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Cervical Cancer Digest

The Month in Cervical Cancer Research

June 2026 brought a landmark month for cervical cancer prevention: the first robust national-level evidence that high HPV vaccination coverage is actually preventing deaths — not just infections or precancers, but cervical cancer deaths — was published in The Lancet, drawing on over two decades of data from England. Alongside that headline finding, June's research spanned the global challenge of making screen-and-treat approaches work in the world's most remote communities, real-world immunotherapy outcomes in practice, evidence on HPV vaccination programs in sub-Saharan Africa, refinements in how to manage precancerous lesions, and qualitative research on the lived experience of accessing screening in settings where access is anything but guaranteed.

HPV vaccination is now demonstrably saving lives

The most important finding this month is direct evidence that vaccination is not just preventing infections; it is preventing cancer deaths, including in the first cohorts to grow to adulthood fully vaccinated.

  • A landmark population analysis examined cervical cancer deaths among women in England between 2001 and 2024. The findings are striking: among women aged 20–24 who had been vaccinated at age 12–13 with coverage around 88–90%, zero cervical cancer deaths occurred in 2020–2024, compared with 23.1 expected deaths based on historical rates — a 100% mortality reduction. In women aged 25–29 with earlier catch-up vaccination, a 69% reduction was observed. In total, the analysis estimates HPV vaccination in England has been associated with preventing approximately 200 cervical cancer deaths to date. This is the first robust national-level evidence of this kind, and it strongly supports the achievability of the WHO's goal of eliminating cervical cancer as a public health problem. The study is observational and cannot prove causation, but the timing and magnitude of the effect align precisely with vaccination cohorts. (Read the full paper)
  • An interrupted time-series analysis showed that after Brazil introduced quadrivalent HPV vaccination in 2014, high-grade cervical intraepithelial neoplasia (CIN, precancerous cell changes on the cervix, graded 1–3 by severity) consultation rates among adolescents aged 15–19 declined from a peak of 7.1 per 100,000 in 2015 to just 1.8 per 100,000 in 2023, falling below pre-vaccination levels. Older age groups showed no comparable decline, and trends in unrelated sexually transmitted infections increased across all ages, suggesting the change in adolescents reflects vaccine impact, not shifts in health-seeking behavior. (Read the full paper)

Getting the vaccine to every girl matters, and gaps persist

Vaccination coverage data from around the world continues to reveal where the gains are not yet reaching those who need them most, and why.

  • A global qualitative evidence synthesis analyzed 71 studies from diverse geographic and socioeconomic settings to understand why HPV vaccine uptake remains suboptimal worldwide. The synthesis found that vaccine decision-making is shaped by a complex interplay of trust, sociocultural norms, political context, and access barriers, well beyond simple awareness or a calculation of risks and benefits. The authors present a novel conceptual framework with eight interacting themes and argue that more person-centered, community-grounded vaccination strategies are needed to reach the WHO's 90% coverage target. This is one of the most comprehensive global analyses to date of the structural and social dimensions of vaccine hesitancy. (Read the full paper)
  • Qualitative research from Nigeria examined barriers to the HPV vaccination rollout in Kwara State. Focus group discussions with caregivers revealed that even after the cost barrier was removed by Nigeria's 2023 free HPV vaccine campaign, uptake was shaped by medical mistrust, fears about fertility and population control (amplified by COVID-19 experiences), geographic exclusion of nomadic and rural communities, and the critical but uneven role of healthcare workers and community leaders. The paper's central point is that free provision is necessary but not sufficient, and it applies well beyond Nigeria's borders. (Read the full paper)
  • A mixed-methods study examining the early HPV vaccine rollout across five Nigerian states found that only 25% of facilities recorded any vaccine availability throughout the study period, with uptake varying from 0 to 308 doses per facility. Sociocultural resistance rooted in misinformation, weak outreach to schools, and supply chain disruptions were the dominant barriers. Frontline healthcare workers' trust and community legitimacy emerged as the most powerful enablers of uptake. (Read the full paper)

Innovative approaches to cervical cancer screening are extending reach to the world's most underserved communities

June brought compelling real-world evidence on what it takes to deliver effective screening in settings where standard clinic-based models simply do not work.

  • A landmark implementation study described a mobile, point-of-care HPV-based screen-and-treat intervention delivered aboard government ships serving remote Amazonian communities accessible only by river. Across four six-week campaigns, 330 women were screened, a ten- to twenty-fold increase over previous ship-based screening. Nearly all received same-day results, and 85% of HPV-positive women received same-day treatment (thermal ablation, a procedure using heat to destroy precancerous tissue). The key innovation was combining portable HPV testing technology with same-day results and treatment, eliminating the need for follow-up visits that remote women could not complete. Culturally adapted recruitment, including audio messages in Indigenous languages delivered by community women, was essential to participation. This study shows what "equitable access" actually looks like when healthcare infrastructure meets people where they are. (Read the full paper)
  • A systematic review and meta-analysis compared the diagnostic accuracy of vaginal self-sampling and urine-based HPV testing against clinician-collected samples across 22 studies and over 9,000 participants. Vaginal self-sampling showed pooled sensitivity of 91.3% and specificity of 86.9% for detecting CIN2+ (high-grade precancerous lesions or worse); urine-based testing showed 86.9% sensitivity and 79.5% specificity, which is lower but still clinically meaningful, and entirely non-invasive. For communities where cultural, logistical, or infrastructure barriers make clinic-based testing unrealistic, self-sampling is a credible and growing option. (Read the full paper)
  • A nationally representative cervical screening initiative in Ghana screened 1,636 women across all 16 regions through a collaborative initiative combining Rotary Clubs and trained alumni of a cervical cancer prevention center. Overall high-risk HPV prevalence was 26.6%, but HPV16 and HPV18 together accounted for less than 5% of infections, with HPV52, HPV58, and HPV51 predominating. This finding has important implications: older bivalent and quadrivalent vaccines cover far fewer of the genotypes circulating in Ghana than the nonavalent vaccine. The study demonstrates a scalable, community-driven model and highlights the need for surveillance-informed vaccination policy. (Read the full paper)

Immunotherapy in practice: real-world data fills in the picture

Clinical trial results set expectations; real-world cohort data shows how treatments perform when delivered outside controlled trial settings.

  • A retrospective cohort study followed 57 patients with metastatic or recurrent cervical cancer treated with immune checkpoint inhibitors (drugs that remove a natural brake on the immune system, helping it attack cancer cells) between 2016 and 2024. In patients receiving an immune checkpoint inhibitor in combination with chemotherapy (35 patients), median progression-free survival was 12.4 months, and median overall survival was 27.5 months — results comparable to those seen in clinical trials, a meaningful real-world validation. Among patients receiving an immune checkpoint inhibitor alone (22 patients), outcomes were shorter, consistent with later-line treatment. Sixteen percent of patients discontinued due to toxicity, underscoring that active toxicity management is essential as these drugs move into routine practice. (Read the full paper)

Precancerous lesion management: new evidence supports tailored approaches

How to manage CIN2, the grade that sits between definitely-treat and watch-and-wait, remained active research territory this month, alongside new treatment options for settings where excisional procedures are unavailable.

