Cancer Causes & Control

The impact of body mass index and physical disability on home-based anal self-sampling

Self-sampling is increasingly being used in screening programs, yet no studies to date have examined the impact of bodily characteristics on self-sampling experiences. Our objective was to assess whether body mass index (BMI) and physical disability were associated with anal self-sampling difficulty. We recruited sexual minority men (SMM) and trans persons in Milwaukee, Wisconsin to participate in an anal cancer screening study. Between January 2020 and August 2022, 240 participants were randomized to a home (n = 120) or clinic (n = 120) screening arm. Home participants received a mailed at-home anal self-sampling kit and were asked to attend a baseline clinic visit where biometric measurements were collected. Participants were asked to complete a survey about their experience with the kit. This research utilized data from participants who used the at-home kit and completed a baseline clinic visit and post-swab survey (n = 82). We assessed the impact of BMI and physical disability on reported body or swab positioning difficulty. Most participants reported no or little difficulty with body positioning (90.3%) or swab positioning (82.9%). Higher BMI was significantly associated with greater reported difficulty with body positioning (aOR = 1.10, 95% CI 1.003-1.20, p = 0.04) and swab positioning (aOR = 1.11, 95% CI 1.02-1.20, p = 0.01). Although not significant, participants who said body positioning was difficult had 2.79 higher odds of having a physical disability. Specimen adequacy did not differ by BMI category (p = 0.76) or physical disability (p = 0.88). Anal self-sampling may be a viable option to reach obese persons who may be more likely to avoid screening due to weight-related barriers.

Determinants of first-line clinical trial enrollment among Black and White gynecologic cancer patients

Abstract Purpose Disparities in gynecologic cancer clinical trial enrollment exist between Black and White patients; however, few examine racial differences in clinical trial enrollment predictors. We examined whether first-line clinical trial enrollment determinants differed between Black and White gynecologic cancer patients. Methods We used the National Cancer Database to identify Black and White gynecologic cancer (cervix, ovarian, uterine) patients diagnosed in 2014–2020. Multivariable logistic regression was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for associations between clinical trial enrollment (yes vs no) and sociodemographic, facility, tumor, and treatment characteristics stratified by race. We included a multiplicative interaction term between each assessed predictor and race to test whether associations differed by race. Results We included 703,022 gynecologic cancer patients (mean [SD] age at diagnosis, 60.9 [13.1] years). Clinical trial enrollment was lower among Black (49/86,058, 0.06%) vs. White patients (710/616,964, 0.11%). Only cancer site differed by race: among Black patients, a cervical vs. uterine cancer diagnosis (OR = 4.63, 95% CI = 1.67–12.88) was associated with higher clinical trial enrollment odds, while among White patients, both cervical (OR = 2.21, 95% CI = 1.48–3.29) and ovarian (OR = 3.40, 95% CI = 2.58–4.47) cancer diagnoses (vs. uterine cancer) were associated with higher enrollment odds. Most predictors were associated with clinical trial enrollment odds among White but not Black patients. Conclusion Few differences in first-line clinical trial enrollment predictors exist between Black and White gynecologic cancer patients. Although small numbers of Black patients and low clinical trial prevalence are limitations, this descriptive analysis is important in understanding racially disparate clinical trial enrollment.

Changes in cervical cancer stage at diagnosis in Zambia over 15 years

Zambia implemented a national cervical cancer screening program in 2006, and in 2016 launched the country's first National Cancer Control & Prevention Plan. This study explored the hypothesis that the proportion of cervical cancer patients diagnosed at a late stage decreased from 2008 to 2022, with these policies. This study included data of 5775 cervical cancer patients seen at the Cancer Diseases Hospital (CDH) in Lusaka, Zambia, between 2008 and 2022. We evaluated the stage at diagnosis over three time periods (2008-2012, 2013-2017, 2018-2022). Regression analysis identified the predictors of late-stage presentation. The proportion of late-stage diagnosis (Stages III and IV) decreased during 2013-2017 compared to the late stages during 2008-2012 (OR: 0.60, 95% CI: 0.49-0.73). Subsequently, the proportion of late-stage diagnoses increased from 2018-2022 compared to 2013-2017 (OR: 1.25, 95% CI: 1.04-1.49), which contradicted our initial hypothesis. Women who were divorced or widowed, unemployed, and lived in provinces distant from Lusaka were more likely to present with late-stage diagnoses, irrespective of the time period. Although there was an initial decrease in late-stage diagnoses from 2008-2012 compared to 2013-2017, the trend reversed from 2018 to 2022. The increase in the proportion of late-stage presentations from 2018 to 2022 is likely due to low screening uptake and poor sensitivity of screening. Increasing the accessibility and availability of cervical cancer treatment, and educating the vulnerable groups about the importance of screening, may lead to early detection and downstaging in Zambia and other low-income countries.

Cervical cancer screening rates in females living with HIV at three healthcare settings in the United States, 2010–2019

Females living with human immunodeficiency virus (FLWHIV) are at increased risk of cervical cancer and U.S. guidelines, first published in 2009 and updated since then, recommend more frequent screening in this population. We examined screening rates among FLWHIV in the U.S. during 2010-2019. This cohort study included 18-89-year-old FLWHIV during 2010-2019 at three U.S. healthcare settings. Sociodemographics, comorbidities, and cervical cancer screening tests were ascertained from administrative and clinical databases. We reported cervical cancer screening rates overall and by modality. Generalized estimating equations with Poisson distribution were used to estimate screening rate ratios (SRRs) and 95% confidence intervals (CIs) for the associations between screening rates and calendar year, age, race and ethnicity, and comorbidity. Among 3,556 FLWHIV, a total of 7,704 cervical cancer screening tests were received over 18,605 person-years during 2010-2019 (screening rate = 41.4 per 100 person-years). Relatively lower screening rates were associated with later calendar years (SRR = 0.71 [95% CI 0.68-0.75] for 2017-2019 versus 2010-2013), older age (SRR = 0.82 [95% CI 0.74-0.89] for 50-65-year-olds versus 18-29-year-olds), non-Hispanic white race versus non-Hispanic Black race (SRR = 0.89 [95% CI 0.81-0.98]) and greater comorbidity burden (SRR = 0.89 [95% CI 0.82-0.98] for ≥ 9 versus 0-6 comorbidity score). The decrease in cervical cancer screening rates during 2010-2019 in this large cohort of FLWHIV may be explained at least partly by guideline changes during the study period recommending longer screening intervals. Our findings of relatively lower screening rates in FLWHIV who were non-Hispanic white, older, and with greater comorbidity burden should be confirmed in other U.S.

The impact of human papillomavirus vaccination implementation in reducing cervical cancer in a heterosexual population

Human papillomavirus remains a leading cause of cervical cancer globally, particularly affecting women in low- and middle-income countries. A gender-stratified deterministic compartmental model is formulated to assess the impact of HPV vaccination on cervical cancer dynamics in a heterosexual population. The model stratifies individuals into vaccinated, exposed, infectious, cancer, treated, and recovered compartments, and simulations are conducted using epidemiological data from Poland. Results show that the basic reproduction number is greater than one under current epidemiological HPV vaccination policy, resulting in persistent transmission, but reduces below unity when male vaccination coverage is included and expanded. The disease-free equilibrium becomes stable under these enhanced coverage levels, and a forward bifurcation is observed, confirming that elimination can be achieved without complex threshold behavior. Sensitivity analysis identifies transmission rates, vaccine efficacy, and male vaccination rates as the parameters most strongly influencing HPV spread. The findings demonstrate that including males in national HPV immunization programs substantially enhances the reduction of secondary infections and accelerates progress toward disease elimination.

Preferences of High-Risk HPV-Based Cervical Cancer Screening among Transgender Men and Gender Diverse People Assigned Female at Birth: A Cross-Sectional Study at a Single Academic Center

The purpose of this study was to evaluate the willingness of gender diverse people assigned female at birth with a cervix for different high-risk HPV (hrHPV) methods of cervical cancer screening (CCS). We examined provider-collected hrHPV, at-home, self-collected hrHPV, and in-clinic, self-collected hrHPV, as well as their impact on gender dysphoria and screening barriers. This cross-sectional survey study was conducted in 2024 among transgender men, non-binary, genderqueer, and agender individuals at a single academic medical center. Data from 123 participants included demographics, gender dysphoria, screening barriers, past experiences, and willingness to receive hrHPV testing. Statistical analyses identified differences in gender dysphoria, barriers to CCS, past Pap test experiences, and hrHPV testing preferences via logistic regression analyses. Most transgender men (63%) preferred at-home, self-collected hrHPV, and 37% of transgender men were unwilling to provider-collected hrHPV. Gender diverse people with gender dysphoria preferred at-home, self-collected hrHPV (60%), while those without gender dysphoria preferred alternating at-home, self-collected and provider-collected hrHPV (38%). Logistic regressions showed 78% (p < 0.005) and 53% (p < 0.001) lower odds of provider-collected hrHPV for those with gender dysphoria and screening barriers, respectively. Our findings showed that the concealment of procedural steps (Adjusted Odds Ratio = 0.01, p < 0.02), use of gendered language (AOR = 0.17, p < 0.01), and misgendering (AOR = 0.31, p < 0.05) reduced the willingness to undergo provider-collected hrHPV. However, these experiences did not show a difference between self-collected hrHPV testing methods. This is one of the largest U.S. studies assessing the preferences for hrHPV testing among gender diverse people. Our findings emphasize that transgender men prefer at-home, self-collected hrHPV, which can reduce gender dysphoria and screening barriers. This underscores the need for patient-centered screening and gender-inclusive care to help reduce disparities in CCS among gender diverse people.

Symptom attributions by cervical cancer patients attending specialized care at the Uganda cancer institute: a cross-sectional study

Most women in the low- and middle-income countries who develop cervical cancer are diagnosed at advanced stages following symptomatic presentations to healthcare professionals. This study sought to describe the symptoms experienced, symptoms' attributions, and factors associated with the perceived causes of the symptoms among a cohort of cervical cancer patients. This was a cross-sectional study conducted at the Uganda Cancer Institute (UCI) during October 2019 to January 2020. Data were collected using a pre-tested semi-structured questionnaire and a data abstraction form for clinical variables in the patients' case notes and analyzed using STATA version 15.0. We used modified Poisson regression models with robust variance to determine socio-demographic and clinical characteristics associated with perceived causes of symptoms. We report prevalence ratios with accompanying 95% confidence intervals. Prevalence ratios were considered statistically significant when the two-sided p values < 0.05. We collected data from 449 participants, with a median age of 49.0 (IQR = 42-58). More than half of the participants, 59.2% (n = 266) were diagnosed with early-stage (stages 1/2) cancer. Most participants recognized risk factors for cervical cancer as using hormonal family planning 91.3% (n = 410) and having many sexual partners 89.1% (n = 400). Initial symptoms experienced by the patients included vaginal discharge 78.6% (n = 353) and vaginal bleeding in between monthly periods, 48.3% (n = 217). More than half of the patients, 57.2% (n = 257) thought the symptoms experienced were due to sexually transmitted infections (STI), while only 5.6% (n = 25) of patients thought the initial symptoms were due to cancer. The socio-demographic factors significantly associated with the perceptions that symptoms were due to STIs included having formal education, i.e., secondary and tertiary levels of education with adjusted prevalence ratios (aPR) = 1.84(95% CI: 1.38-2.47) and aPR = 1.71(95% CI: 1.20-2.42), respectively, and being formally employed aPR = 1.19 (95% CI: 1.00-1.40). Women ought to be aware that cervical cancer may present as vaginal discharge or vaginal bleeding in between menstrual periods and should therefore seek care promptly when they develop such symptoms. Primary healthcare physicians need to avoid empirical treatment of every woman with vaginal discharge but rather conduct careful evaluations to properly assess the cervix for diagnoses.

The role of community health workers (CHWs) in improving cervical cancer screening rates and access to treatment in underserved US populations: a scoping review

The purpose of this study is to explore the impact CHWs have in increasing access to cervical cancer screening and treatments for underserved US women while examining the importance of utilizing culturally tailored theoretical frameworks and evidence-based strategies in the design and delivery of the CHW-led interventions. The five-step process outlined by Arksey and O'Malley as well as the recommendations from the Joanna Briggs Institute (JBI) was used for the data extraction, analysis, and presentation of the results. A total of 12 eligible studies published between 2002 and 2023 were retained for analysis. Across all studies, the role of the CHWs led to successful cervical cancer screening interventions as well as improved knowledge levels on pap smears and cancer prevention in underserved US female communities. Barriers experienced by CHWs and underserved women were sorted into the five levels of the socio-ecological (SEM) model. Several theoretical frameworks were used, including the social cognitive theory, the health belief model, the theory of reasoned action (n = 2), the transtheoretical model (n = 1), the Popular Education Theory (n = 1), and the Social Marketing Theory. Major themes were identified qualitatively across studies using thematic analysis regarding monitoring patients, clinical processes, generalizability of study results, and cultural sensitivity. Findings highlight that providing culturally tailored CHW-led interventions improves informed decision-making by underserved US women surrounding cervical cancer screenings and treatment. Our review provides recommendations to strengthen the impact of CHWs on cervical cancer screenings and treatment in underserved US populations.

Perceived discrimination, trust in physicians, and their associations with ovarian cancer mortality among women in the African American Cancer Epidemiology Study

Abstract Purpose Black women are 30% more likely to die of ovarian cancer than White women. Discrimination may affect cancer health disparities through pathways including socioeconomic disadvantage, chronic stress, and access to care. In this study, we evaluated associations of discrimination and trust in physicians with all-cause mortality among Black women with ovarian cancer. Methods Using data from the African American Cancer Epidemiology Study (AACES), we included 592 Black ovarian cancer patients who completed an interview. Discrimination and trust in physicians were measured using the Everyday Discrimination, Major Experiences of Discrimination, and Trust in Physicians scales, respectively. We used Cox proportional hazard models to compute multivariable-adjusted hazard ratios (HR) and 95% confidence intervals (CIs) associating everyday discrimination, major experiences of discrimination, and trust in physicians with all-cause mortality. Results Approximately 43% reported experiencing at least one major experience of discrimination, 16% reported high everyday experiences of discrimination, and the median trust in physician score was 35. The association between higher experiences of everyday discrimination was HR = 0.84 (95% CI: 0.63, 1.11), compared with low experiences of everyday discrimination. We observed that more major experiences of discrimination had 1.25-times the mortality rate compared with low experiences of major discrimination (95% CI: 0.84, 2.20). Higher trust in physicians was associated with slightly lower mortality rates (HR = 0.91, 95% CI: 0.74, 1.14). Conclusion We observed complexities in the relationships of everyday discrimination, major experiences of discrimination, and trust in physicians with mortality among Black women with ovarian cancer. Future work to understand the these relationships is likely warranted.

Positive predictive value of cervical cancer screening results recommended for colposcopy by human papillomavirus vaccination status at 3 U.S. healthcare systems

The positive predictive value (PPV) of cervical cancer screening was projected to decrease in the era of human papillomavirus (HPV) vaccination. We conducted a retrospective cohort study at three U.S. healthcare systems during 2010-2018. Females aged 21-38 years with an abnormal cervical cancer screening test result for which colposcopy was guideline-recommended were included. We estimated age-specific PPVs of cervical intraepithelial neoplasia grade 2 or more severe diagnosis (≥ CIN 2) in HPV-vaccinated and unvaccinated females. The age-specific PPV point estimates were lower in vaccinated versus unvaccinated females in each age group (21-24; 25-29; and 30-38 years), but the difference was statistically significant only among 25-29-year-olds (PPV = 16.4% [95% CI (confidence interval), 14.6-18.4%] and PPV = 19.8% [95% CI 18.5-21.1%], respectively). Among vaccinated 25-29-year-olds, the PPV was lower in those who received their first dose at ≤ 20 versus > 20 years of age (PPV = 12.1% [95% CI 9.5-15.2%] and PPV = 18.8% [95% CI 16.4-21.4%], respectively). Among all age groups combined, the PPV was lower in vaccinated versus unvaccinated females. Our findings suggest that among females with a cervical test result recommended for colposcopy, the PPV for ≥ CIN2 was lower in those vaccinated versus unvaccinated, and was relatively lower in those vaccinated at younger ages. Future studies will have greater ability to estimate the impact of vaccination at the recommended age (9-12 years) on the PPV as more recent birth cohorts, who had greater vaccine uptake, age-in to screening eligibility.

Perspective of females from a rural community in India toward the knowledge, screening, and treatment of breast and cervical cancer and preventive vaccination

The success of a preventive oncology program depends upon the general population's awareness of the disease, its magnitude, and the screening and prevention process. Our study aimed to analyze the situational awareness of a rural community population toward the most common cancers in females. We conducted a cross-sectional study in the rural Indian community of Uttarakhand, recruiting 589 participants from Pauri Garhwal. We developed a questionnaire comprising sociodemographic information, knowledge of the disease, early detection, and the attitude toward breast and cervical cancer treatment. We also registered the participant's knowledge and enthusiasm toward vaccination against cervical cancer. Local non-governmental organization (Uttarakhand Manav Seva Samiti, Delhi) collaborated to conduct door-to-door interviews. Among the participants, 38% and 79% had never heard about breast and cervical cancer, respectively. A limited understanding of various signs and symptoms of breast cancer varying from 14% to 50% was noted. Only 36.1% (132) and 11.5% (42) of the participants had heard about breast cancer and were aware of breast examination and mammography, including its utility in diagnosing early breast cancer. Similarly, the knowledge about various signs and symptoms of cervical cancer varied from 11 to 55% among the participants. Only 6.5% of them have heard about preventive vaccination. Encouraging results of the study were that nearly 57% and 56% of the participants expressed eagerness to participate in cancer screening programs. Participants who were Younger (< 40 years) and had more years of education had significantly higher levels of knowledge about and positive attitudes toward breast and cervical cancers. A grim lack of awareness in the rural community has been observed regarding breast and cervical cancers and preventive vaccination. Strengthening educational activities in the rural community against these cancers seems to be an indispensable step toward a preventive oncology program.

Estimated health outcomes of breast cancer screening in the national breast and cervical cancer early detection program by race/ethnicity

To estimate the number of screenings received, life-years (LYs) saved, and number of screenings per LY saved per woman who participated in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) (Program) compared with those who did not participate (no Program). We developed a time-to-event simulation model to compare the outcomes of women participating in the Program vs. no Program, categorized by race/ethnicity. Model input parameters included data from the Program's minimum data elements, United States Cancer Statistics, National Health Interview Survey, and published literature. The Program's impact was calculated as the difference in LYs between the Program and no Program using data from 2010 to 2019. Among 1 million women of all races/ethnicities who participated in the NBCCEDP in the last 10 years, 457,152 (standard deviation [SD]: 848) received more screenings than those who did not participate. These participants saved an average of 0.027 LYs per woman screened. In addition, we estimated that about 17 screenings would be required to save an additional 1 LY per woman screened in the Program compared with no Program. Per woman screened by race/ethnicity, non-Hispanic Black women had the highest estimated 0.075 LYs saved, followed by Hispanic women with 0.025 LYs, non-Hispanic White with 0.014 LYs, and non-Hispanic American Indian/Alaska Native and Asian/Pacific Islander had the least health outcome with 0.011 LYs. The reported findings underscore the importance of providing preventive health services to populations that might not otherwise have access to these services.

