Knowledge of HPV-related penile cancer among U.S. men: Socioeconomic differences and divergence.

Abstract

e17034 Background: Human papillomavirus (HPV) is a well-established cause of penile cancer, yet awareness of this association among U.S. men remains poorly defined, particularly across sociodemographic groups. Methods: We analyzed pooled cross-sectional data from the National Cancer Institute’s Health Information National Trends Survey (HINTS 5, Cycles 1-4), a nationally representative survey using two-stage stratified sampling of U.S. adults aged ≥18 years. Analyses were restricted to male respondents. The primary outcome was lack of knowledge that HPV can cause penile cancer (responding “no” or “not sure” vs “yes”). Survey-weighted multivariable logistic regression estimated adjusted odds ratios (aORs) for sociodemographic predictors, including age, race, marital status, education (≤high school as reference), income ( < $35,000 as reference), sexual orientation, and cancer history. All analyses accounted for complex survey design using jackknife replicate weights per HINTS methodology. Results: Among 3,211 U.S. men (median age 55 years), only 31% correctly identified HPV as a cause of penile cancer. Education and income demonstrated divergent associations with knowledge. Compared with men with a high school education or less (n = 461), college graduates (n = 987; aOR 0.74, 95% CI 0.56-0.97) and those with postgraduate education (n = 784; aOR 0.59, 95% CI 0.45-0.79) had lower odds of lacking knowledge of HPV-related penile cancer. In contrast, compared with men with annual income < $35,000 (n = 563), those with middle income ($35,000- < $100,000; n = 1,364; aOR 1.69, 95% CI 1.30-2.19) and high income (≥$100,000; n = 1,143; aOR 1.60, 95% CI 1.23-2.08) had greater odds of lacking knowledge. Sexual orientation was not independently associated with knowledge after adjustment. Conclusions: Knowledge that HPV causes penile cancer remains low among U.S. men. While higher educational attainment was associated with greater awareness, higher income was paradoxically associated with lower awareness, highlighting that commonly used socioeconomic indicators may not uniformly reflect HPV-specific cancer knowledge. The observed discordance between income and education suggests that higher income alone does not confer improved HPV- related cancer awareness, underscoring the need for male-focused HPV education and prevention strategies that are not solely targeted by traditional socioeconomic markers.