Carcinoma of cervix is still a major health concern despite the availability of facilities and expertise in detecting the disease in its precancerous stage or the early stage. The main causative agent the HPV is well-known, associating with sexual transmission and the fact that vaccine is also available do not appear to have a major impact in the preventing the disease or detecting early.

It was reported that ‘Sri Lanka has a large sexually active and potentially susceptible population aged between 15 and 49 years’ [13]. According to a National Youth survey conducted in the 2012/2013 period among a cohort of youth, about 30% reported to have engaged in some sexual activity [14]. Adolescent fertility rate is reported to be 30 live births per 1000 women and in 2017 nearly 17000 teenage pregnancies (4.6%) were reported in Sri Lanka [14].

Our study was done among the students of Eastern University, Sri Lanka analyses on the knowledge upon the common factors connected to cervical cancer. Almost 60% of the students have heard about cervical cancer affecting the females. About 44.3% of the students had very poor or poor knowledge on the warning features of cancer. Similarly, about 48% were not aware of the practice of cervical screening available in the Sri Lankan health system. One-fifth of the students are at the risk of contracting HPV due to the sexual activity and less than one fifth (17.7%) had adequate knowledge on HPV Vaccine. The student cohort in the Faculty of Arts & Culture showed the highest number and percentage of poor knowledge on the above analysis and also the risk of contracting the HPV. Gender wise, male cohort showed a statistically better knowledge that they heard about cancer of cervix and about the availability of the HPV vaccine but had a higher risk of contracting PHV due to the sexual activity.

Studies were done in Sri Lanka and other countries among university and college students reveal the increasing tendency of the youth engaging in sexual activities at their early teens. A study carried out on sexual behavior of 3134 higher secondary school students aged 18−20 years in six geographically representative districts of Sri Lanka revealed that half of the men and approximately a third of the women were sexually active at the time, with only 26.5% of men and less than 10% of women reporting using condoms during intercourse [13]. Thus, Sri Lankan younger population is at significant risk of developing Carcinoma of cervix, as far as our study reveals, like in many parts of the world [15-18].

Thus it becomes imperative as the studies reveal, to improve the awareness among the young population about the risk of getting preventable cancer. Young people engaging in sexual activities show increasing tendency and thereby run the risk of contracting HPV which does not only cause cancer of cervix but also of anus, mouth, throat, etc. Further, awareness on other aspects of prevention and early detection such as screening which is readily available needs to be propagated among the young population especially the university students.

It is understood as our study revealed that students engaging in Health care studies have much better knowledge in different aspects of cervical cancer. The students from other study programs especially arts and cultural studies had very poor knowledge on many aspects. In a study done in India among the Medical, Nursing, Engineering and other general graduate students showed that the knowledge on different aspects of cervical cancer including awareness, screening, risk factors and vaccination, the Engineering and general graduate students’ scores were very low compared to the Medical and Nursing students. Further, the authors found that even ‘amongst medical and nursing students to this knowledge was lacking’ [19]. Further, the students in the arts stream have a higher risk of getting HPV as about 25% of the cohort reported engaging in sexual activities (FSc 22%, FCM 15%, FSG 14.6%, FHCS 14% – Table-6).

Universities also have extra-curricular programs to develop the students into competent graduates and professionals. These programs make the students develop a better understanding of various aspects affecting their lives. Similarly Eastern University, Sri Lanka conducts programs in soft skills development, career development, counseling activities among the extracurricular activities. This is evident even in this study as the students advance through their studies show improved knowledge in cervical cancer awareness, screening, and also about the vaccine. This can be noted from the following statements made by students participating in the study.

One student in the final year at the FAC spoke this; “When I entered into the university, knowledge, and awareness on diseases such as cancer were limited. Due to the activities in the university and the access to the internet, I get more knowledge”.

One student from the Faculty of Science remarked “I am interested in reading only a few sections in the newspaper and seldom health articles. This activity pushes me to read them more”.

In the general population too there is laxity in the aspects of taking preventive measures from contracting cervical cancer. In a study done among the females attending two Sri Lankan hospitals outpatient clinics to assess the awareness on cervical cancer and screening concluded that ‘the knowledge about cervical cancer screening and prevention has lower even among educated women in the sample cohort. This urges the need to raise the cervical cancer awareness among women at screening age and encourage them for active participation in the screening programs’ [20]. In this regard one male student participated in this study had this say;

“After you spoke about the study, I spoke to my eldest sister who is 40 years of age with two children. She said the Public Health midwife of the area called her to the screening test done, but she did not show interest and didn’t go to the clinic”.

Prevention of cervical cancer or its early detection continues to be a major challenge. It has been reported that ‘Knowledge and awareness of cervical cancer and HPV are consistently low across developing countries and such lack of knowledge provides a challenge to the implementation of cervical cancer programs’ and the new mass HPV vaccination drive [21]. Its awareness and taking safety measures among the students who obtain higher education continue to be a major issue that apart from the students in Health care studies, those in other study streams especially Arts and Culture report poor status as reveals in this study. A similar situation is also noted in the studies done in Bhutan and India [19,22].

Thus it becomes essential that the message should go across the population including the youth with regard to the screening, activities leading to the risk of contracting HPV, and also the HPV vaccination. In this regard, our study made this observation that ‘the students are of the general opinion that social media are good tools to propagate these types of information’.