap) test screens for the disease. In the multivariate regression models, the most consistent, significant predictors (p < 0.01) of intended care seeking within 2 weeks of symptom onset were age (older women were more likely to seek care) and awareness that symptoms could signal ovarian cancer. Care seeking in response to ovarian cancer symptoms may be delayed among younger women and those who do not recognize the potential significance of symptoms. Raising awareness of ovarian cancer symptoms may promote early detection. However, educational efforts should emphasize that symptoms associated with ovarian cancer may also result from benign conditions.

INTRODUCTION: Current U.S. cervical cancer screening guidelines recommend a 3- or 5-year screening interval depending on age and screening modality. However, many women continue to be screened annually. The purpose of this study is to investigate U.S. women's self-reported frequency of cervical cancer screening, acceptance of an extended screening interval (once every 3-5 years), and preferred screening options. METHODS: Data from a 2012 web-based survey of U.S. women aged ≥18 years who had not undergone a hysterectomy or been diagnosed with cervical cancer (N=1,380) were analyzed in 2014. Logistic regression models of extended screening interval use, acceptance, and preference were developed. RESULTS: Annual Pap testing was the most widely used (48.5%), accepted (61.0%), and preferred (51.1%) screening option. More than one third of respondents (34.4%) indicated that an extended screening interval would be acceptable, but only 6.3% reported that they were currently screened on an extended interval. Women who preferred an extended screening interval (32.9% of those willing to accept regular screening) were more likely to report no primary care visits during the last 12 months (AOR=2.05, p<0.003), no history of abnormal Pap test results (AOR=1.71, p=0.013), and that their last Pap test was performed by an internist/family practitioner rather than an obstetrician-gynecologist (AOR=2.03, p<0.001). CONCLUSIONS: U.S. women's acceptance of and preference for an extended cervical cancer screening interval appears to be more widespread than utilization. Strategies to educate women about the reasoning behind recommendations for less-than-annual testing and to foster informed preferences should be devised and evaluated.

BACKGROUND: The human papillomavirus (HPV) test, administered alone without the Papanicolaou (Pap) test, was recently recognized as a cervical cancer screening option in the United States by the Society of Gynecologic Oncology and the American Society for Colposcopy and Cervical Pathology, and the Food and Drug Administration has approved an HPV test for primary screening. METHODS: Surveys of US internists, family practitioners, nurse practitioners, and obstetrician-gynecologists were conducted in 2009 and 2012 to investigate providers' perceptions of the effectiveness of the HPV test administered alone as a population-based screening modality (2009: N=1040, 141-494 per provider group; 2012: N=1039, 155-435 per provider group). RESULTS: The majority in each provider group agreed that the HPV test administered alone is an effective screening modality in 2009 (75.3%-86.1%) and 2012 (79.5%-91.8%), and agreement rose significantly during this time period among family practitioners (chi2=15.26, df=1, p<0.001) and nurse practitioners (chi2=4.53, df=1, p=0.033). CONCLUSIONS: Agreement that the HPV test administered alone is an effective cervical cancer screening modality was widespread among providers in both 2009 and 2012, however implementation of guidelines for screening with the HPV test may be influenced by many other factors including reimbursement and patient preferences.

The quality and accuracy of health content posted on YouTube varies widely. To increase dissemination of evidence-based gynecologic cancer information to US YouTube users, the Centers for Disease Control and Prevention (CDC) sponsored two types of advertisements: (1) pre-roll videos that users had to watch for at least 5 s before seeing a video they selected and (2) keyword-targeted listings that appeared in search results when users entered terms related to gynecologic cancer. From July 2012 to November 2013, pre-roll videos were shown 9.2 million times, viewed (watched longer than the mandatory 5 s) 1.6 million times (17.6 %), and cost $0.09 per view. Keyword-targeted listings were displayed 15.3 million times, viewed (activated by users) 59,766 times (0.4 %), and cost $0.31 per view. CDC videos in advertisements played completely in 17.0 % of pre-roll video views and 44.4 % of keyword-targeted listing views. Advertisements on YouTube can disseminate evidence-based cancer information broadly with minimal cost.