Utilization and outcomes of serial cervical cancer screening in a National Breast and Cervical Cancer Early Detection Program (NBCCEDP) in a non-Medicaid expansion state

Since 1990, the Centers for Disease Control and Prevention's National Breast and Cervical Cancer Early Detection Program (NBCCEDP) has offered free cervical cancer screening to low-income, uninsured patients, increasing single time point screening and early detection rates. Little is known about NBCCEDP's longitudinal effectiveness. The objective of this study was to assess utilization of Kansas's NBCCEDP, early detection works (EDW) for one-time versus serial screening and compare rates of cervical dysplasia between groups. A retrospective cohort study was conducted among patients who received cervical cancer screening through EDW from 2001 to 2021. Demographic factors, Papanicolaou (Pap) test, and human papillomavirus (HPV) results were compared between patients with one screening versus multiple. Descriptive statistics were performed. From 2014 to 2021, 3.71-7.06% of eligible patients completed screening through EDW annually. 17.4% of 58,582 eligible patients were up-to-date with screening in 2020. Rural patients and those under age forty were less likely to have EDW screening. Of 43,916 ever-screened patients, 14,638 (33.3%) received multiple screenings. 77% of patients did not have HPV testing; rates were lower in serially screened patients. Cervical dysplasia rates differed minimally between groups. Despite screening 24,017 patients over 7 years, EDW maintains up-to-date screening for under one-fourth of eligible Kansans. Young and rural patients less frequently access EDW. HPV testing is underutilized, which limits the negative predictive value of screening. Serial screening is largely used by low-risk patients currently. Identification and prioritization of serial screening in high risk could increase program impact.

Associations of social support, living arrangements, and residential stability with cancer screening in the United States

Social support has been linked to increased use of preventive care services. Living arrangements and residential stability may be important structural sources of social support, but few studies have examined their impact on cancer screening. Data were from the 2021 National Health Interview Survey. Participants were classified as up-to-date or not with female breast cancer (BC), cervical cancer (CVC), and colorectal cancer (CRC) screening recommendations. Multivariable logistic regression was used to model associations between screening and residential stability ( 20 years), living arrangement (with spouse/partner only, children only, both, or neither), and perceived social support (rarely/never, sometimes, usually, or always available), overall and stratified by sex (CRC) and age group (CVC). The adjusted odds of BC (odds ratio [OR]  0.61, 95% CI 0.45-0.81) and CVC (OR 0.76, 95% CI 0.60-0.96) screening were lowest for those who reported never/rarely vs. always having social support. The adjusted odds of BC (OR 1.44, 95% CI 1.22-1.70) and CRC (OR Social support measures were associated with screening to varying degrees by site and age, but higher perceived social support and living with a spouse/partner only demonstrated a consistent positive association. Interventions that mobilize social support networks and address the unmet social needs of parents/caregivers may improve cancer control.

Association between the social vulnerability index and breast, cervical, and colorectal cancer screening rates in Rhode Island

Cancer screening is effective in reducing the burden of breast, cervical, and colorectal cancers, but not all communities have appropriate access to these services. In this study, we aimed to identify under-resourced communities by assessing the association between the Social Vulnerability Index (SVI) with screening rates for breast, cervical, and colorectal cancers in ZIP-code tabulation areas (ZCTAs) in Rhode Island. This study leveraged deidentified health insurance claims data from HealthFacts RI, the state's all-payer claims database, to calculate screening rates for breast, cervical, and colorectal cancers using Healthcare Effectiveness Data and Information Set measures. We used spatial autoregressive Tobit models to assess the association between the SVI, its four domains, and its 15 component variables with screening rates in 2019, accounting for spatial dependencies. In 2019, 73.2, 65.0, and 66.1% of eligible individuals were screened for breast, cervical, and colorectal cancer, respectively. For every 1-unit increase in the SVI, screening rates for breast and colorectal cancer were lower by 0.07% (95% CI 0.01-0.08%) and 0.08% (95% CI 0.02-0.15%), respectively. With higher scores on the SVI's socioeconomic domain, screening rates for all three types of cancers were lower. The SVI, especially its socioeconomic domain, is a useful tool for identifying areas that are under-served by current efforts to expand access to screening for breast, cervical, and colorectal cancer. These areas should be prioritized for new place-based partnerships that address barriers to screening at the individual and community level.

Improving cervical cancer continuum of care towards elimination in Ethiopia: a scoping review

Cervical cancer is the second-leading cause of death among all cancers in Ethiopia. Ethiopia plans to eliminate cervical cancer as a public health problem by 2030, following the World Health Organization's call for action. A scoping review was conducted on the status of the cervical cancer continuum towards elimination in Ethiopia. We searched articles in PubMed, Scopus, and Google Scholar. All studies conducted on cervical cancer in Ethiopia, from first date of publication to March 15, 2023, type of article, or language of publication, were included. However, conference abstracts, commentaries, and letters to the editors were excluded. We used EndNote X9 software to merge articles from different databases and automatically remove duplicates. Screening of titles, abstracts, and full texts was performed independently by two co-authors. The cancer care continuum was employed as a framework to guide data synthesis and present the findings. Of the 569 retrieved articles, 159 were included in the review. They found that most of the articles focused on knowledge, attitude, and practice. However, there were few studies on health-seeking behavior, perception and acceptability of cervical cancer services, as well as the availability and readiness of a screening program. The review identified inadequate knowledge, attitude, and perception about cervical cancer, and highlighted that screening for cervical cancer is not widely utilized in Ethiopia. Knowledge, attitude, education status, and income were repeatedly reported as precursors influencing cervical cancer screening. Most studies concluded that there is a high prevalence of precancerous lesions and cervical cancer, as well as high mortality rates or short survival times. The review also identified significant heterogeneity in findings across time and geographic settings within each component of the cancer care continuum. Overall, there is inadequate knowledge, perception, health-seeking behavior, screening, and treatment services, indicating that the country is falling behind its targets in eliminating cervical cancer, despite the availability of effective interventions and tools. We argue that implementation research is necessary to identify implementation issues, challenges, and strategies to scale up both primary and secondary prevention services. By doing so, Ethiopia can address cervical cancer as a public health problem and work towards its elimination.

Intervention recommendations to improve uptake of breast, cervical, and colorectal cancer screening among individuals living with serious mental illness

Few efforts have been made to inform intervention design for increasing the uptake of cancer screening in individuals living with serious mental illness (ILSMI), who have lower cancer screening rates than the general population. This qualitative study explored ILSMI's and their care team member's (CTM) recommendations on the design of a breast, colorectal, and cervical cancer screening intervention for ILSMI. Twenty-five ILSMI (mean age: 71.4 years; 60% female) and 15 CTM (mean age: 45.3 years; 80% female) were recruited through purposive sampling. Semi-structured in-depth interviews were used to collect participants' intervention suggestions. Interviews were recorded, transcribed verbatim, and imported into NVivo. Content analysis and the constant comparison method were used to analyze interview data. ILSMI and CTMs provided several salient recommendations. ILSMI should receive disease-specific, logistical, and screening education, and primary care staff should receive education on psychopathology. Mental health providers and patient navigators should be considered as the primary interventionist. The intervention should be delivered where ILSMI receive medical or mental health services, receive community and government services, and/or via various digital media. The intervention should improve the collaboration, communication, and coordination between primary and mental health care. Findings also pointed to the implementation of trauma-informed cancer care and integrated care models comprising mental health care and primary cancer care. These findings bring the skills, knowledge, and expertise of ILSM and their care team to intervention design for increasing colorectal, breast, and cervical cancer screening in ILSMI attending an intensive outpatient program.

Persistent cervical cancer disparities among American Indian/Alaska Native women: a systematic scoping review exploring the state of the science in this population

American Indian/Alaska Native (AI/AN) populations experience significantly higher incidence and mortality rates of cervical cancer. The objective of this systematic scoping review is to characterize the volume and nature of research being conducted specific to the AI/AN population regarding cervical cancer and related clinical themes. This scoping review was conducted in collaboration with the Pacific Northwest Evidence-based Practice Center. Search strategies identified eligible publications from 1990 through 4 February 2022. Two reviewers independently abstracted study data, including clinical area, number of participants and percent inclusion of AI/AN, intervention or risk factor, outcomes reported, Indian Health Service (IHS) Region, and funding source. We used published algorithms to assess study design. Database searches identified 300 unique citations. After full-text evaluation of 129 articles, 78 studies and 9 secondary publications were included (total of 87). Approximately 74% of studies were observational in design, with cross-sectional methodology accounting for 42.7% of all included studies. The most common clinical theme was cervical cancer screening. The most common intervention/exposure was risk factor, typically race (AI/AN compared with other groups) (69%). For studies with documented funding sources, 67% were funded by the US Government. Of the small number of publications identified, the majority are funded through government agencies, are descriptive and/or cross-sectional studies that are hypothesis generating in nature, and fail to represent the diversity of the AI/AN populations in the US. This systematic scoping review highlights the paucity of rigorous research being conducted in a population suffering from a greater burden of disease.

Estimating uninsured and underinsured women eligible for Minnesota’s Breast Cancer Screening Program

Since its inception in 1991, the mission of the National Breast and Cervical Cancer Early Detection Program's (NBCCEDP) mission is to improve access to mammography. This program has demonstrated evidence showing that it has improved breast cancer screening rates for women who are uninsured and underinsured. However, the literature has shown that NBCCEDP screenings are decreasing, and only reach a portion of eligible women. Reliable estimates at the sub-county level are needed to identify and reach eligible women. Our work builds upon previous estimates by integrating uninsured and insurance status into spatially adaptive filters. We use spatially adaptive filters to create small area estimates of standardized incidence ratios describing the utilization rate of NBCCEDP services in Minnesota. We integrate the American Community Survey (2010-2014) insurance status data to account for the percentage that an individual is uninsured. We test five models that integrate insurance status by age, sex, and race/ethnicity. Our composite model, which adjusts for age, sex, and race/ethnicity insurance statuses, reduces 95% of the estimation error. We estimate that there approximately 49,913.7 women eligible to receive services for Minnesota. We also create small geography (i.e., county and sub-county) estimates for Minnesota. The integration of the insurance data improved our utilization estimate. The development of these methods will allow state programs to more efficiently use their resources and understand their reach.

Utilization of opportunistic cervical cancer screening in Nigeria

While various interventions have been conducted to decrease cervical cancer's burden in Nigeria, no study has examined the trends in cervical cancer screening uptake over time. The present study sought to fill this gap in knowledge using data collected at Jos University Teaching Hospital (JUTH) in Nigeria. Data collected continuously between 2006 and 2016 were analyzed to identify trends in screening uptake, changes in risk factors for cervical cancer, and to identify factors for women screened at Jos University Teaching Hospital (JUTH) in Jos, Nigeria. Categorical analyses and logistic regression models were used to describe patient characteristics by year, and to identify factors associated with repeated screening uptake. A total of 14,088 women who were screened between 2006 and 2016 were included in the database; 2,800 women had more than one screening visit. Overall, screening uptake differed significantly by year. On average women were first screened at age 38. About 2% of women screened were women living with HIV. Most women (86%) had normal pap smear at first screening, with the greatest decreased risk of abnormalities observed between 2011 and 2014. Odds of a follow-up screening after a normal result decreased significantly between 2008 and 2016 compared to women screened in 2006 and 2007. Finally, women living with HIV had increased odds of follow-up screening after having a normal pap smear. These findings contribute to our understanding of the potential social and health system barriers to cervical cancer control in Nigeria. The findings may assist policy makers to design interventions to increase access and compliance to recommended screening schedules in this vulnerable population.

Associations between sociodemographic factors and breast, cervical, and colorectal cancer screening in the United States

Cancer is the second leading cause of death globally and in the U.S., but screening can reduce cancer-related deaths. We analyzed data from a nationwide survey to compare how sociodemographic factors were associated with never or not timely screening for multiple types of cancer, and the use of different colorectal cancer screening procedures. We analyzed data from the 2019 U.S. National Health Interview Survey. To understand breast, cervical, and colorectal cancer screening participation among those recommended to screen, we respectively analyzed 8,110 women 45 to 74 years of age, 9,583 women 21 to 65 years of age, and 13,497 individuals 50 to 75 years of age at survey. Weighted Poisson regression was used to estimate the unadjusted and confounding-adjusted prevalence ratio and 95% confidence intervals. In our analysis populations, 6.9% never had a mammogram, 14.6% never screened for cervical cancer, and 26.8% never screened for colorectal cancer; the prevalence respectively increased to 24.7%, 23.8%, and 32.3% for not timely screening according to national guidelines. The prevalence of never screening was 81.9% for non-invasive colorectal cancer tests, compared with 32.5% for colonoscopy or sigmoidoscopy. Individuals with lower education level, with no health insurance, or in poverty had higher prevalence of never screening for all three cancers. There was low sociodemographic disparity for the use of non-invasive colorectal cancer screening tests. Socioeconomically disadvantaged individuals have higher prevalence of never or not timely screening. The utilization of non-invasive colorectal cancer screening procedures remains low across sociodemographic groups.

Gestational weight gain and risk of epithelial ovarian cancer

To examine the association between (GWG) and epithelial ovarian cancer (EOC). We compared GWG between 670 incident EOC cases and 1,551 community controls from a population-based, case-control study conducted in Pennsylvania, Ohio, and New York from 2003 to 2008. Multivariable unconditional logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) associated with GWG adjusting for potential confounders. To explore the potential effect of maternal long-term weight retention after childbearing, we restricted analyses to women who began their childbearing years as normal/underweight and examined differences in EOC risk between those who were normal/underweight versus those who were overweight/obese at study baseline reference date. Average GWG per full-term pregnancy did not differ between cases and controls. Among women who were normal/underweight at study baseline, greater average GWG was not associated with EOC (OR = 0.9, 0.8, 0.7 for quartiles 2, 3 and 4 of GWG gain, respectively, compared to quartile 1). In contrast, among women who were overweight/obese at study baseline, greater average GWG was positively associated with EOC (OR = 1.4, 1.8, 1.2, for quartiles 2, 3, and 4 compared to quartile 1; interaction p = 0.04). We posit that maternal post-partum weight retention and not gestational weight gain itself among normal/underweight women may impact subsequent risk of EOC. If our hypothesis is supported in other studies designed to assess this question directly, then counseling women on the importance of healthy weight management after a pregnancy could provide another means to help women reduce their risk of this often-fatal malignancy.

Variation in hysterectomy prevalence and trends among U.S. States and Territories—Behavioral Risk Factor Surveillance System, 2012–2020

We estimated up-to-date state- and territory-level hysterectomy prevalence and trends, which can help correct the population at risk denominator and calculate more accurate uterine and cervical cancer rates. We analyzed self-reported data for a population-based sample of 1,267,013 U.S. women aged ≥ 18 years who participated in the Behavioral Risk Factor Surveillance System surveys from 2012 to 2020. Estimates were age-standardized and stratified by sociodemographic characteristics and geography. Trends were assessed by testing for any differences in hysterectomy prevalence across years. Hysterectomy prevalence was highest among women aged 70-79 years (46.7%) and ≥ 80 years (48.8%). Prevalence was also higher among women who were non-Hispanic (NH) Black (21.3%), NH American Indian and Alaska Native (21.1%), and from the South (21.1%). Hysterectomy prevalence declined by 1.9 percentage points from 18.9% in 2012 to 17.0% in 2020. Approximately one in five U.S. women overall and half of U.S. women aged ≥ 70 years reported undergoing a hysterectomy. Our findings reveal large variations in hysterectomy prevalence within and between each of the four census regions and by race and other sociodemographic characteristics, underscoring the importance of adjusting epidemiologic measures of uterine and cervical cancers for hysterectomy status.

Rural women choose self-sampling over a pelvic exam for cervical cancer screening: a mixed-method study

Abstract Background Barriers to cervical cancer screening are significantly higher among US rural populations. To understand these barriers and explore potential remedies, we compare perceptions of screening exam techniques, pelvic exam vs. self-sampling, and how perceptions vary by participants’ beliefs, physician characteristics, and known barriers among under-screened rural people in Michigan, United States. Methods Our mixed-methods study explored experiences with a vaginal self-sampling technique in comparison to the memory of the most recent pelvic exam. We developed quantitative survey questions using Health Information National Trends Survey (HINTS) modules. We created the qualitative interview guide using Likert scales and the Theoretical Domains Framework (TDF). We provided vaginal self-sampling kits (HerSwab) to participants to try this new test modality. We used descriptive statistics and t tests to analyze quantitative data. We analyzed the interview responses thematically. Results Of the forty rural white women who shared their experiences of the two screening techniques, the pelvic exam technique had significantly worse negative ratings across all fourteen perceptions than the self-sampling technique, and the self-sampling technique had significantly higher positive ratings. Analysis of interviews revealed four themes that elaborated survey results: 1) preference for the self-sampling technique; 2) physical and emotional discomfort with the pelvic exam technique; 3) convenience of the self-sampling technique; and 4) empowerment through self-sampling. Conclusions The powerful negative perceptions of the pelvic exam may be why people do not participate in screening. The self-sampling cervical cancer screening technique offers a quick and easy method for screening that many prefer.

How would Australian women and people with a cervix like to access self-collection for cervical screening? Screening preferences from a national survey

Abstract Purpose In Australia, cervical screening is usually offered face-to-face through primary care. As self-collection offers flexibility in how and where screening can be accessed, we assessed participant preferences for flexible screening models. Methods We recruited women and people with a cervix aged 24–74 years into a national survey (December 2023–April 2024) via a paid Meta campaign and community networks. Sociodemographic factors associated with a preference for appointment- or non-appointment-based models were assessed using logistic regression, stratified by age, &lt; 50 and ≥ 50 years. Results Among 9,586 respondents, the median age was 41 years, 67.9% lived in a major city, 82.5% were born in Australia, and 62.6% screened regularly. Most (82.6%) viewed flexible options for accessing screening as very important/important. Respondents favored non-appointment-based compared to appointment-based models, with 53.5% of those &lt; 50 ( n  = 4,842) and 49.5% of those ≥ 50 ( n  = 1,257) preferring to receive a swab in the mail when due. Non-appointment-based models were preferred by participants aged &lt; 50 and ≥ 50 years who were never-screened (adjOR = 1.52, 95% CI = 1.18–1.96, p  = 0.001; adjOR = 2.91, 95% CI = 1.67–5.09, p  &lt; 0.001), irregular screeners (adjOR = 1.58, 95% CI = 1.36–1.85, p  &lt; 0.001; adjOR = 1.52, 95% CI = 1.17–1.98, p  = 0.002) and recently eligible for screening (adjOR = 1.64, 95% CI = 1.08–2.50, p  = 0.02) compared to regular screeners. Convenience was the most common reason for participants’ preferred screening model (87.4% non-appointment-based; 55.1% appointment-based). Conclusion Flexibility in how cervical screening can be accessed appeals to many screen-eligible people. Further research trialing different models assessing screening uptake and clinical pathways to follow-up care is needed.

