Nuno Lunet

The cervical cancer screening program in the North of Portugal: Outcomes after nearly two decades of coexistence with the human papillomavirus vaccine

Abstract As the first vaccinated cohorts are gradually becoming eligible for cervical cancer screening (CCS), changes in the distribution of high‐risk human papillomavirus (hrHPV) infection and associated disease endpoints are expected to occur. We aimed to describe the clinical outcomes of the Regional CCS Program of the North of Portugal in the latest years and to estimate the impact of different hrHPV genotypes on the occurrence of cervical neoplasia. Secondary data collected from the Regional CCS Program of the North of Portugal between January 2019 and December 2024 was used. Descriptive analysis was performed, and the proportion of high‐grade squamous intraepithelial lesion (≥HSIL) attributable to different hrHPV genotypes was estimated. Between January 2022 and December 2024, the prevalence of hrHPV infection was 14.1%, and multiple infections accounted for 28.4% of the cases. Overall, the most prevalent genotypes were HPV‐68 (16.6%), HPV‐52 (14.5%), and HPV‐31 (13.3%). Among the samples that underwent cytological analysis, 14.8% were atypical squamous cells of undetermined significance, 7.2% were low‐grade squamous intraepithelial lesion, and 3.9% were ≥HSIL. Between 2019 and 2024, there was a decrease in the prevalence of the hrHPV genotypes included in the quadrivalent vaccine (17.5%–11.4%), especially in the youngest females, who also experienced a decrease in the frequency of ≥HSIL (6.0%–2.4%). The proportion of ≥HSIL attributable to these hrHPV types decreased from 38.5% to 23.5% in the youngest females, and no significant variations were found for the remaining. This study highlights the considerable reduction of the prevalence of both hrHPV infection and associated cervical abnormalities among the youngest and presumably vaccinated cohorts.

Cervical cancer in Mozambique: Clinical characteristics, treatment and survival of incident cases admitted to the Oncology Service of Maputo Central Hospital in 2016‐2018

AbstractIn Mozambique, cervical cancer is the most frequent cancer in women. However, studies about cervical cancer treatment and prognosis are scarce. We describe the clinical characteristics, treatment and survival of patients with cervical cancer admitted to Maputo Central Hospital (MCH) in 2016 to 2018. Sociodemographic, clinical and cancer‐related data were retrieved from clinical records of patients admitted to the Oncology Service of the MCH with an incident cervical cancer in 2016 to 2018 (n = 407). The Pathology Service database was used to obtain information regarding pathological diagnosis. Survival data was obtained through the MCH Cancer Registry and clinical records. Odds ratios for the association between patients' characteristics and the diagnosis of advanced stage cancer were computed using logistic regression. Survival analyses were performed using the Kaplan‐Meier estimator. A total of 91.2% of the patients were diagnosed with advanced disease (stage IIB‐IV) and squamous cell carcinoma was the predominant histological subtype. Most of the patients underwent chemotherapy (93.1%) but <7% were submitted to surgery, radiotherapy or brachytherapy. Those living with HIV had 3.4‐fold higher odds of advanced disease. Overall survival was 72.7% (95% confidence interval [CI]: 67.9‐77.0) at 1‐year and 51.0% (95%CI: 45.3‐56.3) at 2‐years. Those with early stage (IA‐IIA) and asymptomatic at diagnosis had a significantly higher 2‐year overall survival. In Mozambique, cervical cancer is diagnosed mostly in advanced stages, resulting in poor prognosis. This highlights the importance of HPV vaccination and screening, to decrease the burden of cervical cancer in this context.

How can cervical screening meet the needs of vulnerable women? A qualitative comparative study with stakeholder perspectives from seven European countries

Objective This study explored and compared stakeholder perspectives on enhancements to cervical cancer screening for vulnerable women across seven European countries. Design In a series of Collaborative User Boards, stakeholders were invited to collaborate on identifying facilitators to improve cervical cancer screening. Setting This study was part of the CBIG-SCREEN project which is funded by the European Union and targets disparities in cervical cancer screening for vulnerable women ( www.cbig-screen.eu ). Data collection took place in Bulgaria, Denmark, Estonia, France, Italy, Portugal and Romania. Participants Represented stakeholders at various levels, including user representatives (vulnerable women), healthcare professionals, social workers, programme managers and decision makers. Methods 14 meetings lasting 2 hours each were held in these seven countries between October 2021 and June 2022. The meetings were audio or video recorded, transcribed and translated into English for qualitative framework analysis. Results We engaged 120 participants in the Collaborative User Boards. Proposed solutions targeted both provider and system levels. In all countries, fostering trusting relationships between vulnerable women and social or healthcare professionals, coupled with community outreach for awareness and access to testing was a consistent recommendation. Participants in Estonia, Denmark, France, Italy, Portugal and Romania advocated for tailoring healthcare services to meet the unique needs of vulnerable populations through a holistic approach. In Bulgaria and Romania, participants advocated for the need to secure free access, from screening to follow-up, and emphasised the need for organised screening with target population screening registries. Conclusion The study offers insights into stakeholders' recommendations for enhancing cervical cancer screening services for vulnerable women across seven European countries. Despite variations in the implementation level of population-based screening programmes, the imperative to optimise outreach and proximity work to improve cervical cancer screening resonated across all countries.

What are the barriers towards cervical cancer screening for vulnerable women? A qualitative comparative analysis of stakeholder perspectives in seven European countries

Objectives The aim of this study was to map and compare stakeholders’ perceptions of barriers towards cervical cancer screening for vulnerable women in seven European countries. Design In Collaborative User Boards, stakeholders were invited to participate to identify barriers towards participation in cervical cancer screening. Setting The study is nested in the European Union-funded project CBIG-SCREEN which aims to tackle inequity in cervical cancer screening for vulnerable women ( www.cbig-screen.eu ). Data collection took place in Bulgaria, Denmark, Estonia, France, Italy, Portugal and Romania. Participants Participants represented micro-level stakeholders covering representatives of users, that is, vulnerable women, meso-level stakeholders covering healthcare professionals and social workers, and macro-level stakeholders covering programme managers and decision-makers. Methods Across the seven countries, 25 meetings in Collaborative User Boards with a duration of 2 hours took place between October 2021 and June 2022. The meetings were video recorded or audio recorded, transcribed and translated into English for a qualitative framework analysis. Results 120 participants took part in the Collaborative User Boards. Context-specific barriers were related to different healthcare systems and characteristics of vulnerable populations. In Romania and Bulgaria, the lack of a continuous screening effort and lack of ways to identify eligible women were identified as barriers for all women rather than being specific for women in vulnerable situations. The participants in Denmark, Estonia, France, Italy and Portugal identified providers’ lack of cultural and social sensitivity towards vulnerable women as barriers. In all countries, vulnerable women’s fear, shame and lack of priority to preventive healthcare were identified as psychological barriers. Conclusion The study provides an overview of stakeholders’ perceived barriers towards vulnerable women’s cervical cancer screening participation in seven European countries. The organisation of healthcare systems and the maturity of screening programmes differ between countries, while vulnerable women’s psychological barriers had several similarities.