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For Peer Review Only Journal: BMJ Open BMJ Open BMJ Open: first published as 10.1136/bmjopen-2015-008740 on 26 February 2016. Downloaded from PRINT AND ONLINE NEWSPAPER COVERAGE OF THE LINK BETWEEN HPV AND ORAL CANCER IN THE UK: A MIXED METHODS STUDY For peer review only Journal: BMJ Open Manuscript ID bmjopen-2015-008740 Article Type: Research Date Submitted by the Author: 11-May-2015 Complete List of Authors: Dodd, Rachael; UCL, Epidemiology and Public Health Marlow, Laura; University College London, ; UCL, Epidemiology and Public Health Forster, Alice; UCL, Epidemiology and Public Health Waller, Jo; UCL, Epidemiology and Public Health <b>Primary Subject Communication Heading</b>: Secondary Subject Heading: Health services research, Qualitative research Keywords: Human Papillomavirus, Oral cancer, Media, United Kingdom http://bmjopen.bmj.com/ on September 24, 2021 by guest. Protected copyright. For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 1 of 22 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2015-008740 on 26 February 2016. Downloaded from 1 2 3 PRINT AND ONLINE NEWSPAPER COVERAGE OF THE LINK BETWEEN HPV AND ORAL 4 CANCER IN THE UK: A MIXED METHODS STUDY 5 6 7 Rachael H. Dodd MSc, Laura A.V. Marlow PhD, Alice S. Forster, PhD, Jo Waller PhD 8 9 10 Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology & Public 11 Health, UCL, Gower Street, London WC1E 6BT, United Kingdom 12 13 14 15 For peer review only 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 http://bmjopen.bmj.com/ 35 36 37 38 39 40 Keywords: Human papillomavirus, oral cancer, media, United Kingdom 41 42 on September 24, 2021 by guest. Protected copyright. 43 Word Count: 4194 44 45 46 Corresponding author: 47 R Dodd, Health Behaviour Research Centre 48 Department of Epidemiology and Public Health 49 50 UCL 51 Gower Street 52 London WC1E 6BT, UK 53 54 [email protected] 55 Tel: +44 (0)20 7679 8234 56 57 Fax: +44 (0)20 7679 8354 58 59 60 1 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 2 of 22 BMJ Open: first published as 10.1136/bmjopen-2015-008740 on 26 February 2016. Downloaded from 1 2 3 ABSTRACT 4 5 Objectives: The role of human papillomavirus (HPV) in some oral cancers has been reported in the 6 7 news press. Little is known about the content of these articles. This study aimed to examine how 8 frequently the link between HPV and oral cancer has been reported in the news press and to examine 9 10 the content of these articles. 11 12 13 Design: UK media articles were searched for articles relating to oral cancer and HPV in the database 14 15 NexisUK. Of 854For articles identifiedpeer by the initial review search, 112 were eligible only for inclusion (2002-2014) 16 17 and content analysis was used to determine the main themes discussed. 18 19 Results: Themes included: actor Michael Douglas’ claim that his throat cancer was caused by HPV, 20 21 the riskiness of oral sex, health information (including HPV as a cause of oral cancer) and the need to 22 23 vaccinate boys against HPV. Many articles also referred to the link between HPV and cervical cancer 24 25 and the increasing incidence of HPV-related oral cancer. The largest peak in articles occurred when 26 27 Michael Douglas discussed his cancer (June 2013). Facts about HPV and references to research 28 29 were provided in some articles. 30 31 Conclusions: The link between HPV and oral cancer and the transmission of HPV via oral sex was 32 33 regularly discussed, yet coverage often lacked detailed health information. This could increase 34 http://bmjopen.bmj.com/ 35 awareness of the link between oral sex and HPV risk, but may also lead to public concern about this 36 37 sexual behaviour. 38 39 40 Article summary 41 Strengths and limitations of this study: 42 on September 24, 2021 by guest. Protected copyright. 43 44 • This is the first study to examine the content of newspaper articles addressing the relationship between 45 HPV and some oral cancers. 46 47 • Using NexisUK to examine UK media coverage of the link between HPV and oral cancer provides a 48 49 systematic analysis of a large number of publications. 50 51 • This study is limited to UK publications and to print and online media, so the results may not be 52 53 representative of wider information available to the public. 54 55 • The articles in the study were only examined for content and not for accuracy of the information 56 57 presented. 