  • A five-year cohort study compared thermal ablation (TA), loop electrosurgical excision (LEEP), and cold knife conization (CKC) for treating CIN across 17,202 women with up to five-year follow-up. For CIN1 and CIN2, TA achieved five-year cure rates of 79.0% and 87.9% respectively, comparable to LEEP (90.3%) for CIN2, with excellent high-risk HPV clearance. For CIN3, TA's cure rate (66.0%) was significantly lower than LEEP or CKC (97.0% and 94.1%). This is among the largest and longest real-world comparisons of these approaches, and it supports TA as a valid option for CIN1/CIN2 while reinforcing that CIN3 requires excisional treatment. For settings where thermal ablation is the only available option, which describes much of Sub-Saharan Africa, these data are particularly important. (Read the full paper)
  • A qualitative study described Kenyan women's experiences participating in a Phase 1 clinical trial of intravaginal artesunate pessaries, a self-administered home treatment for CIN2/3. Using the socioecological framework, the researchers found that participants (most of whom were low-income women living with HIV) found the pessary acceptable and convenient, were highly motivated to treat their precancer, and were able to complete the protocol with support from partners, families, and the study team. Personal and community experiences with cancer mortality strongly motivated engagement, and patient education was central to enabling correct self-administration. If randomized efficacy trials confirm artesunate's effectiveness, self-administered treatments could play a critical role in closing the precancer treatment gap in LMICs. (Read the full paper)
  • A multicenter French study identified clinical predictors of no high-grade lesion on LEEP specimens after a prior biopsy diagnosis of high-grade disease. Among 2,037 patients, 9.4% had no high-grade lesion on the final excision specimen. Three factors predicted this: small transformation zone (one quadrant or less), colposcopic appearance of normal or minor changes, and normal or low-grade cytology. These findings support more tailored counseling for patients where the clinical picture is ambiguous; some may be candidates for closer surveillance rather than immediate excision. (Read the full paper)

Cervical cancer screening disparities: qualitative evidence on whose voice is missing

Among June's most important contributions were studies examining why women from marginalized communities are not being reached by screening programs.

  • A Kaupapa Māori qualitative study heard from 24 young Māori women (aged 18–30) about their experiences and knowledge of cervical screening. Their answers were organized into four pillars of self-determination, support, education, and equity. The findings showed that cost is the greatest barrier to accessing screening, that general practice plays a critical role in championing screening, and that HPV self-testing has genuine potential to shift the narrative from screening as a burden to screening as an act of self-determination. Grounded in Kaupapa Māori methodology, this study centers the knowledge and perspectives of Māori women and offers directly applicable insights for programs working to close persistent equity gaps in screening rates. (Read the full paper)
  • Qualitative interviews with 30 healthcare providers in Bolivia revealed multilevel barriers to cervical cancer screening access: women's information gaps at the individual level; family-driven misconceptions and gender norms at the interpersonal level; centralized cytology services, unclear guidelines, and bureaucratic delays at the organizational level. Incentive-based campaigns temporarily raised numbers but didn't address underlying structural barriers, and long waiting times for results eroded trust and discouraged return visits. Facilitators included use of the Quechua language during care. The barriers identified map onto systemic challenges across Latin America and other LMICs. (Read the full paper)

Molecular insights and biomarkers: groundwork for more targeted treatment

June's translational science set the stage for better-targeted surveillance and immunotherapy approaches.

  • A review synthesized the emerging evidence that the cervicovaginal microbiome, the community of microorganisms in and around the cervix, is a functional determinant of whether HPV infections persist or clear. Lactobacillus-dominant microbial communities are associated with regulated inflammation and higher likelihood of HPV clearance; anaerobe-rich dysbiosis is linked to elevated pro-inflammatory signals and immune dysfunction that favors persistence. The review presents evidence that the interaction is bidirectional: HPV itself can remodel the microbial environment in ways that reinforce dysbiosis and favor persistence. This opens potential avenues for microbiome-informed risk stratification and adjunctive interventions, though prospective clinical validation is needed. (Read the full paper)
  • An exploratory genomic study analyzed targeted sequencing in 42 patients with recurrent or metastatic cervical cancer receiving immune checkpoint inhibitor therapy. Specific genomic alterations, including PIK3CA, EP300, and homologous recombination pathway mutations, were associated with longer progression-free survival, while TP53 and KEAP1 mutations predicted worse outcomes. An exploratory five-feature genomic model achieved meaningful risk stratification, though validation in larger independent cohorts is needed. For patients and oncologists, this supports the long-term direction of precision immunotherapy, matching treatment to tumor biology rather than a one-size-fits-all approach. (Read the full paper)
  • A real-world study from Uganda tracked 184 women treated for CIN at Mbarara Regional Referral Hospital over six years. Overall cure rate was 81.5%, but persistent lesion rates increased over time, particularly among women with unknown HIV status and those infected with HPV16 or mixed HPV18/45 genotypes. This highlights both the impact of limited HIV testing integration and the importance of HPV genotype in predicting treatment response, with direct implications for post-treatment surveillance protocols in resource-limited settings. (Read the full paper)

A neglected dimension of prevention in Africa

One commentary published this month raised an issue that rarely appears in cervical cancer discussions but may be affecting millions of women.

  • A commentary argued that female genital schistosomiasis (FGS, a neglected tropical disease caused by schistosome parasites that affect millions of women in Sub-Saharan Africa, causing chronic inflammation and scarring in the genital tract) should be explicitly integrated into Africa's cervical cancer prevention agenda. FGS lesions may complicate cervical screening, potentially mimicking or obscuring precancerous changes; HPV-based screening may miss women with schistosomiasis-related cervical pathology who test HPV-negative. While the causal relationship between FGS and HPV/cervical cancer progression remains unproven, the biological plausibility and co-endemic overlap are sufficient to warrant serious attention, particularly as Africa scales up HPV screening infrastructure. The author argues that integrating FGS assessment into screening programs is both a biomedical and social justice imperative. (Read the full paper)

What Does This Mean for Me?

If you have been vaccinated against HPV as an adolescent, the England mortality data published this month is directly relevant to you and to anyone whose children you care about. The evidence now shows that people who received HPV vaccination with high coverage are not just experiencing fewer precancers, they are not dying of cervical cancer. This doesn't mean screening is no longer necessary (vaccination doesn't cover all HPV types, and people vaccinated later or with partial coverage still need screening), but it is powerful confirmation that the vaccine works. If you have children or young people in your life who have not been vaccinated, ask a healthcare provider about options. Ask specifically about the nonavalent vaccine, which covers more HPV types than earlier formulations.

If you or someone you care for has not been screened recently, June's qualitative research from several countries is a reminder that the barriers to screening are real, structural, and often unaddressed by standard clinic-based approaches. If cost, transportation, trust in the healthcare system, or privacy concerns are barriers, ask whether HPV self-sampling is available in your area. Self-collected HPV testing is now available in a growing number of countries and has been shown to detect high-risk HPV nearly as effectively as clinician-collected samples and is often preferred by people who have had difficult prior screening experiences.

If you are living with cervical precancer (CIN) and weighing treatment options, the large cohort study published this month provides real-world, long-term data that may be useful for your conversations with your care team. Thermal ablation offers cure rates comparable to LEEP for CIN1 and CIN2, with excellent HPV clearance, but for CIN3, excisional treatment with LEEP or cold knife conization remains clearly superior. Questions worth asking: What grade is my CIN, and what does that mean for my treatment options? What is the likelihood this will progress without treatment? What follow-up will I need after each approach?

If you are living with recurrent or metastatic cervical cancer, this month's real-world cohort confirms that immunotherapy combinations are delivering survival benefits in routine practice comparable to clinical trial results. The exploratory genomic data points toward a future of more personalized treatment. Ask your oncologist whether you've been tested for PD-L1 combined positive score (CPS, a biomarker that helps predict who benefits most from immune checkpoint inhibitors) and whether genomic profiling has been considered for your case. Ask about clinical trials in precision immunotherapy that may be open to you.

Research on cervical cancer, especially for the global communities most affected, depends on people who participate in clinical trials and advocate for equitable access. Visit ocrahope.org to learn about OCRA's resources and how to connect with the broader gynecologic cancer community.

This digest is prepared by OCRA (Ovarian Cancer Research Alliance) for patients, caregivers, and advocates. It is intended to inform, not to guide individual treatment decisions. Please speak with your care team about what research findings may mean for your specific situation.