Circulating biomarkers of infection and endometrial cancer risk

Abstract Purpose Incidence and mortality rates for endometrial cancer are rising. We need to better understand the etiology of this disease and identify new risk factors. We examined whether common genital infections are associated with endometrial cancer. Methods Using serum samples from The Polish Endometrial Cancer Study (443 cases, 443 controls), we measured antibodies against microbial antigens with a multiplex fluorescent bead-based assay. We estimated adjusted odds ratios (OR) and 95% confidence intervals (CI), comparing women with positive versus negative serology. Results Most antibodies were not associated with endometrial cancer overall, but seropositivity for Herpes simplex virus 2 was associated with low-grade tumors (OR 1.43 CI 1.02, 2.00). While increased risks for type II, but not type I tumors, were consistently indicated for multiple Chlamydia trachomatis antigens, most estimates did not reach statistical significance (e.g., Pgp3 seropositivity and type I cancers: OR 0.97 CI 0.73, 1.31; and type II: OR 2.96 CI 0.85, 10.31; heterogeneity p -value = 0.03). The strongest associations for type II tumors were observed with seropositivity for Chlamydial stress response proteins. Conclusion Reproductive tract infections may increase risk for endometrial cancer, but the biologic mechanisms are likely both microbe- and histology-specific. Some C. trachomatis infections may be a risk factor for type II endometrial cancers. Given that so few risk factors for type II endometrial cancers are identified, infection-related mechanisms of carcinogenesis in the endometrium merit continued investigation.

Physical activity and exercise in cervical cancer: a state-of-the-art review

Cervical cancer remains the second most prevalent malignancy in terms of both incidence and mortality among women of reproductive age globally. Emerging evidence suggests that physical activity and structured exercise interventions may exert distinct influences across the cancer continuum. These include reducing the risk of cancer onset, mitigating treatment-related declines in muscle mass, enhancing quality of life, and improving post-treatment survival outcomes. This state-of-the-art review aims to synthesize the current body of literature regarding the role of physical activity and exercise in: (i) the primary prevention of cervical cancer, and (ii) supportive care during and following oncological treatment. Additionally, we propose future research directions to advance understanding and optimize exercise-based strategies in cervical cancer care.

Knowledge of human papillomavirus and self-sampling, including vaccination practices among female students in Free State, South Africa

Abstract Background and Aim Human papillomavirus (HPV)-related cancers, especially cervical cancer, remain highly prevalent in low- and middle-income countries, despite the availability of preventive measures such as vaccination and self-sampling screening, due to limited HPV awareness. The study aimed to assess the knowledge of HPV, HPV vaccination practices, and HPV self-sampling awareness and perceptions among female students at the University of the Free State in Bloemfontein, South Africa. Methods Data were collected from female university students through a self-administered questionnaire distributed via the secure web-based platform Research Electronic Data Capture (REDCap). HPV infection and vaccination knowledge were measured using a self-administered questionnaire. Knowledge was assessed by assigning one (1) point for each correct answer, while incorrect or “don't know” responses received a score of zero (0). A knowledge score above 75% was categorized as “good knowledge.” The data were analyzed using SAS version 9.4. Results The study included 381 participants with a median age (interquartile range, IQR) of 23.0 (20–26) years. The findings showed that while 40.9% of participants had good knowledge of HPV infection, only 9.7% demonstrated good knowledge of HPV vaccination, and 13.3% had good overall knowledge. Only 13.4% of participants reported having received the HPV vaccine, while 19.1% expressed unwillingness to receive the vaccine. Barriers to vaccine uptake included lack of information about the HPV vaccine (46.0%) and safety concerns (46.0%). The majority (78.2%) were unaware of HPV self-sampling. Having heard about HPV self-sampling was predictive for HPV knowledge (OR: 2.684, 95% CI: 1.389–5.188, p  = 0.003). Conclusion These findings suggest that while some participants are informed about HPV infection, the majority are not well-informed about HPV vaccination and are unaware of HPV self-sampling. Additionally, barriers to HPV vaccination persist. Targeted educational interventions are needed to address awareness and knowledge gaps and vaccine hesitancy. These interventions could significantly improve HPV and cervical cancer prevention outcomes.

Self-collected biospecimen consent and return rates in a population-based study among women with ovarian cancer: insights from the ORCHiD study

A scoping review of evidence on routine cervical cancer screening in South Asia: investigating factors affecting adoption and implementation

Abstract Need Cervical cancer is a major global public health issue, particularly affecting low and middle-income countries, distinctly in the South Asian region. This geographical region lacks a well-organized routine cervical screening program. Consequently, this scoping review aimed to investigate the evidence on factors influencing the adoption and implementation of routine cervical cancer screening in South Asia. Methods Adopting the “Arksey and O’Malley and Levac et al.” methodology, databases such as PubMed, CINAHL, Web of Science, and Scopus were scrutinized in the pursuit of relevant studies. Subsequently, the collected data were synthesized by adopting the Consolidated Framework for Implementation Research (CFIR) model. Results A total of 837 records were initially identified and screened for eligibility, including 55 studies. The successful adoption and implementation of cervical cancer screening in South Asia encounter numerous obstacles within the health system, including the absence of a comprehensive program protocol for screening, inadequate health infrastructure, and the presence of multiple sociocultural factors, such as social stigma, low levels of education, and concerns related to modesty. Conclusion To optimize adoption and implementation, it is imperative to construct a customized policy framework that incorporates a risk communication strategy tailored to the specific contexts of these nations. Drawing insights from the experiences of South Asian countries in executing cervical cancer screening programs can inform the formulation of policies for similar healthcare initiatives aimed at facilitating the expansion of HPV vaccination efforts.

Performance of urine samples compared to cervical samples for detection of precancer lesions among HPV-positive women attending colposcopy clinic in Mexico City

Abstract Background High-risk human papillomavirus (hrHPV) detection in self-collected urine samples (SeCUS) may be a promising alternative for cervical cancer screening because of its greater acceptability, as long as it can offer comparable sensitivity to clinician-collected cervical samples (CCoS) for detecting precancer lesions. Objective To evaluate the performance of the SeCUS compared to that of the CCoS for cervical intraepithelial neoplasia grade 3 (CIN3) detection among hrHPV-positive women receiving colposcopy in Mexico City using different specific extended HPV typing procedures: HPV16/18, HPV16/18/35/39/68 or HPV16/18/35/39/68/31. Methods From March 2017 to August 2018, 4,158 female users of the cervical cancer screening program at Tlalpan Sanitary Jurisdiction in Mexico City were invited to participate in the FRIDA-Tlalpan study. All participants provided ≥ 30 mL of SeCUS, and then a CCoS was obtained with Cervex-Brush®, which was used for hrHPV typing. Participants who tested positive for hrHPV in CCoS were referred for colposcopy for diagnostic confirmation, and all SeCUS of these women were also tested for hrHPV typing. Results In total, 561 hrHPV-positive women were identified by CCoS via colposcopy, and 82.2% of the SeCUS of these women were also hrHPV positive. From both CCoS and SeCUS, 7 cases of CIN3 were detected. Considering HPV16/18 typing, CCoS and SeCUS detected 4 cases of CIN3, but after HPV16/18/35/39/68/31 extension typing, both CCoS and SeCUS detected all 7 of the CIN3 cases among the hrHPV-positive women. Conclusions Using extended hrHPV typing based on HPV16/18/35/39/68/31, our results suggest that the performance of SeCUS may be equivalent to that of CCoS for detecting CIN3 lesions. Although our results are inconclusive, they support the hypothesis that SeCUS may be an attractive alternative worthy of further research.

Higher chemical complementarity of EBV epitopes and IGH CDR3s correlates with better outcomes for lymphoma and ovarian cancer

This study investigated the relationship between Epstein-Barr virus (EBV) epitopes and tumor-resident immunoglobulin heavy chain (IGH) CDR3 amino acid (AA) sequences sourced from cancers with a link to EBV. In the case of ovarian cancer, the results revealed that higher chemical complementarity between certain EBV epitopes and IGH CDR3 AA sequences was linked to better outcomes. Additionally, IGH CDR3 and EBV epitope chemical complementarity was examined for Burkitt lymphoma (BL) and diffuse large B-cell lymphoma (DLBCL). For both BL and DLBCL, higher chemical complementarity to certain EBV epitopes was associated with improved overall survival probabilities. This latter result may be relevant to the occasional misdiagnosis of lymphoma for ovarian epithelial carcinoma. In sum, the results justify a more detailed study of the role of EBV and the anti-EBV immune response in the ovarian cancer and lymphoma settings.

The effects of vitamin D levels on risk and prognosis of ovarian cancer: a systematic review

Ovarian cancer is the eighth most common cancer in women with the highest mortality rate of all gynecological cancers. Serum vitamin D level has been explored as a possible modifiable risk factor for development and progression of this disease. The proposed study aims to answer the questions: do women with low levels of vitamin D have a higher risk for developing ovarian cancer and, do low vitamin D levels at the time of ovarian cancer diagnosis predict a poorer prognosis? A systematic search was performed in PubMed, CINAHL, Cochrane, and Scopus. Cohort, case-control, in vivo, in vitro, and ex vivo studies assessing the effect of vitamin D levels on the risk of developing ovarian cancer, prognosis at time of diagnosis of ovarian cancer, or both, published in English since July of 2008 were included. Eighteen studies were included in this review. Six of the nine case-control studies found ovarian cancer patients to have lower vitamin D levels. Of the studies to investigate survival rates, both articles reported significant increases in survival rate in vitamin D sufficient patients. Cohort studies found similar mixed results to the case-control experiments, while experimental studies produced significant results pertaining to vitamin D's ability to reduce proliferation and decrease progression in ovarian cancer cell lines. However, two large-scale, nested studies noted no significant association between low vitamin D levels and ovarian cancer incidence. This review has determined that lower vitamin D levels are a risk factor for the development of ovarian cancer. In addition, it was found that ovarian cancer patients with low vitamin D levels have a worse prognosis comparatively.

Fertility preservation in rare ovarian malignancies: a decade-spanning systematic review of menstrual and reproductive outcomes

Fertility preservation is a growing priority in the management of young women with rare ovarian tumors, including malignant ovarian germ cell tumors (MOGCTs), sex cord-stromal tumors (SCSTs), and borderline ovarian tumors (BOTs). These malignancies often affect adolescents and women of reproductive age and are frequently treated with fertility-sparing surgery and platinum-based chemotherapy. Our objective is to systematically evaluate reproductive outcomes, menstrual function recovery, and fertility preservation strategies in female survivors of rare cancers such as MOGCTs, SCSTs, and BOTs. A systematic review was conducted in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. PubMed, Scopus, and BioMed Central were searched for studies published between 2005 and 2025. Eligible studies included observational or cohort designs reporting on fertility status, menstrual recovery, and reproductive outcomes following treatment for rare tumors. A total of 24 studies met the inclusion criteria. Data extraction included fertility preservation approaches, rates of natural versus assisted conception, menstrual function outcomes, and the incidence of premature ovarian insufficiency (POI). Fertility-sparing surgery with or without chemotherapy was the most applied fertility preservation strategy. Spontaneous conception was predominant, with pregnancy rates ranging from 50% to over 90%. Menstrual recovery occurred in 71-100% of patients. POI was rare in solid tumor survivors but occurred in up to 87% of leukemia patients. Long-term follow-up showed durable ovarian function and no increase in cancer recurrence. Ovarian tissue cryopreservation (OTC) and oocyte retrieval were effective in selected high-risk cases. Fertility preservation in patients with rare ovarian malignancies is both safe and effective. Early fertility counseling and individualized, risk-adapted strategies should be integrated into standard cancer care, especially for patients at high risk for gonadal failure.

Barriers and attitudes toward cervical cancer screening among eligible women

This study examined barriers and attitudes toward cervical cancer screening among eligible women in São Paulo, Brazil, and their associations with sociodemographic factors, screening behaviors, and knowledge. A survey was conducted with 384 women aged 25-64 attending primary healthcare units, selected through multistage random sampling across 50 primary health units from 17 regional health departments of São Paulo. Participants rated barriers and attitudes using 5-point Likert items, which were later condensed in a 3-point scale for analysis. Non-parametric tests assessed associations with sociodemographic factors, screening practices, and knowledge levels. The sample was predominantly low-income (40% in the lowest income bracket; 82% without private health insurance), with 87% reporting a Pap smear within the past five years. Key personal and structural barriers included fear of bad news (41%), test results delays (30%), long wait times (30%), and shame (29%). Significant associations were found between lower income and reporting delays in test results (p = 0,020) and long wait times (p = 0,012), as well as between lower education and experiencing delays (p = 0,030) and shame (p = 0,007). Positive attitudes toward screening exceeded 95% overall and were stronger among women who understood the Pap smear's role in early detection (p = 0,026) and improving survival (p = 0,006). While screening participation was high, persistent socioeconomic disparities in access and personal barriers require targeted interventions. Strengthening primary healthcare systems with patient-centered approaches could improve screening adherence and reduce inequities.

Breast and cervical cancer screenings across gender identity: results from the Behavioral Risk Factor Surveillance System before and during the COVID-19 pandemic

Although national medical organizations often neglect to include trans and gender diverse (TGD) people in their breast and cervical cancer screening recommendations, the World Profession Association of Transgender Health recommends that TGD people who are at risk for these cancers follow existing guidelines for cisgender women. Despite WPATH's recommendations, TGD people are less likely to get screened in large part due to discrimination. The COVID-19 pandemic has limited access to cancer screenings among cisgender people, but it is unknown how this has impacted TGD people. Using national survey data from the Behavioral Risk Factors Surveillance System (BRFSS), we examined differences in cervical and breast cancer screening noncompliance across gender identity at two time points: before and during the COVID-19 pandemic. Screening noncompliance increased during the COVID-19 pandemic among cisgender and TGD people (e.g., transgender men, gender non-conforming people). Compared to cisgender women, transgender men and gender non-conforming respondents had higher odds of breast cancer screening noncompliance before and during COVID-19. Transgender men had lower odds of cervical cancer screening noncompliance than cisgender women before COVID-19, but higher odds during the pandemic. Gender non-conforming respondents also had lower odds of cervical cancer screening noncompliance during COVID-19 compared to cisgender women. Screening noncompliance for breast and cervical cancer was more common among TGD people than cisgender women; while these disparities existed before the COVID-19 pandemic, they were exacerbated during the pandemic. Future work should move beyond descriptive statistics and elucidate underlying causes to inform interventions.

Associations between pregnancy-related factors and birth characteristics with risk of rare uterine cancer subtypes: a Nordic population-based case–control study

Uterine sarcomas are a rare group of uterine malignancies. Due to the low incidence and changes in uterine sarcoma classification, risk factors are not well characterized. Our objective was to evaluate risk factors for uterine sarcoma and compare risk factors between uterine sarcoma, malignant mixed Mullerian tumors (MMMTs), and type I endometrial carcinomas. This nested case-control study utilized linked data from population-based medical birth and cancer registries in Denmark, Finland, Norway, and Sweden. Up to 10 controls were matched on country and birth year for each uterine cancer case. Using multivariable adjusted multinomial logistic regression, estimates of the associations between pregnancy-related factors and risk of uterine sarcoma, MMMTs, and type I endometrial carcinomas were determined. Having a very-low-birth-weight infant (< 1500 vs. 2500-3999 g: OR [95% CI] 2.83 [1.61-4.96]) was associated with an increased risk of uterine sarcoma. Whereas, having a more recent pregnancy was associated with reduced risks of MMMT (< 10 vs. ≥ 30 years: 0.66 [0.20-2.23]) and type 1 endometrial carcinomas (0.35 [0.30-0.41]) but not uterine sarcomas (1.33 [0.90-1.98], p-heterogeneity < 0.01). Our study provides evidence that risk factors for uterine sarcoma and MMMT, previously grouped with uterine sarcomas, vary substantially. Additionally, MMMT and type I endometrial carcinomas are more similar than uterine sarcoma in that pregnancy complications like gestational hypertension and preeclampsia were associated with reduced risks of both but not uterine sarcoma, suggesting different etiologies.

Interventions to increase breast and cervical cancer screening uptake among rural women: a scoping review

Despite widespread promotion of breast and cervical cancer (BCC) screening, uptake remains low in rural communities. Barriers to healthcare, which often result in poorer health outcomes, differentially impact residents of rural communities. Effective interventions addressing the unique needs of rural women may target these barriers and increase BCC screening participation. Our objective is to review and assess the published literature on interventions to increase BCC screening in rural communities. A systematic scoping review of PubMed/Medline was performed to identify BCC screening interventions conducted in rural settings. English language articles from peer-reviewed journals published from January 2006 to October 2019 were included if they reported results for BCC screening interventions in rural communities in the United States. We reviewed 228 articles and identified eight articles consistent with our inclusion criteria. Studies varied in sample population characteristics, geographic location, design, and mode of intervention delivery. Interventions included patient navigation strategies, educational outreach programs, peer counseling, and small media initiatives. Interventions focused on promoting uptake of initial or one-time screening rather than targeted repeat screening, and few studies detailed the cost-effectiveness of the interventions. This review may inform efforts to develop strategies to increase BCC screening among rural women. Additional cancer prevention and control research gaps in rural communities include the examination of the theoretical foundations, design, delivery, and cost-effectiveness of BCC screening interventions for rural communities. Future research might focus on methods to promote repeat BCC screening and effective translation of these interventions for other rural populations.

Patterns of HIV testing among women diagnosed with invasive cervical cancer in the New Jersey Medicaid Program

Practice-based guidelines recommend HIV testing during initial invasive cervical cancer (ICC) workup. Determinants of HIV testing during diagnosis of AIDS-defining cancers in vulnerable populations, where risk for HIV infection is higher, are under-explored. We examine factors associated with patterns of HIV testing among Medicaid enrollees diagnosed with ICC. Using linked data from the New Jersey State Cancer Registry and New Jersey Medicaid claims and enrollment files, we evaluated HIV testing among 242 ICC cases diagnosed from 2012 to 2014 in ages 21-64 at (a) any point during Medicaid enrollment (2011-2014) and (b) during cancer workup 6 months pre ICC diagnosis to 6 months post ICC diagnosis. Logistic regression models identified factors associated with HIV testing. Overall, 13% of women had a claim for HIV testing during ICC workup. Two-thirds (68%) of women did not have a claim for HIV testing (non-receipt of HIV testing) while enrolled in Medicaid. Hispanic/NH-API/Other women had lower odds of non-receipt of HIV testing compared with NH-Whites (OR: 0.40; 95% CI: 0.17-0.94). Higher odds of non-receipt of HIV testing were observed among cases with no STI testing (OR: 4.92; 95% CI 2.27-10.67) and < 1 year of Medicaid enrollment (OR: 3.07; 95% CI 1.14- 8.26) after adjusting for other factors. Few women had HIV testing claims during ICC workup. Opportunities for optimal ICC care are informed by knowledge of HIV status. Further research should explore if lack of HIV testing claims during ICC workup is an accurate indicator of ICC care, and if so, to assess testing barriers during workup.