OBJECTIVE: To investigate the longevity and reach of television public service announcements (PSAs) developed by the Centers for Disease Control and Prevention's Screen for Life: National Colorectal Cancer Action Campaign. METHODS: Television airtime donated to Screen for Life PSAs was tracked, and the impressions (a broadcasting metric for audience size) generated by PSAs in circulation ≥ 5 years were analyzed in 2014. The sample consisted of 8 PSAs, including English and Spanish PSAs, PSAs featuring celebrities, and PSAs redistributed multiple times after their initial release. RESULTS: During the most recent year of circulation (5-9 years after initial release), each PSA generated 15.7 million to 251.7 million impressions. Peak annual impressions were achieved as late as 9 years after a PSA's initial release. When PSAs were redistributed 2 years or longer after the prior distribution, annual impressions increased over the preceding year by > 20 million in 80.0% of instances. Among English PSAs, those featuring celebrities produced the highest mean and peak annual impressions. CONCLUSIONS: Donated-placement television PSAs can be a long-lived health promotion strategy. Redistribution may enhance PSA longevity, and featuring celebrities, particularly in English PSAs, may expand reach.

The Centers for Disease Control and Prevention's Screen for Life: National Colorectal Cancer Action Campaign works with the Entertainment Industry Foundation's National Colorectal Cancer Research Alliance to develop public service announcements (PSAs) featuring celebrities. Selection of Screen for Life celebrity spokespersons is based on a variety of factors, including their general appeal and personal connection to colorectal cancer. Screen for Life PSAs featuring celebrities have been disseminated exclusively through donated media placements and have been formatted for television, radio, print, and out-of-home displays such as dioramas in airports, other transit stations, and shopping malls. A 2012 national survey with women aged 50-75 years (n=772) investigated reported exposure to Screen for Life PSAs featuring actor Terrence Howard. In total, 8.3% of women recalled exposure to the PSAs. Celebrity spokespersons can attract the attention of both target audiences and media gatekeepers who decide which PSAs will receive donated placements.

The Centers for Disease Control and Prevention's Screen for Life: National Colorectal Cancer Action Campaign (SFL) is one of the longest running national multimedia campaigns to promote colorectal cancer screening. Since its inception in 1999, no study has quantified the benefits and costs of SFL. We modeled the impact of SFL campaign on screening rates, assuming that the effect size would range from 0.5% to 10% of the unscreened population exposed to the campaign in the last 14 years. Given the estimated benefits of the campaign and costs, we calculated the cost per person screened (2012 dollars). We hypothesize that if 0.5% of the population exposed to campaign messages were screened for colorectal cancer, an additional 251,000 previously unscreened individuals would be screened. The average cost of SFL per person screened would be $2.44. On the other hand, if 10% of the population exposed to campaign messages were screened, an additional 5.01 million individuals would be screened. The average cost per person screened would be $0.12. Results indicate that SFL improves screening rates at a relatively low cost per person screened. The findings in this study provide an important starting point and benchmark for future research efforts to determine the benefits and costs of health communication campaigns to promote cancer prevention.

To direct online users searching for gynecologic cancer information to accurate content, the Centers for Disease Control and Prevention's (CDC) 'Inside Knowledge: Get the Facts About Gynecologic Cancer' campaign sponsored search engine advertisements in English and Spanish. From June 2012 to August 2013, advertisements appeared when US Google users entered search terms related to gynecologic cancer. Users who clicked on the advertisements were directed to relevant content on the CDC website. Compared with the 3 months before the initiative (March-May 2012), visits to the CDC web pages linked to the advertisements were 26 times higher after the initiative began (June-August 2012) (p<0.01), and 65 times higher when the search engine advertisements were supplemented with promotion on television and additional websites (September 2012-August 2013) (p<0.01). Search engine advertisements can direct users to evidence-based content at a highly teachable moment-when they are seeking relevant information.

BACKGROUND: Some primary care physicians choose not to provide cervical cancer screening. PURPOSE: To investigate the characteristics and screening beliefs of family practitioners and internists who treat adult women in outpatient settings but perform no routine Pap tests. METHODS: A survey of U.S. primary care physicians (N=892) was conducted and analyzed in 2012. RESULTS: Participants who performed no Pap tests during a typical month (17.2% of family practitioners and 44.3% of internists) generally reported that they referred patients to gynecologists for cervical cancer screening. The most significant predictor of Pap test non-provision was agreement that patients are best served by having Pap tests performed by gynecologists (AOR=8.80, 95% CI=5.58, 13.88, p<0.001). CONCLUSIONS: The perception that patients benefit from cervical cancer screening administered by gynecologists may deter screening in primary care settings, resulting in missed opportunities to offer screening to women who are never or rarely screened.