Sources

Directly Referenced in This Digest

  1. Sasieni P, Falcaro M. "Cervical cancer mortality trends following HPV vaccination in England, 2001–24: an analysis of population-based mortality data." Lancet. June 17, 2026. PMID 42309117. https://doi.org/10.1016/S0140-6736(26)00918-9
  2. Bierrenbach AL, Pungartnik PC, Gonçalves Queijo R, et al. "Early effects of HPV vaccination on high-grade cervical intraepithelial neoplasia in Brazil: Evidence from outpatient data." Human Vaccines & Immunotherapeutics. June 15, 2026. PMID 42295873. https://doi.org/10.1080/21645515.2026.2684304
  3. Cooper S, Wiysonge CS, Jama NA, et al. "Understanding the roots of hesitancy to unlock the game-changing impact of HPV vaccination: Insights from a global qualitative evidence synthesis." Human Vaccines & Immunotherapeutics. June 23, 2026. PMID 42334459. https://doi.org/10.1080/21645515.2026.2681769
  4. Muhammad-Olodo AO, Asher L. "Understanding factors influencing HPV vaccine uptake among caregivers in Kwara State, Nigeria: A qualitative study." PLOS ONE. June 16, 2026. PMID 42302043. https://doi.org/10.1371/journal.pone.0351659
  5. Olubayo GT, Bakare A, Salako J, et al. "Early implementation and contextual determinants of the human papillomavirus vaccine rollout and uptake in Nigeria: a mixed-methods study." Frontiers in Public Health. June 2, 2026. PMID 42311987. https://doi.org/10.3389/fpubh.2026.1834756
  6. Paz-Soldan VA, Nussbaum L, Hidalgo C, et al. "Delivering cervical cancer screening and management to women in remote communities of the Peruvian Amazon: a mixed methods analysis of a mobile point-of-care intervention." Lancet Regional Health – Americas. June 25, 2026. PMID 42395932. https://doi.org/10.1016/j.lana.2026.101535
  7. Rakhat A, Aimagambetova G. "Diagnostic Accuracy of Urine and Vaginal Self-Sampling for Detection of High-Risk Human Papillomavirus: A Systematic Review and Meta-Analysis." Viruses. June 18, 2026. PMID 42357689. https://doi.org/10.3390/v18060681
  8. Effah K, Ametefe DL, Amuah JE, et al. "A collaborative cervical precancer screening strategy with concurrent HPV genotyping and visual inspection using alumni of a training centre across Ghana: The Rotary 'Protect Your Pearl' initiative." PLOS ONE. June 26, 2026. PMID 42361154. https://doi.org/10.1371/journal.pone.0350573
  9. Bischof K, Fredriksen KM, Bjørnstad M, et al. "Oncological outcome and immune-checkpoint-blockade-induced toxicities in patients with cervical cancer — a Norwegian real-world cohort." Acta Oncologica. June 1, 2026. PMID 42220011. https://doi.org/10.2340/1651-226X.2026.45737
  10. Yuan M, Zhao X, Hu S, et al. "Thermal ablation, loop electrosurgical excision procedure and cold knife conization for cervical intraepithelial neoplasia: efficacy and HPV clearance in a 5-year cohort of Chinese women." Cancer Biology & Medicine. June 5, 2026. PMID 42252730. https://doi.org/10.20892/j.issn.2095-3941.2025.0415
  11. Sadana A, Guliam A, Opiyo EA, et al. "'When a Thorn Comes Into Your Body, You Must Remove It'. A Socio-Ecological Analysis of the Acceptability of Intravaginal Artesunate as Cervical Precancer Treatment in a Phase 1 Clinical Trial." International Journal of Women's Health. June 29, 2026. PMID 42403515. https://doi.org/10.2147/IJWH.S573262
  12. Assirlikian S, Mancini J, Philip CA, et al. "Predictive factors for the absence of high-grade intraepithelial lesions in LLETZ specimens following a prior histological diagnosis." Acta Obstetricia et Gynecologica Scandinavica. June 18, 2026. PMID 42316784. https://doi.org/10.1111/aogs.70213
  13. Slater T, Stevenson K, Adcock A, et al. "Opportunities to flip the narrative from burden to action for young women joining the National Cervical Screening Programme in Aotearoa New Zealand: a Kaupapa Māori qualitative exploration." Journal of Primary Health Care. June 26, 2026. PMID 41414979. https://doi.org/10.1071/HC25151
  14. Challgua CH, Rodriguez DE, Goicolea I, Linander I. "Barriers and facilitators in access to cervical cancer secondary prevention in Cochabamba, Bolivia: a qualitative study of healthcare providers' perceptions." BMC Primary Care. June 15, 2026. PMID 42298405. https://doi.org/10.1186/s12875-026-03422-2
  15. Suárez-Rico DO, Rizo de la Torre LDC, Zermeño-Ruiz M, et al. "Bidirectional Interactions Between Cervicovaginal Microbiota and Human Papillomavirus Drive Persistence and Disease Progression." International Journal of Molecular Sciences. June 22, 2026. PMID 42353329. https://doi.org/10.3390/ijms27125616
  16. Gu L, Zhu B, Liu C, et al. "Genomic determinants and an exploratory prognostic model for immunotherapy outcomes in recurrent or metastatic cervical cancer." The Oncologist. June 6, 2026. PMID 42332782. https://doi.org/10.1093/oncolo/oyag236
  17. Ssedyabane F, Kajabwangu R, Mudondo H, et al. "Recent treatment outcomes of cervical intraepithelial neoplasia in south western Uganda: a six year retrospective study." Gynecologic Oncology Reports. June 19, 2026. PMID 42383152. https://doi.org/10.1016/j.gore.2026.102149
  18. Bunduki GK. "Beyond HPV: why female genital schistosomiasis must be addressed in Africa's cervical cancer prevention agenda." Academic Pathology. June 10, 2026. PMID 42318309. https://doi.org/10.1016/j.acpath.2026.100274

