Objective We conducted a baseline study of human papillomavirus (HPV) type prevalence in invasive cervical cancers (ICC) using data from seven cancer registries (CR) in the US. Cases were diagnosed between 1994 and 2005, before the implementation of the HPV vaccines. Materials and Methods CRs from Florida, Kentucky, Louisiana, Michigan, Hawaii, Iowa and Los Angeles, California identified eligible ICC cases, and obtained sections from representative blocks of archived tumor specimens for DNA extraction. All extracts were assayed by Linear Array and if inadequate or HPV negative, re-tested with INNO-LiPA Genotype test. Clinical and demographic factors were obtained from the CRs and merged with the HPV typing data to analyze factors associated with different types and with HPV negativity. Results A total of 777 ICCs were included in this analysis, with broad geographic, age and race distribution. Overall, HPV was detected in 91% of cases, including 51% HPV16, 16% HPV18 (HPV16 negative), and 24% other oncogenic and rare types. After HPV16 and 18, the most common types were 45, 33, 31, 35 and 52. Older age and non-squamous histology were associated with HPV negative typing. Conclusions This study provides baseline pre-vaccine HPV types for post-vaccine ICC surveillance in the future. HPV16 and/or 18 were found in 67% of ICCs, indicating the potential for vaccines to prevent a significant number of cervical cancers.

Although a relatively high percentage of women found the HPV vaccination acceptable for their own use, there was less enthusiasm for supporting vaccination to girls. This finding is of concern since the vaccine is being recommended for adolescent girls and young women, prior to sexual initiation. Educational campaigns will be needed for a successful vaccine implementation.

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Although cervical cancer rates in the U.S. have declined sharply, certain groups remain at elevated risk, including Appalachian women. To establish culturally-relevant cervical cancer prevention programs requires a comprehensive, current understanding of the factors which influence women's decisions to undergo Pap tests. Since most studies that found low rates of Pap test use in Appalachia were carried out decades ago, an in-depth update is warranted. Local, trained interviewers conducted interviews with rarely or never screened Appalachian women from Kentucky and West Virginia. Sessions were tape recorded, transcribed, and content analyzed. Participants (N = 25) suggested the following positive influences on obtaining screening: having an orientation toward the use of preventive health services; having health insurance and access to a good medical environment; and maintaining a flexible enough schedule to keep appointments. Screening barriers included: fear of subjecting oneself to medical scrutiny because of obesity or being a smoker; inadequate health care access such as clinician shortages, scarcity of specialty providers, long travel time to services, and clinic schedules that do not accommodate working women; and lack of providers' recommendations. Rarely mentioned were some previously reported factors including male relatives' refusal to permit Pap tests, concern over privacy, and lack of belief in Pap tests.