Given the absence of effective population-based screening tests for ovarian, uterine, vaginal, and vulvar cancers, early detection can depend on women and health care providers recognizing the potential significance of symptoms. In 2008, the Centers for Disease Control and Prevention's (CDC) Inside Knowledge campaign began distributing consumer education materials promoting awareness of gynecologic cancer symptoms. We investigated providers' in-office use of CDC gynecologic cancer materials and their recognition of the symptoms highlighted in the materials. We analyzed data from a national 2012 survey of US primary care physicians, nurse practitioners, and gynecologists (N = 1,380). Less than a quarter of providers (19.4%) reported using CDC gynecologic cancer education materials in their offices. The provider characteristics associated with the use of CDC materials were not consistent across specialties. However, recognition of symptoms associated with gynecologic cancers was consistently higher among providers who reported using CDC materials. The possibility that providers were educated about gynecologic cancer symptoms through the dissemination of materials intended for their patients is intriguing and warrants further investigation. Distributing consumer education materials in health care provider offices remains a priority for the Inside Knowledge campaign, as the setting where women and health care providers interact is one of the most crucial venues to promote awareness of gynecologic cancer symptoms.

In 2013, the Centers for Disease Control and Prevention's (CDC) Inside Knowledge: Get the Facts About Gynecologic Cancer campaign tested creative concepts for English- and Spanish-language video advertisements (for use on television and the Internet) with women aged 35-64 years. Sixteen English and nine Spanish focus groups were conducted in four U.S. cities. CDC used animatics (a series of photographs edited together with a sound track) to simulate produced advertisements, without having to incur the high cost of filming and production. Advertisement concepts consistently resonating with participants featured cancer survivors, were straightforward, included information about cancer symptoms, displayed Inside Knowledge educational materials, and featured diverse women. In the general population focus groups, a primacy testing order effect was observed in which the concept tested first tended to be the most favorably received. Varying the order in which concepts were tested and considering testing order when interpreting results was critical.

OBJECTIVE: Colorectal cancer screening has been widely promoted in the United States. We investigated the association between reported exposure to screening information during the past year and screening participation and knowledge. METHOD: Data from the 2012 HealthStyles Fall survey of U.S. adults were examined using adjusted logistic regression to examine the frequency of exposure to screening information as a predictor of screening participation and knowledge; analyses were limited to participants aged ≥50 years with no history of colorectal cancer or polyps (N=1,714). RESULTS: Nearly half of participants (44.9%) reported exposure to colorectal cancer screening information during the previous year. The most common sources of screening information were news reports, advertisements, and health care providers. Screening participation and knowledge consistently increased with the reported frequency of exposure to screening information, and these associations generally persisted when demographic variables were controlled. Compared with unexposed participants, significant gains in screening participation were associated with exposure to screening information 2-3 times (Adj. OR= 1.84, p=0.001), 4-9 times (Adj. OR= 2.00, p=0.001), and ≥10 times (Adj. OR= 3.03, p<0.001) in the adjusted model. CONCLUSIONS: Increasing public exposure to screening promotion messages may augment screening participation and knowledge.

BACKGROUND: With limited screening options, early detection of gynaecologic cancers can depend on women recognizing the potential significance of symptoms and seeking care. OBJECTIVE: We investigated women's concern about symptoms that might be related to gynaecologic cancers, the underlying conditions they associated with symptoms and their actual and hypothetical response to symptoms. METHODS: Fifteen focus groups with women aged 40-60 years were conducted in Chicago, Los Angeles, Miami and New York City. Participants were given an untitled list of symptoms that could indicate various gynaecologic cancers and asked if any would concern them, what could cause each and what they would do if they experienced any of them. RESULTS: Overall, participants expressed greater concern about symptoms clearly gynaecologic in nature than other symptoms. Participants generally did not associate symptoms with any form of cancer. Some women who had experienced symptoms reported waiting an extended period before seeking care or not seeking care at all. The belief that a symptom indicated a benign condition was the most common reason given for delaying or foregoing care seeking. Strategies participants reported using to supplement or replace consultations with health care providers included Internet research and self-care. CONCLUSION: Raising awareness of symptoms that can indicate gynaecologic cancers may lead to earlier detection and improved survival. In particular, women should be informed that gynaecologic cancers can cause symptoms that may not seem related to the reproductive organs (e.g. back pain) and that unusual vaginal bleeding should prompt them to seek care immediately.