Additional Open-Access Papers Published in June 2026 on Related Topics

  1. Chuwa AH. "Innovations in HPV vaccination and their role in global cervical cancer control: a review." Therapeutic Advances in Vaccines and Immunotherapy. June 29, 2026. PMID 42389684. https://doi.org/10.1177/25151355261449446 (Comprehensive review of prophylactic and therapeutic HPV vaccines — from bivalent to nonavalent formulations, next-generation pan-genotype candidates, and therapeutic vaccines targeting E6/E7 oncoproteins — with particular attention to sub-Saharan Africa, where HPV16/18 account for most cervical cancers but vaccine access remains limited.)
  2. Bai J, Cui XL, Bo SJ, Sun L. "Using peripheral blood indicators and T cell subsets to evaluate the efficacy of immunotherapy for advanced and recurrent cervical cancer." Human Vaccines & Immunotherapeutics. June 23, 2026. PMID 42334275. https://doi.org/10.1080/21645515.2026.2664301 (Prospective study of 50 patients with stage III-IVa or recurrent cervical cancer receiving first-line immunotherapy combined with chemo/radiotherapy; high baseline CD4+ T-cell percentage and post-treatment normalization of CA125/SCCA levels and PD-1 expression were associated with treatment response — potentially useful minimally invasive biomarkers.)
  3. Cardoso L, Saidu R, Kuhn L. "Screen-and-treat: a sustainable solution for cervical cancer elimination in low and middle income countries." BMJ Oncology. June 15, 2026. PMID 42369561. https://doi.org/10.1136/bmjonc-2025-000827 (Narrative review synthesizing evidence on clinical effectiveness and operational feasibility of screen-and-treat (SAT) approaches in LMICs; compares VIA and HPV testing as screening modalities and cryotherapy vs thermal ablation vs LLETZ as treatment options; addresses management of women living with HIV, who require tailored protocols given higher HPV prevalence, lower test specificity, and lower post-treatment cure rates.)
  4. Saithong S, Prompetchara E, Ketloy C, et al. "Preventive and therapeutic efficacy of mRNA/LNP vaccines encoding HPV16 E6 and E7 in an early-intervention HPV tumor mouse model." Human Vaccines & Immunotherapeutics. June 16, 2026. PMID 42301768. https://doi.org/10.1080/21645515.2026.2686510 (Preclinical study from Chulalongkorn University showing that mRNA/lipid nanoparticle vaccines encoding HPV16 E7 oncoprotein — the same technology platform used in COVID-19 vaccines — achieved significant tumor regression and durable immune memory in low-burden early-intervention mouse models; supports clinical development of therapeutic HPV vaccines.)
  5. Wang R, Wang J, Ruan J, et al. "Innovative peptide-loaded hybrid membrane nanovaccine enables precise personalized immunotherapy for HPV-related cervical diseases." Signal Transduction and Targeted Therapy. June 3, 2026. PMID 42236671. https://doi.org/10.1038/s41392-026-02680-x (Preclinical study of a nanoparticle-based therapeutic cancer vaccine co-delivering HPV16 tumor antigens alongside bacterial cytoplasmic membranes as natural immune stimulants; demonstrated significant tumor suppression, durable immune memory, and synergy with anti-PD-1 immunotherapy in murine models; scalable production is a noted strength.)
  6. Omar DI, Althobaiti S, Nabil N, et al. "Human papillomavirus vaccination: knowledge, acceptance, and barriers among medical students. An Egyptian multicenter cross sectional study." Scientific Reports. June 15, 2026. PMID 42297846. https://doi.org/10.1038/s41598-026-51547-2 (Survey of 601 Egyptian medical students finding HPV vaccine uptake of only 12.1%, with substantial knowledge gaps, concerns about vaccine safety and efficacy, cultural and parental objections, and cost barriers — a signal about the general population given that even healthcare trainees show suboptimal vaccine literacy.)
  7. Sinuraya RK, Postma MJ, Puspitasari IM, Suwantika AA. "Health Equity Barriers to Accessing Vaccination and Screening Services in Low- and Middle-Income Countries: A Narrative Review." Risk Management and Healthcare Policy. June 22, 2026. PMID 42370037. https://doi.org/10.2147/RMHP.S612390 (Narrative review of multilevel barriers to vaccination and cervical cancer screening in LMICs, with screening evidence predominantly from HPV/cervical cancer programs; poverty, transportation costs, health literacy, stigma, and weak primary care infrastructure were the most consistent cross-cutting barriers, disproportionately affecting rural populations, women, and ethnic minorities.)
  8. Wang J, Wang X, Xu J, Xu Q. "Cost-effectiveness of single-dose versus two-dose HPV vaccination: a Markov cohort modelling analysis of a Kenya-India LMIC composite." Frontiers in Public Health. June 4, 2026. PMID 42326956. https://doi.org/10.3389/fpubh.2026.1833764 (Markov cohort model comparing single-dose and two-dose HPV vaccination in a Kenya-India composite LMIC; under the base case of 20-year single-dose protection, eliminating second-dose dropout improved cost-effectiveness by concentrating protection in younger women, but this finding is structurally dependent on the assumed protection duration and should not be generalized without country-specific data.)
  9. Sui L, Yin R. "Global research trends and hotspots in human immunodeficiency virus-associated cervical cancer (1990–2025): a multi-database bibliometric analysis." Frontiers in Immunology. June 10, 2026. PMID 42358990. https://doi.org/10.3389/fimmu.2026.1835957 (Bibliometric analysis of 6,137 publications on HIV-associated cervical cancer identifying research hotspots including screening of women living with HIV, HPV vaccination strategies, and precision therapies guided by the immune microenvironment; notes accelerating publication growth and identifies future directions in lifecycle vaccination and scalable screening for low-resource settings.)
  10. Ran L, Lian Z, Tian Y, et al. "Prognostic value of an integrated immune-inflammatory phenotype in surgically treated cervical cancer: survival modeling and immunohistochemical validation." Frontiers in Immunology. June 16, 2026. PMID 42382777. https://doi.org/10.3389/fimmu.2026.1850891 (Retrospective cohort study of 612 surgical cervical cancer patients; a combined immune phenotype using tumor-infiltrating lymphocytes (TILs) and the systemic immune-inflammation index (SII) was independently associated with post-surgical recurrence risk; immunohistochemical validation confirmed CD8+ cell density, CD163+ cell density, and PD-L1 combined positive score as tissue correlates.)
  11. Yuan Y, He W, Tong L, et al. "Conversion-oriented multimodal therapy enabling definitive surgery in a patient with FIGO stage IVA cervical cancer at high risk of fistula formation: a case report." Frontiers in Immunology. June 17, 2026. PMID 42389528. https://doi.org/10.3389/fimmu.2026.1853610 (Case report of stage IVA cervical cancer with extensive pelvic invasion and risk of fistula; individualized multimodal strategy combining emergent hemostatic radiotherapy, immunotherapy, targeted therapy, and adaptive replanning achieved pathologic complete response and enabled radical surgery; illustrates potential of multidisciplinary, image-guided adaptive approaches in complex presentations.)
  12. Stalp JL, Schneider JA, Steinkasserer L, et al. "Comparing clinical decision-making between colposcopists and large language models in cervical dysplasia management: a pilot prospective multicenter study." Archives of Gynecology and Obstetrics. June 18, 2026. PMID 42313159. https://doi.org/10.1007/s00404-026-08498-w (Prospective multicenter pilot study comparing ChatGPT-4o and ChatGPT-5 with board-certified colposcopists on 23 real patient cases; overall concordance rates were similar (~70% for all), with AI outperforming clinicians on straightforward precancerous lesion cases while clinicians excelled in complex scenarios with ambiguous histopathology; clinicians showed a tendency to overtreat low-grade lesions, suggesting a potential role for AI decision support.)
  13. Kigongo E, Heaney C, McBride L, et al. "A global scoping review of interventions to increase participation in screening programmes for breast, cervical and colorectal cancer between 2016 and 2025." BMC Public Health. June 25, 2026. PMID 42343351. https://doi.org/10.1186/s12889-026-27893-1 (Scoping review of 110 studies across 10 intervention categories for increasing cancer screening participation; multicomponent interventions showed the greatest impact; most evidence was from controlled settings with limited scalability; HPV self-sampling, peer education, and patient navigation were among the strongest individual components for cervical cancer screening.)
  14. Le Bonniec A, Woods S, McGlacken T, et al. "What are the views and experiences of human papillomavirus (HPV) self-sampling for cervical screening in high-income countries? A qualitative systematic review using the Theoretical Domains Framework." BMC Public Health. June 11, 2026. PMID 42277744. https://doi.org/10.1186/s12889-026-27668-8 (Qualitative systematic review of 36 studies on HPV self-sampling views and experiences in high-income countries; previous negative experiences with provider-performed screening strongly enhanced interest in self-sampling; convenience, privacy, and autonomy were valued; concerns about test reliability and correct technique persisted; multiple kit access routes (mail and clinic) were recommended.)
  15. Lincha B, Geda B, Ahmed K, et al. "Follow-up rescreening among women living with human immunodeficiency virus who tested positive and treated for cervical pre-cancer lesions in South Ethiopia." The Oncologist. June 6, 2026. PMID 42316805. https://doi.org/10.1093/oncolo/oyag237 (Retrospective study of 191 HIV-positive women treated for VIA-positive precancer in South Ethiopia; only 31.4% returned for follow-up rescreening within three years; higher education level and cryotherapy treatment (vs thermal ablation) were associated with return — with implications for counseling, post-treatment support, and treatment modality selection in HIV-positive populations.)