Estimating the impact of increasing cervical cancer screening in the National Breast and Cervical Cancer Early Detection Program among low-income women in the USA

The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides free cervical cancer screening to low-income women. This study estimated the health benefits gained in terms of life years (LYs) saved and quality-adjusted life years (QALYs) gained if cervical cancer screening by the NBCCEDP increased to reach more eligible women. Data from Surveillance, Epidemiology, and End Results, NBCCEDP, and Medical Expenditure Panel Surveys were used. LYs saved and QALYs gained/100,000 women were estimated using modeling methods. They were used to predict additional health benefits gained if screening by the NBCCEDP increased from 6.5% up to 10-25% of the eligible women. Overall, per 100,000 women screened by the NBCCEDP, 1,731 LYs were saved and 1,608 QALYs were gained. For white women, 1,926 LYs were saved and 1,780 QALYs were gained/100,000 women screened by the NBCCEDP. For black women, 1,506 LYs were saved and 1,300 QALYs were gained/100,000 women screened. If the proportion of eligible women screened by the NBCCEDP increased to 10-25%, the estimated health benefits would range from 6,626-34,896 LYs saved and 6,153-32,407 QALYs gained. The reported estimates emphasize the value of cervical cancer screening program by extending LE in low-income women. Further, it demonstrates that screening a higher percentage of eligible women in the NBCCEDP may yield more health benefits.

Cervical cancer screening among sexual minority women: findings from a national survey

Sexual minority women (SMW; lesbian, bisexual, and other women who have sex with women) are at risk for cervical cancer but less likely than non-SMW to receive regular cervical cancer screening (Pap- and/or HPV-testing). We examined factors contributing to receipt of guideline-based cervical cancer screening among SMW. During October 2019, we conducted an online survey of self-identified SMW aged 21-45 years living in the United States (n = 435). We estimated risk differences (RD) in women's likelihood of being within current cervical cancer screening guidelines by sociodemographic and health-related characteristics. Overall, 75% of respondents were within current screening guidelines. Adjusting for other factors, SMW were more likely to be within guidelines if they were insured (aRD 0.26, 95% CI 0.13, 0.39), had a partner (aRD 0.18, 95% CI 0.09, 0.28), and were older (aRD 0.12, 95% CI 0.04, 0.20). Overall, the most common reasons for not being screened recently were lack of insurance/cost (42%) and perceiving it was unnecessary (28%). Many SMW are not being screened for cervical cancer according to guidelines. Findings can inform efforts to improve screening among this population.

The determinants of cervical cancer screening uptake in women with obesity: application of the Andersen’s behavioral model to the CONSTANCES survey

Despite their higher risk for and mortality from cervical cancer, evidence indicates low rates of cervical cancer screening (CCS) among women with obesity. The literature on the specific factors related to CCS nonadherence in this population is limited. We examined the data on 2,934 women with obesity included in the CONSTANCES survey from 2012 to 2015. Using the Andersen's behavioral model, we studied the relationships between the socioeconomic, sociodemographic, health, health personal behaviors, and healthcare use-related factors with CCS nonadherence. The analysis was performed using structural equation models. Regular follow-up by a gynecologist, good quality of primary care follow-up, and comorbidities were negatively associated with CCS nonadherence. Limited literacy, older age, being single, living without children, and financial strain were positively associated with CCS nonadherence. Our results do not point to competitive care, since women with comorbidities had better CCS behaviors, which were explained by a good quality of primary care follow-up. Our study identified the factors that explain CCS nonadherence among women with obesity and clarified the effects of health status and healthcare use on screening. Further efforts should be undertaken to reduce the obstacles to CCS by improving care among women with obesity.

Arguments in favor of and against the HPV vaccine school-entry requirement in Puerto Rico: a content analysis of newspaper media

Vaccine requirements are effective population-based strategies to increase vaccination rates. In 2018, Puerto Rico's DOH announced that the HPV vaccine would be required for school entrance. This study explored arguments in favor of and against the HPV vaccine school-entry requirement in PR. We conducted a content analysis of two Puerto Rican newspapers. Articles (n = 286) published between 1/1/2015 and 7/31/2018 containing the Spanish terms for "HPV" and "human papillomavirus" were included. Data were summarized using descriptive statistics. Articles that mentioned the HPV vaccine school-entry requirement (n = 33) were reviewed qualitatively using applied thematic analysis. The top five primary focus areas were education about HPV and the HPV vaccine, advertisements promoting the HPV vaccine, general vaccine information, cervical cancer and screening information, and the HPV vaccine school-entry requirement. Of the 33 articles that mentioned the requirement, 61% presented arguments in favor, 15% presented arguments against, 12% presented both arguments, and 12% only mentioned the existence of the requirement or were the DOH announcement. Arguments in favor centered on cancer prevention, high rates of HPV-associated cancers, and population wellness. Arguments against included worries about sexual transmission of HPV, HPV vaccine's side effects, issues related to the policy (e.g., mandatory), and lack of education. Understanding reasons people support or oppose an HPV vaccine school-entry requirement is important for the policy processes to be successful. Education efforts must continue to change the HPV vaccine narrative. Messages should be crafted to educate and gain support among parents and stakeholders towards this population-based cancer prevention strategy.

Racial disparities in routine health checkup and adherence to cancer screening guidelines among women in the United States of America

Routine health checkup and cancer screening rates among women are suboptimal, partially due to the health care disparities by race/ethnicity in the USA. This study examined the previously understudied associations between routine health checkup, cervical cancer screening, and breast cancer screening by race/ethnicity using the national representative sample of women. Data were obtained from three cycles (2017, 2018, and 2019) of the Health Information National Trends Survey (HINTS) (n = 12,227). Survey-weighted logistic regressions were evaluated to assess associations between routine health checkup and cervical and breast cancer screening compliance with the established guidelines with the age criteria and frequency of screening by race/ethnicity (Black, White, Hispanic, and Other). This study included 6,941 women in the cervical cancer screening and 8,005 women for breast cancer screening, considering the age criteria. Women who had received routine health checkups were more likely to meet the cervical cancer screening guideline (Odds ratio 3.24, p < 0.05) and breast cancer screening guideline (OR 5.86, p < 0.05) compared to women who did not receive routine health checkups. While routine health checkups were associated with both types of cancer screenings in most racial/ethnic groups, analyses stratified by race/ethnicity suggest that Hispanic women and Other women did not benefit from routine health checkup in relation to cervical and breast cancer screening, respectively. Promotion of routine health checkups could promote cancer screening among women across racial/ethnic groups, although specific racial/ethnic groups may require additional support.

Acceptability of a multicomponent, community-based, HPV self-test intervention among Jamaican women

Jamaican women do not participate in routine Pap test screening as recommended, despite the availability of free Pap test services at community clinics. This low uptake has been associated with cultural and structural barriers such as limited knowledge and awareness, fear of pain associated with Pap tests, fear of diagnosis, modesty or self-consciousness, medical mistrust, and discontent with healthcare services. This study suggests that a multicomponent, community-based intervention that includes education and self-testing for the virus that causes cervical cancer (i.e., Human Papillomavirus, HPV) might increase screening rates. Community outreach workers were hired and recruited 163 women from two low socioeconomic status communities in Kingston, aged 30 to 65 years, and who had not had a Pap test in at least 3 years, to use an HPV self-test kit. Almost all the women (95.6%) used and returned the kit and reported in structured interviews that it was easy to use and preferable to visiting a doctor. Paired samples t-tests revealed that participants perceived higher threat of cervical cancer, greater susceptibility to cancer, greater sense of self-efficacy, and more positive screening social norms at post-test than at pretest. Among returners, 22% had an oncogenic HPV type detected in their sample. Findings demonstrate high acceptability of the HPV self-test among Jamaican women and, therefore, the potential of HPV self-test tools to increase screening uptake. Community-based approaches to disseminate this tool, such as outreach workers and educational small group sessions, appear to be culturally appropriate and effective in this context.

Downstaging of cervical cancer in Tanzania over a 16-year period

Globally, the highest cervical cancer mortality rates are found in East Africa. Visual inspection with acetic acid (VIA)-based screening in resource-poor settings has been shown to decrease the proportion of women presenting with late-stage cervical cancer, a process known as clinical downstaging. The only cancer treatment center in Tanzania, Ocean Road Cancer Institute (ORCI) in Dar es Salaam, opened a VIA-based cervical cancer screening program in 2002. We reviewed 6,676 medical records of cervical cancer patients at the ORCI from 2002-2011 to 2014-2018 for stage at diagnosis and screening status, among other variables. We investigated whether clinical downstaging occurred in this period among women screened at the ORCI, when compared to unscreened women. Our results indicated that the proportion of women presenting with late-stage cervical cancer among women screened at the ORCI decreased by 27.7% over the 16-year period (χ

Correlates of non-adherence to breast, cervical, and colorectal cancer screening among screen-eligible women: a population-based cohort study in Ontario, Canada

Breast, cervical, and colorectal cancers are cancers that can be detected early through screening. Despite organized cancer screening programs in Ontario, Canada participation remains low among marginalized populations. Although extensive research has been done about factors contributing to under-screening by cancer site, the predictors of under/never screened conjointly for all three types of cancer remain unknown. Using provincial-level linked administrative data sets, we examined Ontario women who were screen-eligible for all three types of cancer over a 36-month period (i.e., April 2014-March 2017) and determined how many were up to date on 0, 1, 2, and all three types of screenings. Multivariate logistic regression was utilized to examine individual and structural predictors of screening with the group overdue for all screening being the reference group. Of the 1,204,551 screen-eligible women, 15% were overdue for all. Living in the lowest income neighborhoods (AOR 0.46 [95% CI 0.45-0.47]), being recent immigrants (AOR 0.54 [95% CI 0.53-0.55]), having no primary care provider (AOR 0.17 [95% CI 0.16-0.17]), and having no contact with health care services (AOR 0.09 [95% CI 0.09-0.09]) significantly increased the likelihood of being overdue for all versus no screening type. Considering that more than 15% of screen-eligible women in Ontario were overdue for all types of cancer screening, it is imperative to address structural barriers such as lack of a primary care provider. Innovative interventions like "one-stop shopping" where screening for different cancers can be offered at the same time could promote screening uptake.

Prevalence of cervical human papillomavirus in Mexico, 2010–2017: analysis of 2.7 million women

Prevalence of cervical high-risk human papillomavirus (hrHPV) infection varies greatly. Data on distribution of hrHPV infection constitute important evidence for decision-making when implementing HPV testing into cervical cancer screening programs. We estimate the prevalence of cervical hrHPV infection in a large sample of women in a middle-income country and explore variation by age, community marginalization and region in women using public cervical cancer screening services. Records covering 2010-2017 from a registry of hrHPV test results (Hybrid Capture 2 and polymerase chain reaction) in 2,737,022 women 35-64 years were analyzed. In this observational study, 32 states were categorized into five geographical regions and classified by degree of marginalization. We stratified by test type and estimated crude and adjusted prevalence and rate ratios and used Poisson models and joinpoint regression analysis. Prevalence was higher in women 35-39 years, at 10.4% (95% CI 10.3-10.5) and women 60-64 years, at 10.1% (95% CI 10.0-10.3). Prevalence was higher in the southeast, at 10.5% (95% CI 10.4-10.6). Women living in less marginalized areas had a significantly higher prevalence, at 10.3% (95% CI 10.2-10.4) compared to those in highly marginalized areas, at 8.7% (95% CI 8.5-8.7). HPV16 infection was detected in 0.92% (2,293/23,854) of women and HPV18 infection was detected in 0.39% (978/23,854) of women. Understanding the distribution of HPV prevalence has value as evidence for developing policy in order to improve cervical cancer screening strategies. These results will constitute evidence to allow decision makers to better choose where to focus those resources that they do have.

Cervical cancer in Ethiopia: a review of the literature

Cervical cancer is one of the most common malignancies affecting women worldwide with large geographic variations in prevalence and mortality rates. It is one of the leading causes of cancer-related deaths in Ethiopia, where vaccination and screening are less implemented. However, there is a scarcity of literature in the field. Therefore, the objective of this review was to describe current developments in cervical cancer in the Ethiopian context. The main topics presented were the burden of cervical cancer, knowledge of women about the disease, the genotype distribution of Human papillomavirus (HPV), vaccination, and screening practices in Ethiopia. Published literature in the English language on the above topics until May 2021 were retrieved from PubMed/Medline, SCOPUS, Google Scholar, and the Google database using relevant searching terms. Combinations of the following terms were considered to retrieve literature;  . The main findings were described thematically. Cervical cancer is the second most common and the second most deadly cancer in Ethiopia, The incidence and prevalence of the disease is increasing from time to time because of the growth and aging of the population, as well as an increasing prevalence of well-established risk factors. Knowledge and awareness about cervical cancer is quite poor among Ethiopian women. According to a recent report (2021), the prevalence of previous screening practices among Ethiopian women was at 14%. Although HPV 16 is constantly reported as the common genotype identified from different grade cervical lesions in Ethiopia, studies reported different HPV genotype distributions across the country. According to a recent finding, the most common HPV types identified from cervical lesions in the country were HPV-16, HPV-52, HPV-35, HPV-18, and HPV-56. Ethiopia started vaccinating school girls using Gardasil-4™ in 2018 although the coverage is insignificant. Recently emerging reports are in favor of gender-neutral vaccination strategies with moderate coverage that was found superior and would rapidly eradicate high-risk HPVs than vaccinating only girls. Cervical cancer continues to be a major public health problem affecting thousands of women in Ethiopia. As the disease is purely preventable, classic cervical cancer prevention strategies that include HPV vaccination using a broad genotype coverage, screening using a high precision test, and treating cervical precancerous lesions in the earliest possible time could prevent most cervical cancer cases in Ethiopia. The provision of a focused health education supported by educational materials would increase the knowledge of women about cervical cancer in general and the uptake of cervical cancer prevention and screening services in particular.

The association of sexual orientation with prostate, breast, and cervical cancer screening and diagnosis

Data on heterogeneity in cancer screening and diagnosis rates among lesbians/gays and bisexuals (LGBs) is lacking. Recent studies showed that LGBs have decreased healthcare utilization compared to heterosexual counterparts. Few studies have examined how sexual orientation impacts cancer screening and prevalence. We, therefore, investigated the association between sexual orientation and prevalent sex-specific cancer including prostate (PCa), breast (BC), and cervical (CC) cancer. This was a cross-sectional survey-based US study, including men and women aged 18 + from the Health Information National Trends Survey (HINTS) database between 2017 and 2019. The primary endpoint was individual-reported prostate, breast, and cervical cancer screening and prevalence rates among heterosexual and LGB men and women. Multivariable logistic regression analyses assessed association of various covariates with undergoing screening and diagnosis of these cancers. Overall, 4,441 and 6,333 heterosexual men and women, respectively, were compared to 225 and 213 LGB men and women, respectively. LGBs were younger and less likely to be screened for PCa, BC, and CC than heterosexuals. A higher proportion of heterosexual women than lesbian and bisexual women were screened for CC with pap smears (95.36% vs. 90.48% and 86.11%, p ≤ 0.001) and BC with mammograms (80.74% vs. 63.81% and 45.37%, p ≤ 0.001). Similarly, a higher proportion of heterosexual men than gay and bisexual men were screened for PCa with PSA blood tests (41.27% vs. 30.53% and 27.58%, p ≤ 0.001). There were more heterosexuals than LGBs screened for CC, BC, and PCa. However, no association between sexual orientation and cancer diagnosis was found. Healthcare professionals should be encouraged to improve cancer screening among LGBs.

Predictors of cervical cancer screening for refugee women attending an international family medicine clinic in the United States

Cervical cancer screening (CCS) rates are lower for foreign-born women in the United States (U.S.) compared with the overall population. This study aimed to determine the CCS rate and predictors among refugees who were identified as female attending a family medicine clinic. A retrospective chart review included refugee individuals aged 21+, seen in the previous 3 years (3/23/2015-3/20/2018), without hysterectomy (n = 525). Lab results determined CCS rate. Chi-square and logistic regression models explored predictors of CCS. Overall, 60.0% were up-to-date (UTD) on CCS. Individuals aged 30-49, married, and with [Formula: see text] 1 child had higher odds of being UTD. Ten or more years living in the U.S. was a significant bivariate predictor of CCS, and approached significance in the multivariate model. This study begins to fill gaps in knowledge about cervical cancer control among individuals who resettled in the U.S. as refugees and, given that CCS rates are suboptimal, informs clinical practice improvements and directions for future research.

Cervical cancer screening and predictors of screening by diabetes status

Women with diabetes have lower survival rates after a cervical cancer diagnosis compared to women without diabetes. Pap smears and human papilloma virus (HPV) testing are highly effective screening tests for cervical cancer, therefore, it is important to know the prevalence of guideline-concordant screening among women with diabetes and understand if their predictors of screening differ. The purpose of this analysis was to assess guideline-concordant cervical cancer screening and predictors by diabetes status. We used the 2019 National Health Interview Survey data, limited to women aged 21-65 years without a previous diagnosis of cancer, a hysterectomy, or diagnosed with diabetes in the year prior to the survey. We considered the Pap and HPV tests together and concordance as being tested within the past 3 years as part of a routine exam. We calculated weighted, adjusted prevalence, and prevalence ratios (PRs) of screening concordance comparing women with diabetes to those without. The unadjusted prevalence of concordant screening was 66.5% for women with diabetes compared to 73.3% for women without diabetes (PR = 0.91 95% CI 0.84-0.98). In the fully adjusted model adjusting for factors known to be associated with diabetes and access to healthcare, the association was attenuated and no longer statistically significant (PR = 0.96 95% CI 0.89-1.04). Cervical cancer screening concordance was lower in women with diabetes compared to those without overall but the deficit appears to be due primarily to underlying differences in sociodemographic characteristics and access to healthcare and not diabetes independently.

Social support and cervical cancer screening among sub-Saharan African immigrant (SAI) women

Low rates of Papanicolaou (Pap) screening among sub-Saharan African immigrant (SAI) women in the US contribute to cancer diagnoses at late stages and high mortality rates. This study was conducted to examine if social support, positively associated with preventive health practices, was predictive of Pap screening in a sample of SAI women. We conducted a cross-sectional study with SAI women who recently immigrated to the US. Participants completed a survey to assess ever having had Pap screening and social support using the Medical Outcomes Study Social Support Survey. Among the 108 SAI women in our study, Pap screening uptake was 65.7%. Affectionate and positive social support were each associated with Pap screening [adjusted odds ratio (AOR) = 1.73 (1.05, 2.87) and 1.68 (1.01, 2.78), respectively]. These findings suggest that consideration should be given to strengthening certain aspects of social support to increase uptake of Pap screening among SAI women.