The demographic and practice-related characteristics of physicians who use social networking websites, portable devices to access the internet, email to communicate with patients, podcasts, widgets, RSS feeds, and blogging were investigated. Logistic regression was used to analyze a survey of US primary care physicians, pediatricians, obstetrician/gynecologists, and dermatologists (N=1750). Reported technology use during the last 6 months ranged from 80.6% using a portable device to access the internet to 12.9% writing a blog. The most consistent predictors of use were being male, being younger, and having teaching hospital privileges. Physician specialty, practice setting, years in practice, average number of patients treated per week, and number of physicians in practice were found to be inconsistently associated or unassociated with use of the technologies examined. Demographic characteristics, rather than practice-related characteristics, were more consistent predictors of physician use of seven internet-based communication technologies with varying levels of uptake.

OBJECTIVE: To examine physicians' beliefs about the pelvic examination and identify physician characteristics associated with routine use of this procedure in the United States. METHODS: A total of 1250 United States family/general practitioners, internists, and obstetrician/gynecologists who participated in the 2009 DocStyles survey completed questions on beliefs regarding the utility of routine pelvic examinations for cancer screening. The survey also asked participants how often they performed this procedure as part of a well-woman exam, to screen for ovarian and other gynecologic cancers, to screen for sexually transmitted infections, and as a prerequisite for prescribing hormonal contraception. RESULTS: A total of 68.0% of obstetrician/gynecologists, 39.2% of family/general practitioners, and 18.7% of internists reported routinely performing pelvic examinations for all the purposes examined (<0.001). Adjusted analyses revealed that the factors most strongly associated with use of pelvic examinations for all purposes were being an obstetrician/gynecologist (odds ratio 8.5; 95% confidence interval 5.8-12.6) and believing that this procedure is useful to screen for gynecologic cancers (odds ratio 3.8; 95% confidence interval 2.6-5.5). CONCLUSION: Misconceptions about the utility of pelvic examinations to screen for gynecologic cancers are common. More effective strategies to change physicians' beliefs regarding the value of performing pelvic examinations in asymptomatic women are needed.

BACKGROUND: There is strong scientific evidence that human papillomavirus (HPV) vaccines, which protect against two oncogenic HPV types (16 and 18), can prevent cervical, vaginal, and vulvar cancers in women. In addition, recent research has established that the HPV vaccine can prevent anal cancer and has implied that it may also prevent oropharyngeal cancers. METHODS: A 2009 web-based survey of 1500 physicians from four specialties (pediatricians, family practitioners, internists, and obstetrician-gynecologists) explored knowledge about which female cancers the HPV vaccine was effective in preventing. Physician characteristics associated with the belief that the HPV vaccine prevents cervical, vaginal, vulvar, anal, and other cancers were examined using logistic regression models. RESULTS: Nearly all respondents (97.8%) identified cervical cancer as being prevented by the HPV vaccine; however, lower awareness that the vaccine prevents vaginal (23.8%), vulvar (27.8%), and anal cancer (28.4%) was found. Physician specialty was the most significant covariate identified, with obstetrician-gynecologists being more likely than other physicians to report that the HPV vaccine protected against vaginal (p<0.001), vulvar (p<0.001), and anal (p<0.001) cancers. CONCLUSIONS: Physicians may benefit from educational efforts clarifying which noncervical cancers can be prevented by the HPV vaccine. Education is needed across all medical specialties, but it is particularly important for pediatricians and family practitioners, the physicians most likely to administer the HPV vaccine to young adolescents.

According to the Centers for Disease Control and Prevention (CDC), approximately 63.4 million pelvic examinations were performed in US physicians' offices and US clinics in 2008.1 Traditionally, this procedure has been performed in conjunction with annual Papanicolaou tests but since the American College of Obstetricians and Gynecologists extended its recommended cervical cancer screening interval to no more than every 3 years with human papillomavirus co-testing,2 there are questions about whether an annual pelvic examination is needed. | Pelvic examinations have been performed on asymptomatic women to screen for sexually transmitted infections, to screen for ovarian and other gynecologic cancers, and to determine whether women should receive hormonal contraceptives. However, use of pelvic examinations for these purposes is not supported by scientific evidence and is not recommended by any US organization.3-6 | Little is known about physicians' pelvic examination practices. In a recent Australian study, reasons general practitioners gave for performing pelvic examinations of asymptomatic women ranged from detecting pathologic conditions to simply performing this procedure “out of habit.”7 In this study, we sought to determine the purposes for which US physicians conduct pelvic examinations.