  16. Hempel S, Groß S, Steinkasserer L, et al. "Comparison of three different HPV self-sampling tools — a subanalysis of the prospective, randomized Hannover self-collection study." Archives of Gynecology and Obstetrics. June 25, 2026. PMID 42347973. https://doi.org/10.1007/s00404-026-08457-5 (Randomized comparison of Evalyn Brush, FLOQSwabs, and first-void urine (Colli-Pee) among 19,995 German women; Colli-Pee (10.4%) and FLOQSwabs (10.1%) had higher return rates than Evalyn (7.4%); 66.7% of participants preferred self-testing over clinic-based screening; all three devices performed strongly and appear suitable for integration into screening programs.)
  17. Saini V, Guo Z, Yu J, et al. "Development of a novel, urine-based high-risk human papillomavirus polymerase chain reaction test to predict cervical intraepithelial neoplasia abnormalities associated with cervical cancer." Microbiology Spectrum. June 17, 2026. PMID 42307270. https://doi.org/10.1128/spectrum.03796-25 (Development and optimization of a urine-based hrHPV PCR test achieving 92.7% sensitivity for CIN2+ and 93.9% for CIN3+ using large-volume urine samples; adjustable cycle threshold cutoffs allow performance tailoring for different screening contexts, with potential for expanded non-invasive screening access.)
  18. Liu L, Chen N, Zhu Q, Liu Q. "Effect of prophylactic HPV vaccination and timing of administration on recurrence of cervical HSIL after LEEP: A retrospective study." Medicine (Baltimore). June 5, 2026. PMID 42260881. https://doi.org/10.1097/MD.0000000000049167 (Retrospective study of 343 patients showing HPV vaccination before or within 6 months after LEEP was associated with significantly lower HSIL recurrence risk (OR 0.249); CIN3, glandular involvement, positive margins, and persistent HPV infection were independent risk factors for recurrence — clinically actionable guidance for post-LEEP counseling.)
  19. Sørbve SW, Antonsen M, Richardsen E. "Five-Year Risk of CIN3+ After CIN1 Biopsy in a Norwegian Screening Setting." Pathogens. June 22, 2026. PMID 42347269. https://doi.org/10.3390/pathogens15060657 (Population-based Norwegian cohort study finding that repeated CIN1 diagnoses in consecutive calendar years were NOT associated with higher subsequent CIN3+ risk compared with single CIN1 (3.4% vs 4.3%); supports conservative, risk-based follow-up after CIN1 biopsy rather than presumptive escalation of surveillance.)
  20. Bademci EG, Soysal D, Güneş M, Zengin A. "Early colposcopy in non-16/18 high-risk human papillomavirus positivity with normal cytology." Revista da Associacao Medica Brasileira. June 22, 2026. PMID 42339905. https://doi.org/10.1590/1806-9282.20252178 (Randomized study of 122 women who were HPV-positive for non-16/18 types with normal cytology; no significant difference in HPV persistence, abnormal cytology rates, or LEEP requirement between early vs delayed colposcopy at 1-year follow-up; supports risk-based follow-up over immediate colposcopy in this common clinical scenario.)
  21. Lim JH, Yeap LL, Saw PS, et al. "Determinants of cervical cancer screening in Southeast Asia: A systematic review using the COM-B model and the theoretical domains framework." Preventive Medicine. June 2026 (indexed). PMID 41887293. https://doi.org/10.1016/j.ypmed.2026.108564 (Note: official publication date March 24, 2026 — outside the June window.) Systematic review of 72 Southeast Asian articles on cervical cancer screening determinants mapped to the COM-B model; knowledge and environmental context/resources were the most frequently identified domains; findings support combining education with access improvements and community/provider support.
  22. Noreen K, Noor M, Maryam S, Baig M. "From global to local: Developing a context-specific BeSD-HPV tool through cultural and linguistic adaptation in Pakistan." PLOS ONE. June 15, 2026. PMID 42296125. https://doi.org/10.1371/journal.pone.0350162 (Qualitative study developing a culturally adapted WHO Behavioral and Social Drivers of HPV vaccination tool for Pakistan's Punjab province; identified Cultural Integration as a new domain beyond the existing WHO BeSD framework; provides a methodological blueprint for adapting global vaccination behavior frameworks to specific national contexts.)
  23. Butta J, Thonghoi P, Kesakul T, et al. "Incremental impact of community-delivered HPV self-sampling on screening uptake within an active outreach system: A quasi-experimental implementation study in rural Thailand." PLOS ONE. June 1, 2026. PMID 42224174. https://doi.org/10.1371/journal.pone.0349531 (Quasi-experimental study of 108 Thai women comparing community-delivered vs facility-based HPV self-sampling; uptake was 52% in the community-delivered group vs 35% in the facility-based group — a numerically meaningful difference but with wide confidence intervals; provides operational data for optimizing self-sampling delivery in rural Southeast Asian settings.)
  24. Chen X, Xue Z, Zhao S, et al. "Clinical manifestations and ultrasonographic features of lobular endocervical glandular hyperplasia: a retrospective study of 135 patients." Annals of Medicine. June 1, 2026. PMID 42220308. https://doi.org/10.1080/07853890.2026.2673627 (Retrospective analysis of 135 patients with lobular endocervical glandular hyperplasia (LEGH) — a rare endocervical precursor lesion — characterizing its ultrasound appearance as heterogeneous echogenicity with enhanced echogenicity and absent blood flow signals; MRI showed superior detection (92.9%) vs cytology (low sensitivity 11.9%) and vaginoscopic biopsy (48.5%); findings aid early detection in a clinically challenging entity.)
  25. Singini MG, Sitas F, Basu P, et al. "Factors associated with cervical cancer screening in the South African demographic and health survey." Cancer Causes & Control. June 30, 2026. PMID 42380372. https://doi.org/10.1007/s10552-026-02205-5 (Analysis of a nationally representative South African sample; HIV testing history and household wealth were the two strongest drivers of cervical screening uptake; Black South African women had significantly lower screening prevalence than other groups — findings with direct implications for equitable community-based screening expansion.)
  26. Neema Ufoy Mungu Y, Desreux J, Bianchi E, et al. "Human papillomavirus genotypes and factors associated with major cervical smear abnormalities in a sickle cell endemic area of Kisangani, Democratic Republic of the Congo." PLOS ONE. June 10, 2026. PMID 42268849. https://doi.org/10.1371/journal.pone.0350982 (Cross-sectional study of 712 women in the DRC finding overall hr-HPV prevalence of 28.4%, with HPV35, HPV52, and HPV31 predominating — genotypes not covered by bivalent/quadrivalent vaccines; HIV infection was strongly associated with both HPV positivity and major cervical abnormalities; novel HPV variants identified by sequencing.)
  27. Nakamura H, Mori S, Ishii Y, et al. "Prevalence and genotype distribution of human papillomavirus in cervical cancer and precancer in Japan between 2012 and 2025: a retrospective single-center study." Frontiers in Public Health. June 12, 2026. PMID 42368964. https://doi.org/10.3389/fpubh.2026.1857364 (Retrospective genotyping of 2,536 Japanese women with CIN2 to invasive cancer; HPV16 predominated in squamous lesions and increased progressively with lesion severity; HPV52 and HPV58 were prominent in precancerous lesions; among adenocarcinoma subtypes, only usual-type adenocarcinoma showed high HPV positivity (89.8%), while rarer subtypes showed low rates — data supporting the need for nonavalent vaccine adoption in Japan.)
  28. Arrillaga M, Neira D, Rivero DS, et al. "CITOBOT AI for real-world cervical cancer screening using colposcopy imaging." Frontiers in Public Health. June 12, 2026. PMID 42368966. https://doi.org/10.3389/fpubh.2026.1802494 (Cross-sectional study of 650 women in Colombia evaluating an AI-based cervical cancer screening system applied to colposcopy images; internally validated accuracy of 94.3%, sensitivity of 93.4%, and AUC of 0.98; external validation in independent datasets is required before broader implementation.)
  29. Zhang H, Xie L, Liu Y, et al. "Integrated bioinformatics, machine learning, and experimental validation identify a four-gene diagnostic signature for cervical cancer associated with PI3K/AKT signaling." Scientific Reports. June 23, 2026. PMID 42336904. https://doi.org/10.1038/s41598-026-57689-7 (Bioinformatics and machine learning study identifying CCND1, TRIP13, MYBL2, and GNB4 as a four-gene diagnostic signature with AUC of 0.989; GNB4 knockdown suppressed cell proliferation in preclinical validation; PI3K/AKT pathway involvement explored as a potential therapeutic target.)
  30. Godoy-Vitorino F, Vargas-Robles D, Bolaños-Rosero B, et al. "Environmental fungi modulate the vaginal mycobiome and cervical disease progression in Hispanic women." mSystems. June 3, 2026. PMID 42233658. https://doi.org/10.1128/msystems.00056-26 (Characterization of vaginal fungal communities in 86 Hispanic women in Puerto Rico; reduced fungal alpha diversity was observed in high-grade squamous intraepithelial lesions; environmental fungi may contribute to cervical disease progression; suggests mycobiome-bacteriome integration is important in women's health research.)
  31. Terrinoni M, Caputo V, Palisciano M, et al. "Non-Coding RNAs as Emerging Biomarkers in HPV-Associated Cervical Precancer and Cancer: Molecular Mechanisms and Clinical Perspectives." Genes. June 21, 2026. PMID 42353873. https://doi.org/10.3390/genes17060714 (Review of microRNAs, long non-coding RNAs, and circular RNAs as potential diagnostic, prognostic, and treatment-response biomarkers; discusses circulating and urinary ncRNA signatures, lncRNA-encoded peptides (including TUBORF) as therapeutic candidates, and chemoradiotherapy resistance signatures.)