To what extent do age, stage and treatment influence survival after invasive cervical cancer: a French population-based study

In an attempt to understand why cervical cancer (CC) survival is decreasing with diagnosis period among older women in France, this study aimed to estimate the effects of main prognostic factors on net survival in CC according to age. French cancer registries databases were used to retrospectively analyze women diagnosed with CC in 2011-2012. Net survival was estimated with the Pohar-Perme method and prognostic factors (socio-demographic, clinical variables, stage at diagnosis, therapeutic management) were analyzed with Lambert and Royston's flexible parametric model. One thousand one hundred fifty three women with CC were identified. 30.4% were < 45, 41.4% 45-64, and 28.3% ≥ 65 years. Older women were diagnosed at a more advanced stage than younger women: 54.8% regional (FIGO IB2-IVA), 33.0% distant (IVB) in women ≥ 65 years vs 33.7% and 8.0%, respectively in women < 45 years. Half of women with regional stage of CC received recommended treatment; this rate decreased with increasing age (< 45: 66.1%, 45-64: 62.7%, ≥ 65: 29.2%). Older age was significantly associated with increased risk of death: hazard ratio 1.89 for age ≥ 65, as were regional stage (2.81), distant stage (15.99), and not receiving recommended treatment (2.26). Older women with CC diagnosed at advanced stage who do not receive standard of care are at markedly increased risk of death. Special attention to the management of older women is warranted in France, not only to diagnose cancer at an earlier stage (via gynecological follow-up in these menopaused women who remain at risk of CC), but also to ensure they receive standard of care, taking into account their overall state of health.

Secondary peritoneal and retroperitoneal malignancies in the elderly: trends and disparities (1999–2022) with forecasts to 2035 from a national study

Clinical value of serum biomarkers, magnetic resonance imaging risk scoring, and malignancy risk indices in distinguishing benign and malignant ovarian masses: an observational study

Accurate preoperative differentiation between benign and malignant adnexal masses is essential for guiding optimal surgical management. This study aimed to assess the diagnostic performance, calibration, and clinical utility of serum biomarkers (CA-125, CEA), the O-RADS MRI risk score, and Risk of Malignancy Indices (RMI-I-V) in both premenopausal and postmenopausal women. This retrospective study included data from consecutive patients who underwent surgical management for ovarian masses at a rural tertiary care center in Southern India over 2 years. Preoperative ultrasonography, serum CA-125, CEA levels, and O-RADS MRI risk scores were recorded. RMI-I-V were calculated for each case. Statistical analyses included Receiver Operating Characteristic (ROC) curves, calibration plots, and decision curve analysis to assess discrimination and clinical utility across decision thresholds (5-50%). A total of 129 women were evaluated-98 (75.9%) had benign, 5 (3.9%) borderline, and 26 (20.2%) malignant ovarian masses. At recommended cut-offs, all RMI models and serum biomarkers significantly differentiated between benign, borderline, and malignant cases. RMI-IV and RMI-V demonstrated the best sensitivity (92.31%), specificity (90.82% and 92.86%), and negative predictive values (97.80% and 97.85%), whereas CEA showed the poorest sensitivity (23.08%). Calibration was most accurate for RMI-V, with RMI-II and RMI-IV also performing well. Decision curve analysis confirmed the highest net clinical benefit for RMI-II and RMI-IV across thresholds of 5-50%. RMI-based models, especially RMI-IV, demonstrated excellent diagnostic accuracy and clinical utility, supporting their use as a reliable, cost-effective tool for adnexal mass evaluation.

Understanding the genetic epidemiology of hereditary breast cancer in India using whole genome data from 1029 healthy individuals

Sociocultural influences on dietary behavior and meal timing among Native Hawaiian and Pacific Islander women at risk of endometrial cancer: a qualitative investigation

Determine sociocultural influences on dietary behavior, body image, weight loss, and perceptions of the cultural appropriateness of a meal-timing intervention design and menu among Native Hawaiian and Pacific Islander (NHPI) women at risk of endometrial cancer. Six 90-min videoconference focus groups among NHPI women (n = 35) recruited by a community champion in Utah. Eligible women were aged ≥ 18 years at risk of endometrial cancer (i.e., BMI ≥ 25 kg/m Overarching themes included economic factors, cultural influences, meal choice and timing, and perceptions of health. Subthemes included affordability, waste avoidance, inundated schedules, and cultural influences. Perceptions of body size and weight loss were influenced by family, community, and social media, whose messages could be conflicting. Important intervention components included satisfying, convenient pre-made meals, while barriers included the need to cook for family members. Dietary interventions targeting metabolic health among NHPI women should consider the multitude of sociocultural and economic factors that influence food choices and meal timing in this population, including affordability, hectic schedules, and immigrant adjustment. Promoting the link between physical and mental well-being as opposed to weight loss is a key approach to reaching this population.

A preference study for applying mHealth to improve the quality of cervical cancer screening management from a supply and demand perspective: a discrete choice experiment

This study aims to investigate the preferences of women of cervical cancer screening age regarding the use of mobile health (mHealth) technologies in Xinjiang. The purpose is to enhance adherence and acceptance of mHealth applications, thereby improving the quality of cervical cancer screening follow-up for women residing in rural areas of Xinjiang. The attributes and levels were established based on a comprehensive literature review and qualitative interviews. The choice set questionnaire was developed using SAS 9.4 through D-efficiency analysis. The research site was identified using a multi-stage sampling method, and the survey was launched in December 2024. An Optimal Logit model was selected for preference analysis, utilizing Stata 17.0. A total of six attributes were identified through the literature review and subsequently combined with qualitative interviews. The mixed logit regression results indicated that, among the six attributes, five were statistically significant (P < 0.05): mHealth approach, frequency of receiving notifications, reminder content, screening notification time, missionary form, and mission strategy. The results demonstrated a preference for WeChat as the mHealth approach (β = 0.230, P < 0.001, 95%CI 1.214-1.500), not accepting receiving notifications everyday (β = - 0.144, P = 0.001, 95%CI 0.797-0.940), preferred reminders containing positive information (β = 0.159,P = 0.001,95%CI1.068-1.288), opted for screening notifications 1 month in advance (β = 0.208, P < 0.001, 95%CI 1.133-1.339), and preferred the image form of education for missionary form (β = 0.118, P < 0.001, 95%CI 1.102-1.322). A one-size-fits-all approach should be avoided in the design of mHealth solutions to effectively address the diverse needs of individuals with varying preferences, thereby promoting the adoption of mHealth and improving the feasibility of its application.

Adjuvant radiation therapy and health-related quality of life among older women with early-stage endometrial cancer: an analysis using the SEER-MHOS linkage

Radiation therapy (RT) has been associated with decreased health-related quality of life (HRQOL) in clinical trials of early-stage endometrial cancer (EC), but few studies have examined the association in real-world settings. We assessed HRQOL associated with adjuvant RT for older women with early-stage EC within a large U.S. population-based registry resource. The Surveillance Epidemiology and End Results and the Medicare Health Outcomes Survey linkage (1998-2017) was used to identify women with early-stage EC aged ≥ 65 years at survey who received surgery and were diagnosed ≥ 1-year prior (n = 1,140). HRQOL was evaluated with the 36-item Short-Form Health Survey (SF-36) until 2006 and the Veterans RAND 12-Item Health Survey (VR-12) post 2006. Ordinary least squares regression was used to estimate mean difference (MD) in T scores and 95% confidence intervals (CIs) comparing treatment groups (surgery alone, adjuvant external beam radiation therapy [EBRT], or adjuvant vaginal brachytherapy [VBT]) after accounting for confounders using propensity score weighting. Overall, RT was not associated with physical health (MD = 0.97; 95% CI = - 1.13, 3.07) or mental health (MD = - 0.78; 95% CI = - 2.60, 1.05) relative to surgery alone. In analyses by RT type, adjuvant VBT was associated with better general health on the SF-36/VR-12 subscale (MD = 3.59; 95% CI = 0.56, 6.62) relative to surgery alone. No statistically significant associations were observed for adjuvant VBT and physical or mental health, or for adjuvant EBRT and any HRQOL domain. Older women with early-stage EC treated with adjuvant RT did not report worse physical and mental HRQOL scores compared to those treated with surgery alone, though relevant symptoms should be evaluated further to fully understand the disease and treatment specific aspects of the HRQOL.

Outdoor light at night and risk of endometrial cancer in the NIH-AARP diet and health study

Outdoor light at night (LAN) can result in circadian disruption and hormone dysregulation and is a suspected risk factor for some cancers. Our study is the first to evaluate the association between LAN and risk of endometrial cancer, a malignancy with known relationship to circulating estrogen levels. We linked enrollment addresses (1996) for 97,677 postmenopausal women in the prospective NIH-AARP cohort to satellite imagery of nighttime radiance to estimate LAN exposure. Multivariable Cox models estimated hazard ratios (HR) and 95% confidence intervals (95% CI) for LAN quintiles and incident endometrial cancer overall (1,669 cases) and endometrioid adenocarcinomas (991 cases) through follow-up (2011). We tested for interaction with established endometrial cancer risk factors. We observed no association for endometrial cancer overall (HR Our study did not find an association between outdoor LAN and endometrial cancer risk, but was limited by the inability to account for individual-level exposure determinants. Future studies should consider approaches to improve characterization of personal exposures to light.

Systematic review and meta-analysis of studies assessing the relationship between statin use and risk of ovarian cancer

The link between lipid-stabilizing medications and epithelial ovarian carcinogenesis is incompletely understood. Statins may reduce ovarian cancer risk, but results are inconclusive. We conducted a systematic review and meta-analysis of studies reporting associations between statin use and ovarian cancer risk in PubMed. Summary risk ratios (RRs) and confidence intervals (CIs) were calculated. Subgroup analyses by cancer histotype, statin class (lipo- or hydrophilic) and duration of statin use were conducted. Use of individual statins in populations was assessed to determine population-specific differences in statin types. Nine studies with 435,237 total women were included (1 randomized controlled trial (RCT); 4 prospective; 4 case-control). Statin use was associated with a reduced risk of ovarian cancer (RR 0.87, 95% CI 0.74-1.03) and risk was significantly reduced in populations with low pravastatin use (RR 0.83, 95% CI 0.70-0.99). Risk estimates varied by statin class (3 studies; lipophilic: RR 0.88, 95% CI 0.69-1.12; hydrophilic: RR 1.06, 95% CI 0.72-1.57) and cancer histotype (3 studies; serous: RR 0.95, 95% CI 0.69-1.30; clear cell: RR 1.17, 95% CI 0.74-1.86). Long-term use was associated with a reduced risk of ovarian cancer (RR 0.77, 95% CI 0.54-1.10) that further reduced when pravastatin use was low (RR 0.68, 95% CI 0.46-1.01). Between-study heterogeneity was high overall and in subgroups (I Statins may be associated with a reduced risk of ovarian cancer, but the effect likely differs by individual statin, duration of use and cancer histotype. Additional well-powered studies are needed to elucidate important subgroup effects.

Case–control study of endogenous sex steroid hormones and risk of endometrial cancer

Epidemiologic evidence regarding the role of endogenous sex hormones in endometrial cancer etiology remains inconsistent. The objective of this study was to investigate if circulating levels of endogenous estrone, estradiol, sex hormone binding globulin (SHBG), testosterone, and androstenedione are associated with endometrial cancer risk. We conducted a population-based case-control study of 522 incident endometrial cancer cases and 976 population controls, in Alberta, Canada from 2002 to 2006. Study participants completed in-person interviews and provided fasting blood samples. Sex hormone levels were determined by enzyme-linked immunosorbent assays. Higher levels of androstenedione were associated with increased endometrial cancer risk (OR 1.44, 95% CI 1.04-2.02). Endometrial cancer risk in pre- and peri-menopausal women was reduced for the highest versus lowest quartiles of estrone (OR 0.44, 95% CI 0.22-0.88) and estradiol (OR 0.30, 95% CI 0.14-0.65), but in post-menopausal women, the endometrial cancer risk was increased for the highest versus lowest quartile of androstenedione (OR 1.82, 95% CI 1.25-2.65). In addition, endometrial cancer risk in normal/underweight women was decreased for the highest versus lowest quartile of serum SHBG (OR 0.39, 95% CI 0.19-0.84). Overall, positive associations were found for androstenedione concentrations, while sub-group analyses revealed = inverse associations with estrogens and SHBG. Results of this study provide empirical evidence for the role of circulating sex hormones in endometrial cancer etiology and highlight the importance of modifiable factors that contribute to changes in sex hormone concentration levels.

Age at first marriage, menopause status and cervical cancer risk in a middle eastern country: a national cancer registry-based case–control study

Cervical cancer ranks as the fourth leading cause of cancer-related morbidity and mortality among women worldwide. Despite its global significance, evidence on cervical cancer risk factors in Kuwait remains limited. This case-control study aimed to identify factors associated with cervical cancer among women in Kuwait. A total of 50 cervical cancer cases were recruited from the Kuwait Cancer Control Center, and 155 controls were selected from public-sector employees in a 1:3 ratio. Data were collected using a structured questionnaire. Adjusted odds ratios (OR Compared with controls, cases were more likely to have first marriage at a younger age (< 25 vs. ≥ 25 years) (OR Younger age at first marriage, being in menopause, and unawareness of HPV vaccine availability  were independently associated with an increased risk of cervical cancer. These findings should be regarded as preliminary and hypothesis-generating, offering a foundation for further research on this important women's health issue in Kuwait and comparable settings. Larger studies are warranted to confirm these results and to identify additional determinants of cervical cancer risk.

Leveraging the role of families in decision-making to inform a program of HPV-based self-collection for cervical screening in Tamil Nadu, India: a qualitative study

Collectivist cultures often perceive health seeking and decision-making to be less individual and more communal, with most decisions made in consultation with a spouse or other family members. These dynamics are further complicated by heightened cultural sensitivities for women seeking care for reproductive needs. Our study explored community perceptions of cervical screening and recommendations for self-collection for Human Papillomavirus (HPV) testing in south India. We conducted eight focus group discussions (FGDs) with 54 men (mean age 48 years) and 10 FGDs with 67 women (mean age 58 years) belonging to rural, urban poor and tribal communities in Tamil Nadu. We used a framework analysis method for coding using the World Health Organization (WHO) framework for assessing barriers to health service coverage, the Capability Opportunity Motivation-behavior (COM-B) model, and the Theoretical Framework of Acceptability (TFA). Stigma, familial hierarchies, gendered norms and challenges with accessing health facilities contributed to delayed care for women with gynecological symptoms and hindered screening. Both men and women supported the idea of self-collection for their family members, although doubts were raised regarding accuracy, and usefulness for asymptomatic women. Participants suggested group counseling, community-based screening, peer motivation and easily accessible follow-up assessments for ensuring wide coverage. These findings informed the design and implementation of a cervical screening trial using self-collection, in the same locations. Screening programs need to address accessibility and acceptability barriers to cervical screening through family involvement, leveraging family support for the entire screening pathway from screening to follow-up.

Applicability of the levels of the socio-ecological model in the context of cervical cancer prevention: a scoping review

To map the evidence addressing the use of social ecological model (SEM) in cervical cancer (CC) prevention. The Joanna Briggs Institute (JBI) guideline was followed for conducting this scoping review. A search was conducted in thirteen databases, updated in July 2025. Primary quantitative and qualitative studies addressing the use of SEM in CC prevention were included, with no restrictions on time or language. Findings are reported in accordance with the PRISMA-ScR extension for scoping reviews. 80 studies were included. Of these, 56.2% addressed primary prevention, 45% secondary prevention, and 10% tertiary prevention. Regarding SEM levels, 92.5% examined intrapersonal, 86.3% interpersonal, 75% organizational, 67.5% community, and 50% public policy. Overall, 35% addressed all five SEM levels. The barriers to CC prevention include lack of knowledge, low educational level, financial difficulties, lack of trust in healthcare services and professionals, religious and cultural beliefs, fear, absence of professional recommendation and guidance, lack of social and family support, time constraints, limited access to healthcare services, high costs, and lack of health insurance. The facilitators include knowledge and awareness, higher educational level, risk perception, trust in providers and healthcare services, professional recommendation and guidance, social and family support, facilitated access to services, health insurance coverage, and adequate funding. The application of the SEM and the understanding of its multiple levels in the context of CC prevention, as well as the identification of barriers and facilitators, can significantly contribute to the development of targeted interventions and comprehensive strategies aimed at its prevention.

Infertility and Risk of Ovarian Cancer in the Women’s Health Initiative

There is a consistent relationship with greater ovulation frequency and increased risk of ovarian cancer. However, prior research on infertility, which may be associated with ovulation frequency through multiple mechanisms, and ovarian cancer has yielded conflicting results, possibly due to prior research conflating fertility treatment with infertility and restricting follow-up to premenopausal cases. Our objective was to determine the association between infertility and risk of postmenopausal ovarian cancer, overall and by histotype, in a population that had not received treatment with IVF. We utilized data from the Women's Health Initiative (n = 112,925 postmenopausal participants) with over 25 years of follow-up. At baseline, participants were asked whether they had ever tried to become pregnant for more than one year without becoming pregnant and whether a reason was found. Cox proportional hazards models were used to calculate hazard ratios (HRs) of incident adjudicated ovarian cancer comparing participants with a history of infertility to fertile participants overall and by histotype. 17% of participants reported a history of infertility at baseline and 1,109 ovarian cancer cases were diagnosed during follow-up. No statistically significant association was observed between infertility and risk of any ovarian cancer (HR: 1.09, 95% CI 0.92-1.29), but those reporting infertility had a 90% higher risk of endometrioid and clear cell ovarian cancers (HR: 1.90 95% CI 1.09-3.34) compared to fertile participants. The reported reason(s) for infertility had no discernable impact on these associations. Infertility may be associated with clear cell and endometrioid ovarian cancer but not other ovarian tumor histotypes.

The relationship between human papillomavirus (HPV) knowledge and HPV vaccine acceptance among women and affecting factors in Türkiye

The most effective method for preventing cervical cancer is the human papillomavirus (HPV) vaccine, but the vaccine is not included in the national immunization program. This study aimed to investigate the relationship between HPV knowledge and attitudes, intentions and behaviors toward HPV vaccination among Turkish women. This analytical cross-sectional study was conducted in with 320 women aged 18-49 years in Türkiye. Data were collected using the Human Papillomavirus Knowledge Scale (HPV-KS) and the Carolina HPV Immunization Attitudes and Beliefs Scale (CHIAS). Data were analyzed using Mann-Whitney U test, Kruskal-Wallis test, and Bonferroni correction the effects of independent variables (sociodemographic characteristics, vaccination intentions, etc.) on scale scores. Spearman's correlation coefficient was used to investigate the relationship between all total and subscale scores. The backward logistic regression analysis was performed to investigate the effects of all total and subscale scores on HPV vaccination behaviors. Of the participants, 51.2% had knowledge about the HPV vaccine, 90.9% had not been vaccinated against HPV, and 65.9% intended to receive the HPV vaccine. A negative correlation was found between the HPV-KS subscale mean scores and CHIAS subscale mean scores (p < 0.05). As attitudes that perceived HPV vaccine as harmful increased, vaccination behaviors decreased (Z = - 2.326; p = 0.020). Backward logistic regression analysis showed that for every 1-unit increase in "Uncertainty" subscale scores, the uptake of the HPV vaccine decreased by by 54.3% (OR = 0.457; 95% CI 1.015-1.152). Backward logistic regression analysis showed that for every 1-unit increase in "Ineffectiveness" subscale scores, the uptake of the HPV vaccine for yourself/children if it is free decreased by 35.8% (OR = 0.642; 95% CI 0.449-0.197). Women's HPV knowledge and acceptance of vaccination were low. There was a positive correlation between women's HPV knowledge levels and their attitudes and behaviors toward HPV vaccination. HPV awareness should be increased in the community, and HPV vaccines should be integrated into the national immunization program.