58 59 60 2 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 3 of 22 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2015-008740 on 26 February 2016. Downloaded from 1 2 3 INTRODUCTION 4 5 Traditional risk factors for oral cancer are tobacco and alcohol, but there is now overwhelming 6 7 evidence that human papillomavirus (HPV) plays a causal role in some types of the disease [1–4]. At 8 9 least 25% of the estimated 85,000 oropharyngeal cancers diagnosed worldwide in 2008 were HPV- 10 11 positive [5]. HPV is a common sexually transmitted infection, with high risk types shown to be 12 13 responsible for up to 5% of all cancers worldwide, particularly cervical and other anogenital cancers 14 15 [6]. The main Forrisk factors forpeer transmission of reviewHPV are thought to be aonly greater number of sexual and 16 17 (for oral infection) oral sex partners [7–10] due to greater exposure to the virus. As the media has 18 been shown to influence people’s beliefs [11] and is considered a major source of health information 19 20 for many [12], it is possible that media coverage of the link between HPV and oral cancer may 21 22 influence public awareness and perceptions. 23 24 25 The British media is no stranger to reporting stories about people in the public eye with cancer, most 26 27 notably the stories of Jade Goody (an English reality television personality), Kylie Minogue (an 28 29 Australian singer/songwriter) and Angelina Jolie (an American actress). Metcalfe and colleagues 30 reported that an increased public interest in disease prevention can follow a celebrity diagnosis [13]. 31 32 In the UK, the case of Jade Goody (who died of cervical cancer) was associated with an increase in 33 34 the number of women attending cervical screening [14]. However, media reports are sometimes http://bmjopen.bmj.com/ 35 36 criticised for the lack of detail they provide, for example with the announcement of Angelina Jolie’s 37 38 double mastectomy many failed to give information about the rarity of her condition [15]. In 2013, 39 40 American actor Michael Douglas disclosed in an interview with The Guardian newspaper that his 41 throat cancer was ‘caused by HPV which actually comes about from cunnilingus’. This disclosure 42 on September 24, 2021 by guest. Protected copyright. 43 received global attention, giving the media an opportunity to discuss the link between HPV and oral 44 45 cancer. 46 47 48 Prior to the introduction of the HPV vaccination in 2008, public awareness of HPV (primarily in the 49 50 context of cervical cancer) was measured in population-based studies to be between 25 and 50% 51 52 [16,17]. The HPV vaccination attracted a lot of media attention [18] and knowledge of HPV appears to 53 have increased following its introduction [19]. An online survey across the UK, US and Australia 54 55 following the introduction of HPV vaccine showed 61% reported having heard of HPV [20]. 56 57 58 59 60 3 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 4 of 22 BMJ Open: first published as 10.1136/bmjopen-2015-008740 on 26 February 2016. Downloaded from 1 2 3 In the oral cancer context, dental hygienists in North Carolina were found to have low knowledge of 4 5 HPV as a risk factor for oral cancer compared with tobacco and alcohol [21]. In a US population- 6 7 based online survey, HPV was recognised as a common risk factor for mouth and throat cancer by 8 fewer than 1% of participants, and even when prompted explicitly about the link, just 13% said they 9 10 had heard of the association [22]. In an internet survey of men, a greater proportion linked HPV with 11 12 genital warts than with oral cancer, with 43% identifying infection with HPV as a potential cause of 13 14 oral cancer [23]. 15 For peer review only 16 17 Public awareness of the signs and risk factors for head and neck cancer has also been shown to be 18 poor [24–26] and the majority of oral cancers are diagnosed at an advanced stage [27]. Oral health 19 20 providers have expressed concern about appropriate communication regarding HPV-related oral 21 22 cancer [28]. 23 24 25 Media coverage is one route through which public understanding of this issue might be improved, but 26 27 little is known about British media coverage of the link between HPV and oral cancer. The media has 28 29 been shown to be a common source of information about HPV [17] and greatly influences public 30 opinion, and as such it is crucial to examine how the link is portrayed by the British media. As the 31 32 media may play an important role in fulfilling the information needs of the public, examining the 33 34 content of articles will establish what information is being conveyed and how this is communicated.
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