  32. Jelski W, Okrasinska S, Mroczko J, et al. "MicroRNAs as Biomarkers of Cervical Cancers." International Journal of Molecular Sciences. June 12, 2026. PMID 42353050. https://doi.org/10.3390/ijms27125330 (Review summarizing the potential of microRNA molecules as early detection and monitoring biomarkers for cervical cancer, including discussion of analytical limitations, lack of standardized assays, and the need for prospective validation before clinical implementation.)
  33. Tolera ST, Zerihun E, Hunduma G, Letta S. "Application of health belief model (HBM) in health sciences and medical researches: systematic review on African and Asian countries." BMC Public Health. June 26, 2026. PMID 42351066. https://doi.org/10.1186/s12889-026-28281-5 (Systematic review of 77 HBM-based studies in Africa and Asia, including four studies on cervical cancer screening behavior; perceived barriers and susceptibility were the most consistent drivers; provides a foundation for comparing intervention frameworks across health contexts.)
  34. Mbonigaba RE, Kibonire RA. "Bridging the service gap: health facility challenges in HPV vaccine uptake in rural Uganda." BMC Women's Health. June 29, 2026. PMID 42366344. https://doi.org/10.1186/s12905-026-04637-2 (Mixed-methods study of 292 caregivers and 21 key informants in rural Rukiga District, Uganda; HPV vaccine completion rate was only 23.49%; vaccine stock-outs, cold-chain challenges, and understaffing were independent statistical predictors of non-completion; qualitative themes highlighted limited healthcare worker knowledge and absence of strategies for out-of-school girls as additional contextual barriers.)
  35. Thomas V, Devadasan JDC, John NO, et al. "Serum human papilloma virus detection following treatment of cervical cancer: prevalence and its correlation with recurrence." Cancer Causes & Control. June 25, 2026. PMID 42347892. https://doi.org/10.1007/s10552-026-02201-9 (Prospective cross-sectional study of 100 post-treatment cervical cancer patients in India; serum HPV DNA was detected in 18%, strongly associated with disease recurrence (OR 29.17); HPV16 predominated; suggests serum HPV as a potential minimally invasive surveillance tool warranting prospective longitudinal validation.)
  36. Singali DD, Daryanto B, Purnomo AF. "Success rate of Double J stent insertion in patients with advanced cervical cancer and hydronephrosis at tertiary hospital." Archivio Italiano di Urologia, Andrologia. June 5, 2026. PMID 42252923. https://doi.org/10.4081/aiua.2026.15582 (Retrospective study of 275 patients with advanced cervical cancer and hydronephrosis; ureteric stent insertion succeeded in 56.7%; severe hydronephrosis was an independent predictor of failure (OR 0.30) — directly relevant to counseling and management planning for obstructive uropathy in advanced disease.)
  37. Chen S, Yang X, Jiang S, et al. "Burden and temporal trends of female-specific cancers in China: A systematic analysis of the 2023 global burden of disease study." PLOS ONE. June 10, 2026. PMID 42268921. https://doi.org/10.1371/journal.pone.0351539 (GBD 2023 analysis showing age-standardized cervical cancer rates in China declined 1990–2023, but absolute case numbers increased 43.6% due to population growth and aging; projections indicate continued absolute burden growth through 2038, underscoring the need for sustained HPV vaccination and screening efforts.)
  38. Harun SNF, Azlan AA, Mohd Hassan NZA, Mohamad EMW. "Health belief model and cervical cancer screening intention among lower socioeconomic women in Malaysia: a pilot study." Frontiers in Public Health. June 12, 2026. PMID 42368934. https://doi.org/10.3389/fpubh.2026.1843558 (Pilot study of 54 lower socioeconomic women in Malaysia; perceived barriers and perceived severity were significantly associated with lower screening intention in multivariate analysis; provides preliminary data supporting full-scale HBM-guided intervention design for underserved populations.)
  39. Stefanos R, Gargano JW, Niccolai LM, et al. "Decreases in Human Papillomavirus Vaccine Types 16 and 18 in Cervical Precancers: HPV-IMPACT, 2008 to 2019." Cancer Epidemiology, Biomarkers & Prevention. June 2, 2026. PMID 42089801. https://doi.org/10.1158/1055-9965.EPI-25-1065 (Note: official publication date June 2, 2026 — within window.) Population-based US surveillance study showing the proportion of CIN2+ cases positive for HPV16/18 declined by 3.6% per year from 2008–2019, with the largest decline in vaccinated women (−8.9%/year) but significant declines even in unvaccinated women, suggesting both direct vaccine benefit and herd immunity effects.)
  40. Kankaria A, Shukla P, Vijayakumar M, et al. "Enhancing screening, early diagnosis and treatment initiation of oral, breast and cervical cancer in selected districts of India: an implementation research protocol." BMJ Open. June 12, 2026. PMID 42285578. https://doi.org/10.1136/bmjopen-2025-112428 (Protocol for a multisite Indian implementation research project targeting cervical, breast, and oral cancers under the National Programme for Prevention and Control of NCDs — a program that currently achieves less than 2% screening coverage; uses a three-phase formative/optimization/scale-up design across seven districts.)
  41. Gacuta E, Zajkowska M, Ławicki M, et al. "Diagnostic Potential of Selected Matrilysins and Stromelysins in the Diagnosis of Gynecological Malignancies Based on ROC Curve Analysis." International Journal of Molecular Sciences. June 20, 2026. PMID 42353305. https://doi.org/10.3390/ijms27125592 (Study of matrix metalloproteinases as diagnostic markers for cervical, endometrial, and ovarian cancers; MMP-10 showed the highest diagnostic utility for cervical cancer, outperforming both SCC-Ag and CA125; combined panels with routine markers may improve detection.)
  42. Cordovil DC, da Silva Reis LD, Ferreira LSS, et al. "High-risk oncogenic HPV genotypes in vulnerable women from the Amazon: a cross-sectional retrospective study." Virology Journal. June 11, 2026. PMID 42277850. https://doi.org/10.1186/s12985-026-03220-3 (Cross-sectional study of 1,315 women across 18 Amazonian municipalities finding overall HPV prevalence of 13.84%; HPV16 predominated, followed by HPV59 and HPV58; young age, unmarried status, and non-use of condoms were risk factors; highlights the need for HPV surveillance-informed vaccination policy in high-burden remote regions.)
  43. Yang S, Hou Y, Wang X, et al. "Economic evaluation of atezolizumab in combination with bevacizumab and chemotherapy for metastatic, persistent, or recurrent cervical cancer in China: A cost-effectiveness analysis." PLOS ONE. June 11, 2026. PMID 42275400. https://doi.org/10.1371/journal.pone.0351029 (Markov model analysis finding that atezolizumab plus bevacizumab and chemotherapy was not cost-effective from the Chinese healthcare perspective (ICER $432,597/QALY vs WTP threshold of $36,859), highlighting access challenges for newer immunotherapy combinations in LMICs even when survival benefit has been established.)
  44. Villazana-Calderon B, Jiménez-Wences H, Lizano M, et al. "HPV-16 E6 and E7 Oncoproteins Promote Cell Proliferation and Migration Through the miR-218-5p Axis." Pathogens. June 19, 2026. PMID 42347260. https://doi.org/10.3390/pathogens15060648 (Preclinical study identifying miR-218-5p and its target PIK3C2A as a regulatory pathway through which HPV-16 E6/E7 oncoproteins promote cervical cancer cell proliferation and migration; both emerge as potential prognostic biomarkers associated with overall survival in TCGA data.)
  45. Lee TS, Wang YC. "Stage-Specific Healthcare Costs in Cervical Cancer and Cervical Intraepithelial Neoplasia: A Population-Based Analysis Informing Value-Based Oncology and Equitable Prevention." Current Oncology. June 1, 2026. PMID 42346229. https://doi.org/10.3390/curroncol33060329 (Population-based analysis using Taiwan's cancer registry and insurance data showing stage I cervical cancer cost NT$256,095 in the first year vs NT$474,724 for stage IV, while 5-year survival declined from 85.3% to 19.5% — providing quantitative evidence for the economic and survival value of early detection and prevention.)
  46. Oshodin AE, Ehikioya EE, Okobi OE, et al. "Diagnostic accuracy of visual inspection with acetic acid versus Papanicolaou smear in cervical cancer screening among HIV-positive women in rural Nigeria." African Journal of Reproductive Health. June 11, 2026. PMID 42273874. https://doi.org/10.29063/ajrh2026/v30i11.3 (Comparative study of VIA vs Pap smear in 136 HIV-positive women in rural Nigeria; VIA showed higher sensitivity (94.1%) and Pap higher specificity (79.5%); combining both methods improved overall diagnostic performance — clinically relevant findings for HIV-positive cervical cancer screening protocols in low-resource settings.)
  47. Cantidio FS, Costa Diniz PH, Gil G, Silva-Filho AL. "Bone marrow-sparing radiotherapy in women with cervical cancer treated with radiochemotherapy." Cochrane Database of Systematic Reviews. June 11, 2026. PMID 42273975. https://doi.org/10.1002/14651858.CD016258 (Protocol for a Cochrane Review evaluating bone marrow-sparing radiotherapy for locally advanced cervical cancer treated with concurrent chemoradiotherapy — a technique with potential to reduce haematologic toxicity and enable better delivery of systemic therapy.)
  48. Zhang R, Chavana A, Shi Y, et al. "Dosimetric comparison of high dose rate interstitial brachytherapy and stereotactic body radiotherapy as alternative treatment methods for advanced-stage cervical cancer." Biomedical Physics & Engineering Express. June 19, 2026. PMID 42259310. https://doi.org/10.1088/2057-1976/ae7979 (Retrospective dosimetric comparison in 18 patients with stage III-IV cervical cancer; HDR-IBT remained superior for high-risk CTV dose escalation, but SBRT achieved acceptable coverage and organ-at-risk sparing; supports SBRT as an alternative when brachytherapy is medically or logistically unavailable — a common scenario in LMICs.)