Diabetes risk reduction diet and ovarian cancer risk: an Italian case-control study

Abstract Purpose To investigate the relation between a diabetes risk reduction diet (DRRD) and ovarian cancer. Methods We used data from a multicentric case-control study conducted in Italy, including 1031 incident ovarian cancer cases and 2411 controls admitted to hospital centres for acute non-malignant disease. Subjects’ diet prior to hospital admission was collected using a validated food frequency questionnaire. Adherence to the DRRD was measured using a score based on 8 dietary components, giving higher scores for greater intakes of cereal fiber, coffee, fruit, nuts, higher polyunsaturated to saturated fatty acids ratio, lower glycemic index of diet, and lower intakes of red/processed meat, and sweetened beverages/and fruit juices. Higher scores indicated greater adherence to the DRRD. Multiple logistic regression models were fitted to calculate the odds ratios (OR) of ovarian cancer and the corresponding 95% confidence intervals (CI) for approximate quartiles of the DRRD score. Results The DRRD score was inversely related to ovarian cancer, with an OR of 0.76 (95%CI: 0.60–0.95) for the highest versus the lowest quartile of the score (p for trend = 0.022). The exclusion of women with diabetes did not change the results (OR = 0.75, 95%CI: 0.59–0.95). Inverse associations were observed in strata of age, education, parity, menopausal status, and family history of ovarian/breast cancer. Conclusion Higher adherence to a diet aimed at reducing the risk of diabetes was inversely associated with ovarian cancer. Further evidence from prospective investigations will be useful to support our findings.

Evaluating Now I Know mHealth intervention promoting HPV vaccine completion among young women attending federally supported clinics

Abstract Purpose This study evaluated the feasibility, acceptability, usability, and HPV vaccine completion rate of the Now I Know (NIK) mHealth intervention to promote HPV vaccine completion among minority and low-income young women. Methods This quasi-experimental pilot study recruited 35 women aged 18–26 at two federally supported outpatient clinics in a large city in the Northeastern United States. Participants were allocated to two groups: 24 received the NIK intervention plus usual care and 11 received usual care only. After completing a baseline assessment, intervention group participants launched the NIK mobile app, which entailed HPV vaccine education, self-managed vaccine record &amp; reminder, and Q&amp;A features. Follow-up visits were conducted at 2 and 6 months. Feasibility was assessed through screening, recruitment, fidelity, and retention. Acceptability and usability were evaluated via survey and exit interview. The primary outcome—HPV vaccine 3-dose series completion—was analyzed using descriptive statistics. Results This study demonstrated feasibility by reaching the recruitment target (n = 35) and high retention rate (89%). Participants reported the app was acceptable, appreciating reliable information, convenient access, providing a personal touch, and raising awareness. Regarding usability, users found the app easy to navigate, accessible, well organized, and user-friendly. The HPV vaccine completion rate was higher in the intervention group (55%) than in the usual care group (45.5%). Conclusion Findings showed improved vaccination completion among those using the Now I Know mHealth intervention (compared to usual care), acceptability of the intervention, and feasibility of recruiting, retaining, and delivering the intervention to promote HPV vaccine completion among young women in federally subsidized healthcare settings.

The effect of mandala activity on postoperative pain, anxiety, and analgesia use in gynecologic oncology patients: a randomized controlled trial

Abstract Purpose Non-pharmacological complementary therapies in cancer treatment strengthen care. This study aims to investigate the effects of mandala activity on postoperative pain, anxiety level and analgesia use in gynaecological oncology patients. Materials and methods This study is a randomised controlled, two-group pretest/posttest comparative study. The study included 42 patients who underwent open abdominal hysterectomy at a training and research hospital in Istanbul between 1 February and 1 August 2023. Introductory Information Form, Visual Analog Scale (VAS), State-Trait Anxiety Inventory (STAI-I), Postoperative Patient Evaluation Form and Mandala Activity Booklet were used throughout the study. Results Preoperative State Trait Anxiety Inventory (STAI-I) score was significantly higher in the control group (63.48 ± 5.31) compared to the intervention group (56.33 ± 7.65) ( p  &lt; .05). Postoperatively, the STAI-I score of the control group decreased to 47.43 ± 8.29, while the intervention group showed a significant decrease to 31.52 ± 6.73. In addition, the Visual Analog Scale (VAS) scores of the control group decreased from 7.17 ± 1.42 preoperatively to 0.82 ± 1.46 postoperatively, while the intervention group scores decreased from 6.68 ± 2.11 to 1.77 ± 1.79, indicating that mandala activity was significant ( p  &lt; .05). Conclusion In conclusion, this study showed that postoperative mandala activity effectively reduced pain and anxiety levels and influenced the use of analgesia in gynecologic oncology patients.

Sociodemographic inequities in overall survival among younger and older women with cervical cancer

Older Black women and women living in areas of low socioeconomic status (SES) diagnosed with cervical cancer (CC) have worse overall survival (OS). The objective was to investigate associations between OS and race/ethnicity and sociodemographic factors in younger (21-64 years) and older women (≥ 65 years) diagnosed with CC using Surveillance, Epidemiology, and End Results Program data. This retrospective, population-based cohort study included 39,000 women ≥ 21 years diagnosed with CC diagnosed between 2006 and 2020. Age-group stratified Cox proportional hazards models adjusted for age, diagnosis year, and histology examined sociodemographic (rurality, SES, and persistent poverty) differences in OS. In the sample, 82.8% were < 65 years. Compared to younger women, older women were more likely to be non-Latinx (NL) Black (16.0 vs 12.9%) and diagnosed with late-stage CC (67.9 vs 47.5%). Adjusted models suggested younger NL Black women had worse OS than their NL White counterparts (HR 1.45 [95% CI 1.37-1.54]), this association was not found among older NL Black women (HR 1.06 [95% CI 0.96-1.16]). Similarly, younger women in lowest SES areas had worse OS compared to women in highest SES areas (HR 1.82 [95% CI 1.69-1.96]), this association was attenuated in older women (HR 1.27 [95% CI 1.15-1.42]). Finally, younger women living in persistent poverty had worse OS compared to those who did not (HR 1.40 [95% CI 1.32-1.48]), this association was not found in older women (HR 1.10 [95% CI 0.99-1.21]). Sociodemographic disparities were found in CC OS for women < 65 that were attenuated or nonexistent in women ≥ 65 years.

Exploring estrogen-related mechanisms in ovarian carcinogenesis: association between bone mineral density and ovarian cancer risk in a multivariable Mendelian randomization study

Abstract Background Estrogen may play a role in epithelial ovarian cancer (EOC) carcinogenesis, with effects varying by EOC histotype. Measuring women’s long-term exposure to estrogen is difficult, but bone mineral density (BMD) may be a reasonable proxy of longer-term exposure. We examined this relationship by assessing the association between genetic predisposition for higher BMD and risk of EOC by histotype. Methods We used Mendelian randomization (MR) to assess associations between genetic markers for femoral neck and lumbar spine BMD and each EOC histotype. We used multivariable MR (MVMR) to adjust for probable pleiotropic traits, including body mass index, height, menarcheal age, menopausal age, smoking, alcohol intake, and vitamin D. Results Univariable analyses suggested greater BMD was associated with increased risk of endometrioid EOC (per standard deviation increase; lumbar spine OR = 1.21; 95% CI 0.93,1.57, femoral neck: OR = 1.25; 0.99,1.57), but sensitivity analyses indicated that pleiotropy was likely. Adjustment using MVMR reduced the magnitude of estimates slightly (lumbar spine: OR = 1.13; 95% CI 1.00,1.28, femoral neck: OR = 1.18; 1.03,1.36). Results for lumbar spine BMD and high-grade serous EOC were also suggestive of an association (univariable MR: OR = 1.16; 95% CI 1.03,1.30; MVMR: OR = 1.06; 0.99,1.14). Conclusion Our study found associations between genetic predisposition to higher BMD, a proxy for long-term estrogen exposure, and risk of developing endometroid and high-grade serous EOC cancers. These findings add to existing evidence of the relationship between estrogen and increased risk of EOC for certain histotypes.

Racial and socioeconomic disparities in survival among women with advanced-stage ovarian cancer who received systemic therapy

Abstract Purpose The purpose of this study was to assess the association between race/ethnicity and all-cause mortality among women with advanced-stage ovarian cancer who received systemic therapy. Methods We analyzed data from the National Cancer Database on women diagnosed with advanced-stage ovarian cancer from 2004 to 2015 who received systemic therapy. Race/ethnicity was categorized as Non-Hispanic (NH) White, NH-Black, Hispanic, NH-Asian/Pacific Islander, and Other. Income and education were combined to form a composite measure of socioeconomic status (SES) and categorized into low-, mid-, and high-SES. Multivariable Cox proportional hazards models were used to assess whether race/ethnicity was associated with the risk of death after adjusting for sociodemographic, clinical, and treatment factors. Additionally, subgroup analyses were conducted by SES, age, and surgery receipt. Results The study population comprised 53,367 women (52.4% ages ≥ 65 years, 82% NH-White, 8.7% NH-Black, 5.7% Hispanic, and 2.7% NH-Asian/Pacific Islander) in the analysis. After adjusting for covariates, the NH-Black race was associated with a higher risk of death versus NH-White race (aHR: 1.12; 95% CI: 1.07,1.18), while Hispanic ethnicity was associated with a lower risk of death compared to NH-White women (aHR: 0.87; 95% CI: 0.80, 0.95). Furthermore, NH-Black women versus NH-White women had an increased risk of mortality among those with low-SES characteristics (aHR:1.12; 95% CI:1.03–1.22) and mid-SES groups (aHR: 1.13; 95% CI:1.05–1.21). Conclusions Among women with advanced-stage ovarian cancer who received systemic therapy, NH-Black women experienced poorer survival compared to NH-White women. Future studies should be directed to identify drivers of ovarian cancer disparities, particularly racial differences in treatment response and surveillance.

Association between parity and pregnancy-associated tumor features in high-grade serous ovarian cancer

Abstract Purpose High-grade serous ovarian cancer (HGSC) is the most common ovarian cancer subtype. Parity is an important risk-reducing factor, but the underlying mechanism behind the protective effect is unclear. Our aim was to study if the expression of hormones and proteins involved in pregnancy were affected by the woman’s parity status, and if they may be associated with tumor stage and survival. Methods We evaluated expression of progesterone receptor (PR), progesterone receptor membrane component 1 (PGRMC1), relaxin-2, and transforming growth factor beta 1 (TGFβ1) in tumor tissue from 92 women with HGSC parous (n = 73) and nulliparous (n = 19). Key findings were then evaluated in an independent expansion cohort of 49 patients. Survival rates by hormone/protein expression were illustrated using the Kaplan–Meier method. The independent prognostic value was tested by Cox regression, using models adjusted for established poor-prognostic factors (age at diagnosis, FIGO stage, type of surgery, and macroscopic residual tumor after surgery). Results HGSC tumors from parous women were PR positive (≥ 1% PR expression in tumor cells) more often than tumors from nulliparous women (42% vs. 16%; p-value 0.04), and having more children was associated with developing PR positive tumors [i.e., ≥ 3 children versus nulliparity, adjusted for age at diagnosis and stage: OR 4.31 (95% CI 1.12–19.69)]. A similar result was seen in the expansion cohort. Parity status had no impact on expression of PGRMC1, relaxin-2 and TGFβ1. No associations were seen with tumor stage or survival. Conclusion Tumors from parous women with HGSC expressed PR more often than tumors from nulliparous women, indicating that pregnancies might possibly have a long-lasting impact on ovarian cancer development.

Air quality and cancer risk in the All of Us Research Program

Abstract Introduction The NIH All of Us Research Program has enrolled over 544,000 participants across the US with unprecedented racial/ethnic diversity, offering opportunities to investigate myriad exposures and diseases. This paper aims to investigate the association between PM 2.5 exposure and cancer risks. Materials and methods This work was performed on data from 409,876 All of Us Research Program participants using the All of Us Researcher Workbench. Cancer case ascertainment was performed using data from electronic health records and the self-reported Personal Medical History questionnaire. PM 2.5 exposure was retrieved from NASA’s Earth Observing System Data and Information Center and assigned using participants’ 3-digit zip code prefixes. Multivariate logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval (CI). Generalized additive models (GAMs) were used to investigate non-linear relationships. Results A total of 33,387 participants and 46,176 prevalent cancer cases were ascertained from participant EHR data, while 20,297 cases were ascertained from self-reported survey data from 18,133 participants; 9,502 cancer cases were captured in both the EHR and survey data. Average PM 2.5 level from 2007 to 2016 was 8.90 μg/m 3 (min 2.56, max 15.05). In analysis of cancer cases from EHR, an increased odds for breast cancer (OR 1.17, 95% CI 1.09–1.25), endometrial cancer (OR 1.33, 95% CI 1.09–1.62) and ovarian cancer (OR 1.20, 95% CI 1.01–1.42) in the 4th quartile of exposure compared to the 1st. In GAM, higher PM 2.5 concentration was associated with increased odds for blood cancer, bone cancer, brain cancer, breast cancer, colon and rectum cancer, endocrine system cancer, lung cancer, pancreatic cancer, prostate cancer, and thyroid cancer. Conclusions We found evidence of an association of PM 2.5 with breast, ovarian, and endometrial cancers. There is little to no prior evidence in the literature on the impact of PM 2.5 on risk of these cancers, warranting further investigation.

Group concept mapping to develop a salon-based HPV self-collection intervention

Abstract Background Black women in the US face higher cervical cancer mortality rates due to delayed diagnoses linked to lower screening rates. Contributing factors include provider bias, costs, and limited access, particularly affecting women aged 40–64. While innovative approaches like clinical and home-based HPV self-collection exist, equitable dissemination remains challenging. Distributing HPV self-collection kits in unconventional sites like hair salons may offer a solution. Using concept mapping, we gathered community insights to design a salon-based cervical cancer screening intervention. Methods We employed groupwisdom™ and REDCap platforms for community-based participatory intervention development. Participants included members of the Black Community Advisory Council of Tucson (Black CACTus), comprising hairstylists ( n  = 3), salon clients ( n  = 4), and healthcare providers( n  = 3), all identifying as Black women aged 23–53. Concept mapping included: 1) Brainstorming statements, 2) Sorting statements into thematic clusters, 3) Rating importance and feasibility, 4) Reviewing the cluster map, and 5) Evaluating a draft intervention. Results Brainstorming produced 39 statements, forming six clusters: 1) Program Promotion, 2) Insurance, Cost &amp; Benefits, 3) Communication Considerations, 4) Information and Education, 5) Overall Logistics and Process, and 6) Sample Collection. Communication Considerations and Sample Collection were rated most important, with Communication Considerations also ranking highest for feasibility. Communication Considerations, Information and Education, and Sample Collection were the highest rated when importance and feasibility were considered together. Conclusions Engaging community perspectives is essential for adapting cancer screening from clinical settings to community spaces like hair salons. This collaborative concept mapping approach identified strategies to enhance cervical cancer screening access and uptake among Black women.

Molecular mechanisms and differences in lynch syndrome developing into colorectal cancer and endometrial cancer based on gene expression, methylation, and mutation analysis

Abstract Purpose The aim of this study was to screen biomarkers specific to Lynch syndrome (LS) with colorectal cancer (CRC) or endometrial cancer (EC) to explore the mechanisms by which LS develops into CRC and EC and their differences. Methods Differentially expressed or differentially methylated genes and differential mutations were identified in 10 LS, 50 CRC, and 50 EC patients from TCGA, and genes overlapping between LS and CRC or EC (named SGs-LCs and SGs-LEs, respectively) were identified. Afterward, we annotated the enriched GO terms and pathways and constructed a protein–protein interaction (PPI) network. Finally, samples from 10 clinical cases with MSI-H/MSS CRC and EC were collected to verify the mutations and their correlations with five LS pathogenic genes in the SGs-LCs and SGs-LEs. Results A total of 494 SGs-LCs and 104 SGs-LEs were identified and enriched in 106 and 14 GO terms, respectively. There were great differences in the gene count and enriched terms between SGs-LCs and SGs-LEs. In the PPI network, SST , GCG , SNAP25 , and NPY had the highest degree of connection among the SGs-LCs, and KIF20A and NUF2 had the highest degree of connection among the SGs-LE. In the SGs-LCs and SGs-LEs, the genes whose expression levels affected the survival of LS, CRC or EC patients were quite different. Conclusions COL11A1 was found to be mutated in MSS CRC patients, similar to the mutations of MSH6 . SST , GCG , SNAP25 , and NPY may be biomarkers for the development of LS into CRC, and KIF20A and NUF2 may be markers of LS developing into EC.

Association of distance to diagnosis and area-based social measures with stage at diagnosis among Iowans with HPV-related cancers

Abstract Purpose Human papillomavirus (HPV) causes oral and anogenital cancers, the incidence of which is increasing. Late-stage diagnosis is associated with increased mortality. Neighborhood-level characteristics and distance to place of diagnosis may impact timely diagnosis. Being a largely rural state, Iowa presents a unique location to understand the association between distance, neighborhood characteristics, and stage at diagnosis. Methods Data from the Iowa Cancer Registry from 2010 to 2021 were used to identify adults with HPV-associated cancers (cervical, oropharyngeal, vulvar/vaginal, anal/rectal, and penile). Four area based social measures (ABSMs) were used to operationalize neighborhood characteristics: proportion of families living in poverty, proportion of households participating in food stamps, social vulnerability index, and environmental justice index. Distance was measured from the centroid of a person’s census tract to their treatment facility. For each cancer type, we ran four logistic regression models, adjusting for sociodemographic characteristics, to assess associations between distance and each of the ABSMs independently with our outcome, late stage diagnosis. Results Among those with cervical cancer, greater distance to diagnosis was associated with later stage at diagnosis, irrespective of ABSM controlled for. Among those with cervical cancer, greater environmental injustice was associated with later stage at diagnosis (OR = 1.78, 95% CI = [1.02,3.09]). Among those with vulvar/vaginal cancer, greater proportion of families in poverty was associated with earlier stage at diagnosis (OR = 0.31, 95% CI = [0.12, 0.78]). There were no interactions between ABSMs and distance to care. Conclusions It is important to consider ABSMs and distance to care when identifying those at-risk of late-stage diagnosis.

Child caregiving and cancer screening: a nationally representative analysis

Preliminary studies have suggested child caregivers ('caregivers') may experience childcare barriers to cancer screening. The objective of this study was to compare cancer screening adherence among caregivers and non-caregivers in a nationally representative sample. This cross-sectional analysis used 2021-2023 Behavioral Risk Factor Surveillance System survey data. Caregivers were defined as adults 18-65 employed as a 'homemaker' with child(ren) in the home. The primary outcome was colorectal cancer screening adherence, and secondary outcomes were breast and cervical cancer screening adherence. Relative risks (RR) of screening adherence were estimated using regression models adjusting for age, sex, race and ethnicity, income, education, payer status, marital status, employment, language, self-rated health, and year. Models used survey standard error estimation and sampling weights. Sensitivity analyses tested two alternative caregiver definitions: adults 18-65 with child(ren) and employed adults 18-65 with child(ren). There were 1,317,148 participants (weighted: 255,041,726); 2.9% of the weighted sample were caregivers, 95.3% of whom were women. Most caregivers were married or partnered, identified as non-white, and reported <$50,000 for household income. In adjusted analyses, caregiver status was associated with significantly lower rates of colorectal (aRR 0.92, 95% CI 0.85-0.98) and breast (aRR 0.90, 95% CI 0.82-0.98) cancer screening adherence, but not cervical cancer screening adherence (aRR 1.01, 95% CI 0.95-1.09). Sensitivity analyses with alternative caregiver definitions similarly showed lower rates of colorectal and breast cancer screening adherence but not for cervical cancer screening. Caregivers had lower adherence to colorectal and breast cancer screening but not cervical cancer screening, consistent across multiple exposure definitions. Child caregiving may pose barriers to cancer screening.