INTRODUCTION: Women with ovarian cancer typically experience symptoms before diagnosis; such symptoms for other gynecologic cancers have not been systematically studied. We investigated which symptoms of gynecologic cancers prompt intention to seek care among women and whether demographic differences in intention exist. This study was undertaken, in part, to inform development of the Centers for Disease Control and Prevention's campaign, Inside Knowledge: Get the Facts About Gynecologic Cancer. METHODS: We analyzed the 2008 HealthStyles dataset (n = 2,991 women), an annual, cross-sectional, national mail survey. We calculated weighted percentages of women who indicated an intention to seek care for symptoms (defined as intention to call or see a doctor) by demographic characteristics and level of concern about developing a gynecologic cancer. We evaluated independent predictors of intention to seek care for each symptom. RESULTS: For most symptoms, more than 50% of women reported an intention to seek care. Greater percentages of women indicated an intention to seek care for symptoms clearly gynecologic (eg, 91%, postmenopausal bleeding) than for symptoms not clearly gynecologic (eg, 37%, feeling full after eating a small amount). For most symptoms, after adjustment, black women, postmenopausal women, and women with greater concern about developing gynecologic cancers were more likely than their counterparts to intend to seek care. CONCLUSION: Intention to seek care differed by race, menopausal status, and level of concern about developing a gynecologic cancer. These findings will help in developing messages to educate women about the array of gynecologic and nongynecologic cancer symptoms.

BACKGROUND: U.S. women's awareness and knowledge of gynecologic cancer have not been well studied, with the exception of cervical cancer screening and risk factors. METHODS: Fifteen focus groups were conducted with women aged 40-60 years in Miami, New York City, Chicago, and Los Angeles. RESULTS: Most participants said they had heard of cervical, ovarian, and uterine cancers but were unfamiliar with vaginal and vulvar cancers. The misconception that the Pap test screens for multiple gynecologic cancers was prevalent and engendered a false sense of security in some women. An annual Pap screening interval was most familiar to participants; some mentioned a shorter screening interval for high-risk women; few mentioned an extended screening interval. A few participants thought the pelvic examination could detect a variety of conditions, including ovarian cancer. Some knew that the human papillomavirus (HPV) could cause cervical cancer, but no other risk factors for specific cancers were mentioned with any consistency. Although some recognized unexplained vaginal bleeding as a symptom of cervical cancer, participants generally were unfamiliar with gynecologic cancer symptoms. Participants reported learning about the discussion topics from a variety of sources, including the mass media. CONCLUSIONS: Participants lacked critical knowledge needed to understand their gynecologic cancer risk and seek appropriate care. Pap tests and routine examinations offer ideal opportunities to educate women about the purpose of the Pap test as well as risk factors and symptoms associated with various gynecologic cancers. The reported influence of the mass media also supports the viability of multimedia educational strategies.

OBJECTIVE: To inform campaign development by assessing awareness, previous receipt, and knowledge of the purpose of Papanicolaou (Pap) testing among women aged ≥18 years and to identify differences in awareness, receipt, and knowledge by demographic characteristics. METHODS: Data were analyzed from the 2008 HealthStyles survey, an annual mail survey conducted in the United States covering trends in health-related behavior. Women were asked questions on awareness, past use, and knowledge of the purpose of the Pap test and other gynecologic tests and procedures; 2991 women participated. RESULTS: Although 96.7% of the women had heard of and 93.0% reported having received a Pap test, these proportions were lower among those who were 18-34 years old and among those who had lower levels of education and income. Over 80% knew the Pap test was used to screen for cervical cancer, but 63.3% believed it also was used to screen for vaginal cancer (44.9%), sexually transmitted diseases (STDs) other than human papillomavirus (HPV) (41.7%), ovarian cancer (40.6%), and other cancers and infections. CONCLUSIONS: General familiarity and past receipt of the Pap test were high, but misconceptions about its purpose were prevalent. It is important that women understand what a routine Pap test is and is not capable of detecting so that signs and symptoms of gynecologic conditions other than cervical cancer may be recognized and addressed appropriately.