Papers Excluded Due to Licensing Restrictions

  1. Cheung LC, Mao F, Rydzak G, et al. "Benefits and Harms of Immediate Versus Delayed Treatment of Cervical Intraepithelial Neoplasia Grade 2: A Target Trial Emulation." Annals of Internal Medicine. June 23, 2026. PMID 42330497. https://doi.org/10.7326/ANNALS-25-04053 (Excluded: License not confirmed — subscription journal with no open-access confirmation. Topic: NCI target trial emulation in 12,012 Kaiser Permanente women with CIN2; immediate vs delayed LEEP showed comparable 3-year cancer risk, supporting watchful waiting as a valid strategy for many CIN2 cases. Clinically important paper.)
  2. Valstad H, Fauske L, Wang YY, et al. "Pelvic exenteration for cervical cancer — Oncologic outcome and long-term health-related quality of life, a mixed methods study." Gynecologic Oncology. June 9, 2026. PMID 42263503. https://doi.org/10.1016/j.ygyno.2026.06.001 (Excluded: All rights reserved — Elsevier subscription journal. Topic: Mixed-methods study of 55 patients after pelvic exenteration for recurrent cervical cancer at Oslo University Hospital; 5-year cancer-specific survival was 52%; qualitative interviews revealed persistent ostomy burdens, fatigue, pain, altered body image, and permanent loss of sexual function despite generally preserved standardized HRQoL scores.)
  3. Powell J, Myers JB, Horns JJ, et al. "Treatment-related Risk of Urologic Adverse Events in Cervical Cancer Survivors." Urology. June 14, 2026. PMID 42289201. https://doi.org/10.1016/j.urology.2026.06.016 (Excluded: All rights reserved — Elsevier subscription journal. Topic: Large insurance database study of 96,522 cervical cancer patients; radiation was associated with a 63-fold increased risk of urinary fistula and 23.5-fold increased risk of ureteral complications vs healthy controls — survivorship findings with direct counseling and monitoring implications.)
  4. Yeh YC, Chen SL. "Cancer-related stigma in gynaecological cancers: A mixed-methods systematic review." European Journal of Oncology Nursing. June 29, 2026. PMID 42385537. https://doi.org/10.1016/j.ejon.2026.103260 (Excluded: License not confirmed — Elsevier, no open-access indicator confirmed. Topic: Mixed-methods systematic review of 19 studies showing that stigma in cervical cancer is strongly shaped by associations with sexuality and HPV, leading to shame, self-blame, concealment, and barriers to healthcare engagement; findings call for stigma-sensitive oncology nursing practice.)
  5. Sergison JE, Alspaugh A, Janek S, et al. "Scoping Review of Barriers and Facilitators of Cervical Cancer Screening in Appalachia." Nursing Research. June 9, 2026. PMID 42262378. https://doi.org/10.1097/NNR.0000000000000923 (Excluded: All rights reserved — Wolters Kluwer. Topic: Scoping review of 27 studies identifying structural, interpersonal, and psychosocial barriers to cervical cancer screening among Appalachian women; medical mistrust, cost, transportation, fatalism, and health literacy were central; expanding Medicaid and Title X were identified as key system-level opportunities.)
  6. Lumia C, Fumagalli S, Martinelli M, et al. "Economic incentives for cervical cancer screening: A qualitative study of healthcare professionals' perspectives." Public Health. June 16, 2026. PMID 42302570. https://doi.org/10.1016/j.puhe.2026.106385 (Excluded: All rights reserved — Elsevier. Topic: Qualitative interviews with 24 Italian healthcare professionals; economic incentives for screening were considered acceptable when supporting women's autonomy but raised concerns about dependency, equity, and erosion of intrinsic motivation and provider-patient trust.)
  7. Wolswinkel JT, van Lenthe I, Maurits JSF, et al. "Balancing fertility potential and oncologic and obstetric risks: a vignette study on decision-making in fertility-sparing surgery for early-stage cervical cancer." International Journal of Gynecological Cancer. June 9, 2026. PMID 42385629. https://doi.org/10.1016/j.ijgc.2026.104802 (Excluded: All rights reserved — Elsevier. Topic: Vignette-based study with 58 Dutch patients and 33 gynecologic oncologists; patients placed greater weight on likelihood of pregnancy while oncologists were more deterred by increased cancer-related mortality risk — underscoring the importance of shared decision-making in fertility-sparing surgery.)
  8. Nguyen DTN, Islam R, Qin J, et al. "Cervical cancer burden and elimination readiness in the US-affiliated Pacific Islands: A structured narrative review." Cancer Epidemiology. June 29, 2026. PMID 42372369. https://doi.org/10.1016/j.canep.2026.103144 (Excluded: All rights reserved — Elsevier. Topic: Review showing cervical cancer incidence in US Pacific Island jurisdictions exceeds that of the continental US (17.2 vs 10.8/100,000), with the Republic of the Marshall Islands at 68.9/100,000; treatment capacity severely limited; vaccination coverage has improved but major screening and follow-up gaps remain.)
  9. Mills D, Sridharan S, Govindarajulu G. "Cervical Cancer in Australia: A Radiation Oncology Perspective on Recent Developments, Challenges and Future Directions." Journal of Medical Imaging and Radiation Oncology. June 2, 2026. PMID 42226669. https://doi.org/10.1111/1754-9485.70130 (Excluded: License not confirmed — RANZCR/Wiley, no open-access confirmation. Topic: Review of cervical cancer care in Australia from a radiation oncology perspective, covering HPV vaccination and screening progress, brachytherapy expertise challenges amid falling case volumes, and integration of emerging systemic agents.)
  10. Martínez AG, Gonzalez-Martin A, de Agustin LC. "HPV-related cancer prevention in Spain: progress and remaining challenges in vaccination, screening, and surveillance." Clinical & Translational Oncology. June 6, 2026. PMID 42251231. https://doi.org/10.1007/s12094-026-04447-w (Excluded: License not confirmed — Springer, not confirmed as open access for this article. Topic: Narrative review finding Spain has not yet shown a clear sustained decline in HPV-related cancers comparable to other high-income countries; identifies gaps in vaccination coverage, population-based screening programs, follow-up after abnormal results, and national data integration.)
  11. Adebamowo CA, Canfell K, Adebamowo SN, Soerjomataram I. "Global Cancer Prevention: Current Approaches and Future Directions." ASCO Educational Book. May 26, 2026. PMID 42190157. https://doi.org/10.1200/EDBK-26-519768 (Excluded: Published May 26, 2026 — outside the June 2026 window; license not confirmed. Topic: 2026 ASCO Annual Meeting education session chapter synthesizing global cancer prevention burden, cervical cancer elimination strategies including HPV vaccination and screening, and priority actions for cancer control in Africa.)