Fear of cancer levels of women who applied cervical cancer screening: a cross-sectional study of the effects of health beliefs related to cervical cancer and Pap-Smear test

Abstract Background Excessive fear of cancer can be more harmful than the disease itself. Although it is important to address and evaluate this fear, there is a lack of studies providing intervention strategies to effectively reduce cancer-related anxiety. Aim This study aimed to evaluate how health beliefs about cervical cancer and the Pap Smear test influence cancer fear among women participating in a cervical cancer screening program. Methods This was a cross-sectional study. Data were gathered from 210 women who visited a healthy life center for cervical cancer screening. The data collection tools included a personal form, The Health Belief Model Scale for Cervical Cancer and the Pap Smear Test, and the Cancer Worry Scale. Statistical analyses, such as T -tests, ANOVA, and hierarchical linear multiple regression, were conducted using the IBM SPSS software version 23.0. Findings The regression model assessing the impact of the benefits of pap smear tests on cancer worry was not statistically significant ( p  &gt; 0.05). However, when barriers to the pap smear test were added, there was a statistically significant change in R 2 by 0.031 ( p  = 0.012), and including the perceived seriousness of cervical cancer further increased the R 2 value by 0.126, which was statistically significant ( p  = 0.000). Adding susceptibility to cervical cancer and health motivation individually to the model did not lead to a statistically significant change in R 2 ( p  = 0.060, p  = 0.655, respectively). The final model, which included all concepts from The Health Belief Model Scale for Cervical Cancer and the Pap Smear Test, accounted for 15.6% of the variance in cancer worry based on independent variables. Additionally, employed women ( t  = − 2.461, p  = 0.015) and nuclear families ( t  = − 2.554, p  = 0.011) had significantly lower cancer anxiety scores. Conclusion The study indicated that perceived severity and barriers might heighten fear of cancer. These perceptions could be influenced by social environment, media, and language issues related to the meanings of “cancer”. Therefore, oncological care should incorporate culturally sensitive approaches to assess and reduce fear of cancer. Collaboration with public health managers is necessary to develop campaigns that address this issue without inciting fear.

Evaluation of follow-up colposcopy procedures after abnormal cervical screening result across a statewide study in Mississippi

Abstract Purpose Cervical screening is used to detect and treat precancers to prevent invasive cancers. However, successful prevention also requires adequate follow-up and treatment of individuals with abnormal screening results. The aim was to investigate demographics, clinical characteristics, and follow-up status for individuals needing colposcopy after an abnormal screening result. Methods The STRIDES (Studying Risk to Improve DisparitiES) cohort comprises individuals undergoing cervical cancer screening and management at a Mississippi Health Department or University of Mississippi clinic. Follow-up status, demographics, and clinical data were assessed from electronic health records and, if necessary, patient navigation on individuals identified as needing a colposcopy after an abnormal screening. Results Of the 1,458 individuals requiring colposcopy, 43.0% had the procedure within 4 months, 16.4% had a delayed procedure, and 39.5% had no documented colposcopy follow-up, with significant predictors of follow-up identified as age and cytology diagnosis. Individuals 30 + were more likely to have follow up with a colposcopy compared to individuals &lt; 30 years (49% and 38.7%, respectively; p &lt;  .001). Individuals with cytology diagnoses of LSIL (52.9%), ASC-H (51.4%), and HSIL (62.3%) had higher percentages of adherence to follow-up guidelines ( p  &lt; .001). In total, we found that 78% of individuals had some type of follow-up, including a repeat screening visit. Conclusion Despite high cervical cancer screening rates among Mississippians, a substantial proportion did not have adequate next-step intervention. However, it is encouraging that highest risk individuals were more likely to have a colposcopy. Regardless, continuing to understand the underlying causes for incomplete follow-up is crucial for timely secondary targeted interventions to reduce cervical cancer burden, promote awareness, and improve health outcomes.

Sexual orientation and gender identity inequities in cervical cancer screening by race and ethnicity

Abstract Background In the United States, inequities in preventive health behaviors such as cervical cancer screening have been documented. Sexual orientation, gender identity, and race/ethnicity all individually contribute to such disparities. However, little work has investigated their joint impact on screening behavior. Methods Using sampling weighted data from the 2016 and 2018 Behavioral Risk Factor Surveillance System, we assessed differences in two metrics via chi-square statistics: 1) lifetime uptake, and 2) up-to-date cervical cancer screening by sexual orientation and gender identity, within and across racial/ethnic classifications. Results Within all races, individuals who identify as members of sexual and gender minority (SGM) communities reported higher rates of never being screened (except for Black transgender men) than straight or cisgender individuals (p &lt; 0.0001). [*START* Across all races, the Asian/Pacific Islander transgender population (32.4%; weighted n (w.n.) = 1,313) had the lowest proportion of lifetime screening, followed by the Asian/Pacific Islander gay/lesbian (53.0%, w.n. = 21,771), Hispanic transgender (58.7%; w.n. = 24,780), Asian/Pacific Islander bisexual (61.8%, w.n. = 54,524), and Hispanic gay/lesbian (69.6%, w.n. = 125,781) populations. *END*] Straight or cisgender Non-Hispanic White (w.n. = 40,664,476) individuals had the highest proportion of lifetime screening (97.7% and 97.5%, respectively). However, among individuals who had been screened at least once in their lifetime, identifying as SGM was not associated with a decreased proportion of up-to-date screening within or between races. Conclusions Due to small sample sizes, especially among Asian/Pacific Islander and Hispanic populations, confidence intervals were wide. Heterogeneity in screening participation by SGM status within and across racial/ethnic groups were observed. Impact These screening disparities reveal the need to disaggregate data to account for intersecting identities and for studies with larger sample sizes to increase estimate reliability.

A culturally informed model to enhance breast, cervical, and colorectal cancer screenings: perspectives of American Indian adults and healthcare providers in rural New Mexico

Abstract Purpose American Indian/Alaska Native (AI/AN) populations have some of the lowest cancer screening rates compared to other racial/ethnic populations. Using community-based participatory research methods, we sought to characterize knowledge, attitudes, beliefs, and approaches to enhance breast, colorectal, and cervical cancer screening. Methods We conducted 12 focus groups between October 2018 and September 2019 with 96 eligible AI adults and healthcare providers, recruited using non-probability purposive sampling methods from the Zuni Pueblo in rural New Mexico. We used the Multi-level Health Outcomes Framework (MHOF) to conduct a qualitative content analysis identifying mutable systems- and individual- level constructs important for behavior change that we crosslinked with the Community Preventive Services Task Force (CPSTF) recommended evidence-based interventions (EBIs) or approaches. Results Salient systems-level factors that limited uptake of cancer screenings included inflexible clinic hours, transportation barriers, no on-demand service and reminder systems, and brief doctor–patient encounters. Individual-level barriers included variable cancer-specific knowledge that translated into fatalistic beliefs, fear, and denial. Interventions to enhance community demand and access for screening should include one-on-one and group education, small media, mailed screening tests, and home visitations by public health nurses. Interventions to enhance provider delivery of screening services should include translation and case management services. Conclusions The MHOF constructs crosslinked with CPSTF recommended EBIs or approaches provided a unique perspective to frame barriers and promoters of screening utilization and insights for intervention development. Findings inform the development of culturally tailored, theoretically informed, multi-component interventions concordant with CPSTF recommended EBIs or approaches aimed at improving cancer screening.

Dietary patterns linked to gut microbiota and their association with gynecologic cancers: NHANES 2011–2018

The diet-induced gut microbiota (DI-GM) score captures diet quality relevant to microbial health. However, its association with gynecological cancer (GC) remains unclear. The aim of this study was to investigate the association between DI-GM scores and gynecological cancer risk in U.S. women. We analyzed data from 8,512 adult women aged ≥ 20 years from The U.S. National Health and Nutrition Examination Survey (NHANES) 2011-2018. DI-GM scores reflected intake of 14 food groups classified as beneficial or harmful to gut microbial health. Multivariable survey-weighted logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for covariates. Women with GC had significantly lower DI-GM scores than those without (mean 4.7 vs. 5.0; p = 0.031). Higher DI-GM scores were associated with reduced GC risk (adjusted OR per unit increase: 0.92; 95% CI 0.87-0.98; p = 0.011). Participants with DI-GM ≥ 6 had 27% lower odds of GC compared to those with scores 0-3 (p = 0.037). The beneficial component of DI-GM was independently associated with lower GC risk. No significant effect modification was observed in stratified analyses. Greater adherence to a microbiota-friendly diet may lower gynecological cancer risk in women.

The association between body mass index and vulvar and vaginal cancer incidence: findings from a large Norwegian cohort study

Abstract Background There is limited evidence of potential associations between body mass index (BMI) and risk of vulvar and vaginal cancer. We explored these associations in a large cohort of Norwegian women. Methods The analytical dataset included 889,441 women aged 16–75 years at baseline in 1963–1975. Multivariable Cox regression analyses were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between BMI and vulvar and vaginal cancer incidence. Results During 30.1 million person-years of follow-up, 1748 incident vulvar and 408 incident vaginal cancer cases occurred. The HRs (95% CIs) for vulvar cancer for a BMI of 15- &lt; 18.5, 18.5- &lt; 25, 25- &lt; 30, 30- &lt; 35, ≥ 35 were 0.62 (0.38–1.01), 1.00 (reference), 1.23 (1.10–1.40), 1.43 (1.23–1.66) and 1.72 (1.35–2.20, ptrend &lt; 0.001), and per 5 kg/m2 increment was 1.20 (1.13–1.26). The corresponding HRs (95% CIs) for vaginal cancer were 1.05 (0.52–2.15), 1.00, 0.89 (0.71–1.12), 0.95 (0.68–1.34), and 2.01 (1.29–3.13, ptrend &lt; 0.001), respectively, and per 5 kg/m2 was 1.11 (0.99–1.25). The HR (95% CI) per 5 kg/m2 increase in BMI at ages 16–29 was 1.28 (1.07–1.54, n = 250 cases) for vulvar and 1.53 (1.11–2.11, n = 66 cases) for vaginal cancers. The HR (95% CI) per 5 kg/m2 for early-onset (&lt; 50 years age at diagnosis) vulvar cancer was 0.92 (0.66–1.28, n = 87 cases) and 1.70 (1.05–2.76, n = 21 cases) for vaginal cancer. Conclusion These results further support the associations between higher BMI and increased risk of vulvar and vaginal cancers, with suggestive stronger associations between BMI in early adulthood for both cancers and for early-onset vaginal cancer. Further studies are needed to elucidate these findings and investigate the underlying mechanisms.

Survival of epithelial ovarian cancer in Black women: a society to cell approach in the African American cancer epidemiology study (AACES)

Abstract Purpose The causes for the survival disparity among Black women with epithelial ovarian cancer (EOC) are likely multi-factorial. Here we describe the African American Cancer Epidemiology Study (AACES), the largest cohort of Black women with EOC. Methods AACES phase 2 (enrolled 2020 onward) is a multi-site, population-based study focused on overall survival (OS) of EOC. Rapid case ascertainment is used in ongoing patient recruitment in eight U.S. states, both northern and southern. Data collection is composed of a survey, biospecimens, and medical record abstraction. Results characterizing the survival experience of the phase 1 study population (enrolled 2010–2015) are presented. Results Thus far, ~ 650 patients with EOC have been enrolled in the AACES. The five-year OS of AACES participants approximates those of Black women in the Surveillance Epidemiology and End Results (SEER) registry who survive at least 10-month past diagnosis and is worse compared to white women in SEER, 49 vs. 60%, respectively. A high proportion of women in AACES have low levels of household income (45% &lt; $25,000 annually), education (51% ≤ high school education), and insurance coverage (32% uninsured or Medicaid). Those followed annually differ from those without follow-up with higher levels of localized disease (28 vs 24%) and higher levels of optimal debulking status (73 vs 67%). Conclusion AACES is well positioned to evaluate the contribution of social determinants of health to the poor survival of Black women with EOC and advance understanding of the multi-factorial causes of the ovarian cancer survival disparity in Black women.

Disparities in human papillomavirus vaccination uptake across the intersection of disability and sexual orientation

Abstract Purpose Although human papillomavirus (HPV) vaccination provides effective primary prevention against cervical cancer, HPV vaccination rates remain low in the U.S. It is unknown whether women with disabilities and/or LGB + women are likely to experience disparities in HPV vaccination uptake. Methods We used data from the 2014–2022 Behavioral Risk Factor Surveillance System ( N  = 40,401) to estimate HPV vaccination rates among women aged 18–44 years. Adjusted prevalence ratios (aPRs) were estimated using modified Poisson regression models for four subgroups defined by disability status and LGB + status. Analyses were further stratified by age (18–26 years; 27–44 years). Results Overall, only 19% of eligible women had received at least one dose of the HPV vaccine, and 12% had completed the full series. Younger women were more likely than older women to have been vaccinated. Compared with heterosexual women without disabilities, heterosexual women with disabilities, had lower vaccination uptake (heterosexual with disabilities: aPR = 0.95; 95% CI 0.93–0.97; LGB + with disabilities: aPR = 0.97; 95% CI 0.96–0.98), and were 12% less likely to complete the series (heterosexual with disabilities: aPR = 0.88; 95% CI 0.83–0.93). Conclusion HPV vaccination rates remain low, representing missed opportunities for primary prevention. Women with disabilities had lower vaccination rates than women without disabilities and were less likely to complete the vaccine series. These findings, combined with age-stratified results, highlight the need for stronger catch-up campaigns and targeted efforts to address structural barriers related to disability, ultimately improving HPV vaccination coverage and reducing the burden of cervical cancer.

The impact of in-house pathology services on downstaging cervical cancer in Tanzania over an 18-year period

Reducing time between cancer screening, diagnosis, and initiation of treatment is best achieved when services are available in the same hospital. Yet, comprehensive cancer centers are typically unavailable in low- and middle-income countries (LMICs), where resources are limited and services scattered. This study explored the impact of establishing an in-house pathology laboratory at the largest public cancer hospital in Tanzania on the downstaging of cervical cancer. We examined clinical datasets of 8,322 cervical cancer patients treated at the Ocean Road Cancer Institute (ORCI). The first period included patients treated from 2002 to 2016, before establishment of the pathology laboratory at ORCI; the second period (post-pathology establishment) included data from 2017 to 2020. Logistic regression analysis evaluated the impact of the pathology laboratory on stage of cervical cancer diagnosis. Patients treated during the post-pathology period were more likely to be clinically diagnosed at earlier disease stages compared to patients in the pre-pathology period (pre-pathology population diagnosed at early disease stage: 44.08%; post-pathology population diagnosed at early disease stage: 59.38%, p < 0.001). After adjustment for age, region of residence, and place of biopsy, regression results showed patients diagnosed during the post-pathology period had higher odds of early stage cervical cancer diagnosis than patients in the pre-pathology period (OR 1.35, 95% CI (1.16, 1.57), p < 0.001). Integrated and comprehensive cancer centers can overcome challenges in delivering expedited cervical cancer diagnosis and treatment. In-house pathology laboratories play an important role in facilitating timely diagnosis and rapid treatment of cervical and possibly other cancers in LMICs.

Racial and ethnic disparities in the overall survival of women with epithelial ovarian cancer in Florida, 2001–2015

Many studies have focused on white and black disparities in epithelial ovarian cancer (EOC) but fewer include Hispanics. Florida presents a unique opportunity to study racial/ethnic disparities. This study examined racial/ethnic disparities in the overall survival of women with EOC in Florida by histology. All EOC cases from 2001 through 2015 were identified in the Florida Cancer Database System (FCDS). Survival curves by race/ethnicity and histology were generated by Kaplan-Meier methods. Cox regression evaluated the associations between race/ethnicity, histology, and survival. Eligible EOC cases (n = 21,721) identified in the 2001-2015 FCDS were included in the study. The median survival for non-Hispanic whites (NHWs), non-Hispanic blacks (NHBs), and Hispanics was 31, 21, and 35 months, respectively (p < 0.001). NHB had an increased [AHR 1.23 (95% CI 1.15, 1.30)] and Hispanics a nonsignificant decreased hazard [AHR 0.96 (95% CI 0.91, 1.02)] of death compared to NHW after controlling for other demographic, treatment, and tumor characteristics. Relative to NHWs, NBH had worse survival while Hispanics had equivalent survival. Future research should consider evaluating genetic and epigenetic modifications, and prevalence of cancer syndromes to further elucidate the etiologies of disease in these disparate populations.

Lifestyle factors affecting the prognosis of gynecological cancer: systematic review and meta-analysis

This systematic review and meta-analysis aimed to identify key lifestyle factors influencing gynecologic cancer prognosis, focusing on recurrence prevention and mortality reduction. A comprehensive literature search was conducted in PubMed, Scopus, and CINAHL databases. Twenty cohort studies were included, yielding 152 analytical results. The Newcastle-Ottawa Scale was used for quality assessment. Hazard ratios (HR) with 95% confidence intervals were extracted, and random-effects models were applied when significant heterogeneity was present. Age (HR 1.58), body mass index (HR 1.18), marital status (HR 1.25), menopausal status (HR 1.44), physical activity (HR 0.91), and race (HR 1.55) significantly influenced gynecologic cancer prognosis. Dairy consumption (HR 1.29) was associated with adverse outcomes, while fruit (HR 0.78) and vegetable intake (HR 0.82) were correlated with improved survival. Diabetes (HR 1.50) and smoking (HR 1.56) were associated with poorer outcomes. This study highlights the significant impact of modifiable lifestyle factors on gynecologic cancer prognosis. Integrating personalized lifestyle interventions into cancer care may improve patient outcomes and survival rates.

HPV self-sampling among women in the United States: preferences for implementation

With the inclusion of primary HPV testing in 2018 U.S. Preventive Services Taskforce guidelines, at-home HPV self-sampling may provide a future option for cervical cancer screening, especially among hard-to-reach populations in the U.S. This study evaluated the association of implementation preferences with the willingness of at-home HPV self-sampling. We conducted a cross-sectional study in 2018 among U.S. women ages 30-65 years, without a hysterectomy (n = 812). The outcome was willingness to have at-home HPV self-sampling (yes/no). Primary predictor variables (i.e., information source, methods of payment, methods of sending or receiving self-sampling kits) measured self-sampling implementation preferences. Adjusted logistic regression identified associations with willingness to have at-home HPV self-sampling. Participants who preferred receiving information from healthcare providers (OR = 2.64; 95% CI 1.54,4.52) or from media or other sources (OR = 2.30; 95% CI 1.51,3.48) had higher HPV self-sampling willingness than participants who did not prefer those sources. Participants who did not want to pay for self-sampling (OR = 0.21; 95% CI 0.14,0.32) or did not know if they would pay for self-sampling (OR = 0.35; 95% CI 0.22,0.54) had lower odds of HPV self-sampling willingness compared to participants willing to pay. Participants who did not know which method they preferred for receiving a self-sampling kit (OR = 0.15, 95% CI 0.07,0.31) or preferred delivering the sample to the lab themselves (OR = 0.59; 95% CI 0.36,0.96) had lower odds for self-sampling willingness compared to participants who preferred the mail. Understanding the preferences of women regarding the implementation of HPV self-sampling can improve uptake in cervical cancer screening, especially among hard-to-reach populations.

