Katherine Y. Tossas

Potential Protective Effect of Statins against High-Grade Squamous Intraepithelial Lesions in Women with Metabolic Comorbidities

Abstract Background: Although human papillomavirus vaccination and Papanicolaou screening have advanced cervical cancer prevention, high-grade squamous intraepithelial lesions (HSIL) remain common, particularly among individuals with metabolic comorbidities such as diabetes and hypercholesterolemia. Statins, commonly used for lipid control, possess anti-inflammatory and antiproliferative properties that may offer protective effects against cervical dysplasia. We explored the association between statin use and lesion grade in a population of patients with dysplasia and whether effects vary by comorbidity and race. Methods: Cross-sectional, observational retrospective analysis of electronic health records and billing data for 2,378 non-Latina/e (nL) Black (nLB) and nL White patients diagnosed with low-grade squamous intraepithelial lesions or HSIL between 2014 and 2021 at a large academic medical center. Logistic regression assessed associations between statin use, comorbidity profiles (diabetes, hypercholesterolemia), race, and HSIL versus low-grade squamous intraepithelial lesions, adjusting for potential confounders. Interaction terms were tested to evaluate effect modification. Results: Statin users had significantly lower odds of HSIL than nonusers (adjusted OR = 0.48, P < 0.0001), despite being older, and having higher comorbidity rates. Predicted HSIL probabilities ranged from 4% to 20% in statin users versus 13% to 29% in nonusers. The lowest risk was observed among patients with diabetes on statins, particularly among nLB patients, suggesting a possible synergistic protective effect in metabolically vulnerable populations. Only 35% of patients with a hypercholesterolemia diagnosis listed were on statins. Conclusions: Statin use was associated with substantially lower HSIL risk, particularly among nLB patients with diabetes. Impact: These findings support further investigation of statins as a potential low-cost chemopreventive tool for cervical dysplasia, especially in populations with metabolic dysfunction.

Establishing a Cervical Cytology Biorepository: A Protocol for Advancing Translational Cervical Cancer Research through Biobanking

Abstract Background: Cervical cancer remains a major global health concern, with disparities in screening access and outcomes, particularly among younger women in the United States. Although high-risk human papillomavirus infection is the primary etiologic factor, nongenetic and environmental contributors remain underexplored. We established the Sacred Womb Cervical Cytology Biorepository to support research on cervical cancer risk, molecular biomarkers, and gynecologic health disparities. Methods: We implemented standardized protocols for the recovery, processing, and long-term storage of residual ThinPrep Papanicolaou (Pap) specimens from women aged 21 to 65 receiving routine gynecologic care across VCU Health outpatient clinics. Core elements included an opt-out consent model, an Institutional Review Board–approved waiver for discarded cytology material, electronic health record linkage for longitudinal clinical data, and workflows for specimen recovery, aliquoting, and processing of pellet and supernatant fractions. Specimens are cryostored at −80°C with quality control checks and secure data governance. Results: The biorepository supports standardized recovery and processing of residual Pap specimens, yielding sufficient postdiagnostic volume and enabling high-quality genomic DNA extraction and metabolomic profiling. Pilot genomic and metabolomic data demonstrate that residual cervical cytology material provides adequate input for multiomic analyses, confirming feasibility and scalability. Conclusions: This protocol outlines a framework for establishing a cervical cytology biobank using residual clinical specimens. The integration of biospecimens with linked clinical and demographic data enables multidimensional research into cervical cancer etiologies and other gynecologic conditions. Impact: This resource supports molecular epidemiology studies aimed at identifying biomarkers, understanding cervical cancer progression, and addressing reproductive health disparities in diverse populations.