  12. Jerip AR, Noni V, Senian AA, et al. "Mismatch Between Vaccine Targets and Endemic HPV Genotypes in Sarawak, East Malaysia." Journal of Medical Virology. June 2026. PMID 42324898. https://doi.org/10.1002/jmv.71010 (Excluded: License not confirmed — Wiley Periodicals, no open-access confirmation. Topic: Cross-sectional study of 1,108 women in Sarawak; bivalent/quadrivalent vaccines cover only 25.4% of high-risk HPV infections while the nonavalent vaccine covers 56.2%; 43.8% of infections were non-vaccine types — a call for surveillance-informed vaccination policy in the region.)
  13. Angelillo S, Miraglia Del Giudice G, Della Polla G, Angelillo IF. "Cervical cancer and screening: Knowledge, attitudes, and adherence among university students in Italy." Human Vaccines & Immunotherapeutics. June 5, 2026. PMID 42246278. https://doi.org/10.1080/21645515.2026.2682535 (Excluded: License not confirmed for this specific article — Taylor & Francis, PMC does not confirm CC license. Topic: Survey of 1,003 Italian university students finding average HPV knowledge score of 12.6/20; only 65.1% of eligible students had undergone cervical cancer screening; healthcare worker communication and HPV vaccination were key drivers of better knowledge and screening uptake.)
  14. Rietz A, Kumari L, Koirala A, et al. "Covalent inhibitors of human papillomavirus type 16 E6 protein restore p53 function and suppress growth of HPV-driven tumors in vivo." Proceedings of the National Academy of Sciences. June 5, 2026. PMID 42247559. https://doi.org/10.1073/pnas.2606213123 (Excluded: CC BY-NC-ND — confirmed by PMC. Topic: Preclinical study demonstrating that small molecule covalent inhibitors of HPV-16 E6 can restore p53 tumor suppressor function, induce apoptosis in HPV-positive cancer cells, and suppress cervical and oropharyngeal cancer xenograft growth — a potentially transformative approach to HPV-driven cancers.)
  15. Liu FY, Sun W, Ding B, et al. "Association between exposure to perfluoroalkyl ether sulfonate F-53B and cervical cancer risk." Ecotoxicology and Environmental Safety. June 18, 2026. PMID 42314419. https://doi.org/10.1016/j.ecoenv.2026.120373 (Excluded: License not confirmed — Elsevier. Topic: Case-control study and preclinical investigation identifying F-53B, an emerging PFAS chemical used as a PFOS substitute, as a potential environmental risk factor for cervical cancer; F-53B induced ferroptosis at high doses and promoted malignant phenotypes at low doses in vitro and in vivo.)
  16. Sajwani N, Suchitha GP, Prasad TSK, Dagamajalu S. "Procaterol Enhances Cisplatin-Induced Cytotoxicity via Apoptosis, Oxidative Stress, and Cell Cycle Arrest in Breast and Cervical Cancer Cells." OMICS. June 19, 2026. PMID 42319352. https://doi.org/10.1177/15578100261459475 (Excluded: License not confirmed — SAGE/Mary Ann Liebert, no open-access confirmation. Topic: Preclinical drug repurposing study showing procaterol, an FDA-approved bronchodilator, sensitized cervical (HeLa) and breast cancer cells to cisplatin through enhanced apoptosis and oxidative stress.)
  17. Liang X, Lu R, Wu S, et al. "Robot-Assisted Radical Trachelectomy With Sleeve Technique for Preventing Postoperative Cervical Adhesion." International Journal of Medical Robotics. June 2026. PMID 42148536. https://doi.org/10.1002/rcs.70186 (Excluded: License not confirmed — Wiley, no open-access confirmation. Topic: Case series of 8 patients undergoing robot-assisted radical trachelectomy with sleeve technique; all resumed menstruation without cervical adhesion, and one achieved live birth; preliminary evidence supporting an anti-adhesion approach for fertility-sparing surgery.)
  18. Lim LM, Speck SL, Zhang Y, et al. "Isolated ovarian metastasis in otherwise cervix-confined adenocarcinoma of the cervix: A rare clinical conundrum." Gynecologic Oncology Reports. May 28, 2026. PMID 42294119. https://doi.org/10.1016/j.gore.2026.102120 (Excluded: Published May 28, 2026 — outside the June 2026 window. Topic: Case report of two patients with early-stage cervical adenocarcinoma and unexpected unilateral ovarian metastasis; both were treated as stage IVA with chemoradiation and pembrolizumab per KEYNOTE-A18 and were disease-free at follow-up.)
  19. Poulain F, Malassigné V, Roncarati P, et al. "Clonal origin and early lineage divergence in adenosquamous carcinoma." Cell Reports. May 28, 2026. PMID 42207638. https://doi.org/10.1016/j.celrep.2026.117470 (Excluded: Published May 28, 2026 — outside the June 2026 window. Topic: Genomic and histopathological analysis of cervical adenosquamous carcinoma showing glandular and squamous components share identical HPV integration and early somatic mutations before diverging independently — providing definitive evidence of clonal origin with early lineage separation.)
  20. Farrukh S, Kavcic N, Canarutto G, et al. "Rethinking residual p53 function in HPV-positive cervical cancer cells." Journal of Virology. May 27, 2026. PMID 42200670. https://doi.org/10.1128/jvi.00479-25 (Excluded: Published May 27, 2026 — outside the June 2026 window. Topic: CRISPR-engineered p53 knockout HeLa cells showed reduced growth, indicating residual p53 in HPV-positive cells has gain-of-function tumor-promoting activities — new model system for understanding HPV-p53 interaction.)
  21. Zheng X, Pan D, Lin J, et al. "Analysis of Pathological Discrepancies Between Colposcopic Biopsy and Conization in Cytology-Positive Cervical Lesions." Cancer Medicine. June 2026. PMID 42219588. https://doi.org/10.1002/cam4.72002 (Excluded: License not confirmed — Wiley/Cancer Medicine, no CC license confirmed. Topic: Retrospective analysis of 1,407 patients finding only 42.7% concordance between colposcopic biopsy and post-conization diagnosis; younger age, low-grade cytology, no glandular involvement, and short biopsy-to-conization intervals were associated with diagnostic downgrading — clinically useful data for pre-treatment counseling.)
  22. Additional papers from the Tier 2 broad sweep with official publication dates in June 2026 but unconfirmed or all-rights-reserved licenses include: Lim JH et al. Preventive Medicine (41887293, March publication date); multiple preclinical and bioinformatics studies of lncRNA and miRNA pathways (42323795, 42319601, 42377617, 42301387, 42370965, 42369471) in Springer, Molecular Biology Reports, and related journals where per-article licensing was unconfirmed; Chen X et al. on LEGH diagnosis (42220308) is included in additional papers above (CC BY confirmed); Busayo SE et al. on Nigerian antenatal women (42192225, Cancer Medicine, Wiley, unconfirmed license); and multiple Tier 2 papers on radiotherapy dosimetry, biomarker discovery, and drug delivery platforms where license was all-rights-reserved or unconfirmed per the protocol criteria.
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