Cancer screening utilization by residence and sexual orientation

Although few studies have examined screening uptake among sexual minorities (lesbian, gay, bisexual, queer), almost none have examined it in the specific context of rural populations. Therefore, our objective was to assess how cancer screening utilization varies by residence and sexual orientation. Publicly available population-level data from the 2014 and 2016 Behavioral Risk Factor Surveillance System were utilized. Study outcomes included recommended recent receipt of breast, cervical, and colorectal cancer screening. Independent variables of interest were residence (rural/urban) and sexual orientation (heterosexual/gay or lesbian/bisexual). Weighted proportions and multivariable logistic regressions were used to assess the association between the independent variables and the outcomes, adjusting for demographic, socioeconomic, and healthcare utilization factors. Rates for all three cancer screenings were lowest in rural areas and among sexual minority populations (cervical: rural lesbians at 64.8% vs. urban heterosexual at 84.6%; breast: rural lesbians at 66.8% vs. urban heterosexual at 80.0%; colorectal for males: rural bisexuals at 52.4% vs. urban bisexuals at 81.3%; and colorectal for females: rural heterosexuals at 67.2% vs. rural lesbians at 74.4%). In the multivariate analyses for colorectal screening, compared to urban heterosexual males, both rural gay and rural heterosexual males were less likely to receive screening (aOR = 0.45; 95% = 0.24-0.73 and aOR = 0.79; 95% = 0.72-0.87, respectively) as were rural heterosexual females (aOR = 0.87; 95% = 0.80-0.94) compared to urban heterosexual females. For cervical screening, lesbians were less likely to receive screening (aOR = 0.62; 95% = 0.41-0.94) than heterosexuals, and there were no differences for breast screening. We found that rural sexual minorities may experience disparities in cancer screening utilization associated with the compounding barriers of rural residence and sexual minority status, after adjusting for demographic, socioeconomic, and healthcare utilization factors. Further work is needed to identify factors influencing these disparities and how they might be addressed.

Evaluating the implementation of cervical cancer screening programs in low-resource settings globally: a systematized review

Abstract Purpose Cervical cancer disproportionately burdens low-resource populations where access to quality screening services is limited. A greater understanding of sustainable approaches to implement cervical cancer screening services is needed. Methods We conducted a systematized literature review of evaluations from cervical cancer screening programs implemented in resource-limited settings globally that included a formal evaluation and intention of program sustainment over time. We categorized the included studies using the continuum of implementation research framework which categorizes studies progressively from “implementation light” to more implementation intensive. Results Fifty-one of 13,330 initially identified papers were reviewed with most study sites in low-resource settings of middle-income countries (94.1%) ,while 9.8% were in low-income countries. Across all studies, visual inspection of the cervix with acetic acid (58.8%) was the most prevalent screening method followed by cytology testing (39.2%). Demand-side (client and community) considerations were reported in 86.3% of the articles, while 68.6% focused scientific inquiry on the supply side (health service). Eighteen articles (35.3%) were categorized as “Informing Scale-up” along the continuum of implementation research. Conclusions The number of cervical cancer screening implementation reports is limited globally, especially in low-income countries. The 18 papers we classified as Informing Scale-up provide critical insights for developing programs relevant to implementation outcomes. We recommend that program managers report lessons learnt to build collective implementation knowledge for cervical cancer screening services, globally.

Prevalence of HPV and pathological changes among women 70 years of age, 10 years after exclusion from the Swedish cervical cancer screening program

Abstract Purpose Örebro County introduced an updated screening program 2016 with primary HPV test for women over 30 years and prolonged screening, increasing the cut-off age from 56–60 to 64–70. The aim of this study was to investigate the prevalence of HPV genotypes and their correlation to histological changes in women, 10 years after exclusion from the screening program, due to an eventual implementation of a catch-up program including all women aged 60–70. Methods All women in Örebro County, born 1,946 (n = 1,968), were invited to a liquid-based cell sample with primary HPV screening. Samples were analyzed for hrHPV mRNA and positive samples were genotyped. hrHPV positive women were offered to do a conization. Results Out of 809 participants, 31 (3.8%) were hrHPV positive, of these 22 did a conization. Histologically, 5/22 (23%) had LSIL and 5/22 (23%) had HSIL. Normal histology was found in 12/22 (55%). The most prevalent genotypes were HPV 16, 33, 52, 56, and 68. Of the women with HSIL, one case of cervical cancer was confirmed in a recone biopsy after 4 months. Conclusion The study showed considerable prevalence of hrHPV and histologically confirmed LSIL/HSIL. These data led to catch-up screening for women between 60 and 70 years when overlapping two screening strategies.

The eligibility and reach of the national breast and cervical cancer early detection program after implementation of the affordable care act

The uninsured rate declined following passage of the Affordable Care Act in 2010. It is unclear how this decrease affected the size of the population eligible for existing safety net programs. We evaluated trends in the number of women eligible for breast and cervical cancer screening and diagnostic services under the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) and the reach of the program. Using the Census Bureau's Small Area Health Insurance Estimates data, we calculated the number of women who met the NBCCEDP eligibility criteria based on age, income, and insurance status. We used these data in conjunction with program to estimate the proportion of eligible women served by the NBCCEDP. The number of women eligible for breast cancer screening and diagnostic services under the program declined from 5.4 (90% CI 5.2-5.6) to 2.8 (90% CI 2.6-3.0) million from 2011 to 2017. The number of women eligible for cervical cancer screening and diagnostic services declined from 10.3 (90% CI 10.0-10.6) to 5.3 (90% CI 5.1-5.6) million. The share of eligible women served by the program was 15.0% (90% CI 14.8-15.1%) for breast services in 2016-2017 and 6.8% (90% CI 6.7-6.8%) for cervical services in 2015-2017. Insurance coverage expansions may have contributed to a decrease in the number of program-eligible women. There are many more women eligible for the program than are served.

The impact of absent vulvar cancer screening guidelines on outcomes of vulvar squamous cell carcinoma: a national cancer database study

Abstract Purpose To analyze current vulvar squamous cell carcinoma (VSCC) data with respect to age groups and determine if gynecologic cancer screening guidelines address the burden of VSCC on the ≥ 65 cohort. Methods Patient data from 2004 to 2021 was identified from the National Cancer Database using ICD-10 codes specific for the vulva, and ICD-O-3 histology codes for squamous cell carcinoma or premalignant vulvar intraepithelial neoplasia Grade III. GraphPad Prism and IBM SPSS were used to analyze variable frequency with cross analysis. Chi-squared tests, Kaplan–Meier survival curves with log-rank comparison, and Cox proportional hazard regression models were utilized for statistical analysis. For regression models of hazard ratios (HRs) and odds ratios (ORs), the 50–64-year-old cohort was used as a reference variable. Results The patient population was 68,153. Mean overall survival decreased as age increased (≤ 49 years old was 184.9 months, 50–64 years old was 152.1 months, 65–74 years old was 107.3 months, and ≥ 75 years old was 57.7 months). The ≥ 75-year-old cohort had a 330% higher risk of mortality when compared to the reference variable (HR 4.3, p  &lt; 0.001), followed by the 65–74-year-old cohort (HR 1.96, p  &lt; 0.001). The ≥ 75 years old and 65–74-year-old cohorts had the highest likelihood of advanced VSCC (OR 1.91, p  &lt; 0.001 and OR 1.37, p  &lt; 0.001, respectively). Conclusions Patients ≥ 65 years old are significantly more likely to experience worse survival outcomes and higher stage diseases, indicating that a lack of screening protocols may influence VSCC outcomes.

Knowledge of, and beliefs about, access to screening facilities and cervical cancer screening behaviors among low-income women in New Jersey

Racial/ethnic disparities in cancer outcomes have been well documented. Access to Pap testing may account for some of the variation in the racial and socioeconomic differences in cervical cancer outcomes. Literature exploring perceived access to care as it relates to women of color and low-income women is lacking. The goal of the study was to evaluate and characterize the relationship between what respondents believe about access to free/low-cost screening facilities and screening behaviors among low-income women in New Jersey. We used multivariate logistic regression to investigate belief about access to affordable screening on cancer screening behaviors using data from a cross-sectional study of low-income women in New Jersey (n = 430). Having had a Pap test in the past 3 years was inversely associated with age (OR 0.94, 95% CI 0.92-0.97) and was positively associated with having had insurance in the previous 2 years (OR 32.48. 95% CI 1.04-5.91), higher perceived risk of cervical cancer (OR 2.59, 95% CI 1.29-5.66), and knowing where to go to get a check-up that includes a cancer test (OR 1.97, 95% CI 1.11-3.49). These results suggest that insurance status continues to be a predictor of screening behavior but also that perceived risk awareness of where to go to get cancer screenings in general may influence the likelihood of utilizing screening, which can be important in developing targeted prevention strategies.

Method of detection, determinants and subsequent treatments for breast, cervical and prostate cancers in Edo–Benin, Nigeria

Abstract Purpose This study sought to describe the methods of detection (MOD), their determinants and association with type of treatments received for breast, cervical and prostate cancers using a population-based cancer registry in Nigeria. Methods The study analyzed incident breast (n = 205), cervical (n = 147), and prostate (n = 250) cancers from the Edo–Benin Cancer Registry (EBCR) from 2016 to 2018. The MOD was assigned as health check-up detected or clinically detected. Case proportion ratios (CPR) were used to compare MOD across determinant levels. Statistical association between demographic determinants and MOD were assessed using binomial regression. Results Among the cancers recorded by the EBCR, 46% of breast (n = 205), 43% of cervical (n = 146), and 50% of prostate (n = 250) cases were identified through health check-ups. MOD was not significantly linked to age or marital status. Health check-ups were less common in those with less than tertiary education [breast, CPR 0.61 (95% CI 0.46–0.80), cervical, CPR 0.73 (95% CI 0.49–1.08), prostate, CPR 0.64 (95% CI 0.50–0.82)]. Significantly, more cancers detected via health check-ups were assigned to palliative care compared to clinical detection (breast: 76% vs. 58%, cervical: 80% vs. 59%, prostate: 83% vs. 64%). Conclusion Health check-up campaigns are a key source of new cases in EBCR, but cancers detected through them are more often assigned to palliative care than those detected clinically. The findings suggest that efforts at early detection are not expressed in treatments assignment. Pre-symptomatic individuals should be encouraged to participate in health check-ups and proper treatment made available to improve these programmes.

Every move matters: physical activity, walking, sedentary behavior, and endometrial cancer survival

Excess body fat increases endometrial cancer risk, and moderate-to-vigorous physical activity (MVPA) lowers risk, but the relationship between post-diagnosis MVPA, walking, sedentary time (SED), and endometrial cancer survival is under-researched. Cancer Prevention Study-II participants self-reported post-diagnosis MVPA (MET hour/week, h/wk), walking (h/wk), and SED (h/wk). Meeting MVPA guidelines was defined as 7.5 to 6 h/wk. SED was divided into tertiles (T1-T3). Hazard ratios and 95% confidence intervals (HR, CI) are calculated using delayed-entry Cox models, adjusted for covariates. We identified 1016 endometrial cancer survivors (mean BMI: 27.6, age at diagnosis: 72 years, 97% White, 71% college educated, 93% married). Over an average 13.5 years of follow-up, 511 deaths occurred (232 any cancer, 60 endometrial cancer). Compared to no MVPA, associations were not statistically significant, but point estimates suggest that higher amounts of MVPA [measured on average 1.2-year post-diagnosis] are potentially associated with lower all-cause mortality risk [doubling guidelines (HR: 0.71, 95% CI 0.50, 1.00)] but not total cancer mortality risk. Walking <2 h/wk was associated with higher all-cause mortality risk compared to no walking (HR: 1.45, 95% CI: 1.08, 1.96) but not cancer mortality risk. Limiting SED was not associated with survival. This study suggests that higher amounts of MVPA may be associated with survival among older endometrial cancer survivors; however, further research is needed in larger/pooled cohorts with more cancer deaths.

Lymphedema self-assessment among endometrial cancer survivors

Lower extremity lymphedema (LEL), which causes ankle, leg, and feet swelling, poses a significant challenge for endometrial cancer survivors, impacting physical functioning and psychological well-being. Inconsistent LEL diagnostic methods result in wide-ranging LEL incidence estimates. We calculated the cumulative incidence of LEL based on survivor-reported Gynecologic Cancer Lymphedema Questionnaire (GCLQ) responses in addition to survivor- and nurse-reported leg circumference measurements among a pilot sample of 50 endometrial cancer survivors (27 White, 23 Black) enrolled in the ongoing population-based Carolina Endometrial Cancer Study. Self-leg circumference measurements were perceived to be difficult and were completed by only 17 survivors. Diagnostic accuracy testing measures (sensitivity, specificity, positive and negative predictive value) compared the standard nurse-measured Our findings emphasize the need for high quality measurements of LEL that are feasible for epidemiologic study designs among endometrial cancer survivors. Future studies should use patient-reported survey measures to assess lymphedema burden and quality of life outcomes among endometrial cancer survivors.

Prospective cohort of pre- and post-diagnosis alcohol consumption and cigarette smoking on survival outcomes: an Alberta Endometrial Cancer Cohort Study

To examine the independent and joint relationships between cigarette smoking and alcohol consumption with survival outcomes after endometrial cancer diagnosis. Pre- and post-diagnosis smoking and drinking histories were obtained from endometrial cancer survivors diagnosed between 2002 and 2006 during in-person interviews at-diagnosis and at ~ 3 years post-diagnosis. Participants were followed until death or January 2022. Multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated with Cox proportional hazards regression for associations with disease-free survival (DFS) and overall survival (OS). During a median 16.9 years of follow-up (IQR = 15.5-18.1 years), 152 of the 540 participants had a DFS event (recurrence: n = 73; deaths: n = 79) and 134 died overall. Most participants in this cohort were current drinkers (pre = 61.3%; post = 64.7%) while few were current cigarette smokers (pre = 12.8%; post = 11.5%). Pre-diagnosis alcohol consumption was not associated with survival, yet post-diagnosis alcohol intake ≥ 2 drinks/week was associated with worse OS compared with lifetime abstention (HR = 2.36, 95%CI = 1.00-5.54) as well as light intake (HR = 3.87, 95% CI = 1.67-8.96). Increased/consistently high alcohol intake patterns were associated with worse OS (HR = 2.91, 95% CI = 1.15-7.37) compared with patterns of decreased/ceased intake patterns after diagnosis. A harmful dose-response relationship per each additional pre-diagnosis smoking pack-year with OS was noted among ever smokers. In this cohort, smoking and alcohol individually were not associated with DFS and combined pre-diagnosis smoking and alcohol intakes were not associated with either outcome. Endometrial cancer survivors with higher alcohol intakes after diagnosis had poorer OS compared with women who had limited exposure. Larger studies powered to investigate the individual and joint impacts of cigarette smoking and alcohol use patterns are warranted to provide additional clarity on these modifiable prognostic factors.

Impact of an educational tool on young women’s knowledge of cervical cancer screening recommendations

Abstract Purpose Current cervical cancer screening guidelines recommend 3-year screening intervals, in contrast to the previous recommendation of annual screening, to prevent over screening and overtreatment. We evaluated the impact of viewing a tablet-based educational tool prior to seeing a clinician on young women’s knowledge and understanding of cervical cancer screening, HPV vaccination follow-up of abnormal pap smears, and comfort in communicating with their providers. Methods This cross-sectional study was part of a cluster-randomized study of fourteen primary care clinics from January 2015 to December 2016. We developed the cervical cancer education tool in English and Spanish using a community-based approach that included formative work and cognitive interviewing. Clinics were randomized to use the intervention (tablet-based patient education tool) or to participate as a control group. We administered surveys to a convenience sample of 229 English- or Spanish-speaking women aged 19 to 35 years in these clinics. We used descriptive analyses and logistic regression models with cluster-robust standard errors to compare differences among the two groups. Results Compared to women seen in control clinics, women seen in intervention clinics demonstrated greater knowledge regarding human papilloma virus (HPV (p = 0.004) and understanding (p &lt; 0.001) of cervical cancer screening. Comfort in communicating with providers was not statistically different (p = 0.053). Women in the intervention group felt that the tool helped them understand that an abnormal Pap smear does not require immediate treatment (61.5%). Conclusion Innovative online patient education that is offered prior to patients’ interaction with their clinicians can improve their knowledge about cervical cancer prevention and treatment.

Endometrial cancer risk after fertility treatment: a population-based cohort study

Using data from a large population-based cohort of women with fertility problems in Denmark, we examined the association between use of fertility drugs and endometrial cancer incidence. Women aged 20-45 years living in Denmark during 1 January 1995-31 December 2017 and diagnosed with fertility problems (i.e., subfertile women) were identified from the Danish Infertility Cohort. Information on use of fertility drugs, endometrial cancer, covariates and vital status was obtained from various Danish national registers. Cox proportional hazard models were used adjusted for calendar year of study entry, highest level of education, parity status, hormonal contraceptive use, obesity and diabetes mellitus. Of the 146,104 subfertile women, 129,478 (88.6%) were treated with fertility drugs. During a median follow-up of 10.1 years, 119 women were diagnosed with endometrial cancer. Use of any fertility drugs was not associated with an increased rate of overall (HR 0.82; 95% CI 0.50-1.34) or type I endometrial cancer (HR 1.08; 95% CI 0.60-1.95). No associations between use of specific types of fertility drugs and endometrial cancer were observed. No marked associations were observed according to cumulative dose of specific fertility drugs, parity status, or with increasing follow-up time. No marked associations between use of fertility drugs and risk of endometrial cancer were observed. The relatively young age of the cohort at end of follow-up, however, highlights the need for longer follow-up of women after fertility drug use.

Joint associations of physical activity and body mass index with the risk of established excess body fatness-related cancers among postmenopausal women

Excess body fatness and physical activity independently influence the risk of several types of cancer. However, few studies have examined whether physical activity mitigates the excess risk associated with higher body mass index (BMI). We examined the individual and joint associations between BMI (kg/m BMI and MVPA were individually associated with breast and endometrial cancer risk, but only BMI was associated with colon cancer risk. In joint analyses, increasing levels of MVPA did not lower the risk of these cancers among obese women. For example, compared to the common referent (BMI 18.5- < 25 kg/m Our results do not support the hypothesis that leisure-time physical activity mitigates the excess risk associated with higher BMI for risk of breast, endometrial, or colon cancer among postmenopausal women.