Cancer Control

“Correcting Misinformation is Challenging”: Exploring Barriers and Facilitators of Health Care Providers’ Responsiveness to Cervical Cancer Screening Literacy Needs of Rural Women Living With HIV in Eastern Uganda

Introduction Cervical cancer screening literacy among rural women living with HIV (WLHIV), the ability to access, understand, appraise, and apply cervical cancer screening information to use cervical cancer screening services, is affected by individual factors including low educational attainment, low socioeconomic status, poor cervical cancer risk perception, fear, misconceptions, and beliefs, as well as interpersonal, community, and health facility barriers. However, rural public health facilities have limited resources that limit their ability mitigate these challenges. This research identified barriers and facilitators of healthcare providers’ responsiveness to cervical cancer screening literacy needs of rural WLHIV in Eastern Uganda. Methods This was a descriptive qualitative study that involved conducting 15 Key Informant Interviews with all individuals involved in planning, communicating, and providing cervical cancer screening services at 4 purposively selected rural public health facilities in Eastern Uganda. Data were collected using a guide developed based on the organizational Health Literacy responsiveness framework. This framework was used to derive deductive categories (domains and sub-domains) during thematic analysis, and barriers and facilitators were inductively identified from the interviews. Results Barriers included non-involvement of health workers and affected women in planning, limited funding, few trained health workers, long waiting times, limited space, limited communication modalities, inadequate Information Education and Communication (IEC) materials, IEC materials not translated to the local language, challenges with addressing misconceptions, and language barriers. Facilitators included support from implementing partners, free cervical cancer screening services, integration of cervical cancer screening into HIV care, consumer-centered care, clear pathways and navigation support, using peers during health education, availability of IEC materials, using simple, local language during education sessions, and health worker facilitation. Conclusion Strategies targeted at the identified factors can improve health care providers’ responsiveness to the cervical cancer screening literacy needs of rural WLHIV in Eastern Uganda.

Cervical Cancer Screening Utilization and Barriers to Uptake in Ethiopia: An Umbrella Review

Background Cervical cancer (CCa) is the second most common type of cancer and a leading cause of death among adult women in Ethiopia. However, at the moment, there is a lack of evidence that can be generalizable as a whole to the country regarding the uptake of cervical cancer screening. Objective The aim of this review was to assess the pooled estimated uptake of CCa and to identify the major barriers to cervical cancer screening (CCS) uptake among adult women in Ethiopia. Method The review protocol was registered at the International Prospective Register of Systematic Reviews (PROSPERO) with a registration number of CRD42022353954. The data were searched electronically using Google Scholar, PubMed, Medline, and Web of Science search engines. The heterogeneity of the literature was assessed using Cochran’s (Q) test and Higgin’s and Thomson’s (I 2 ) statistic. The Rosenthal approach, Fail-safe N method, Egger’s test with a P-value <0.05, and funnel plot symmetry were used to detect publication bias. Random effect analysis was used to find out the pooled effect size. The Stata 17 software was used to perform analysis. Result The pooled estimated uptake of CCS was 13.08% (POR 13.08; 95% CI: 10.24, 15.93; I 2 = 81.93%). Common factors associated with uptake of CCS were adequacy of knowledge (POR = 3.48; 95% CI: 2.74, 4.23; I 2 = 0%), attitudes of women (POR = 3.51; 95% CI: 2.96, 4.07; I 2 = 0%), and perceived susceptibility (POR = 4.03; CI: 2.68, 5.39; I 2 = 46.38%). A slightly high degree of overlap of studies was observed. Conclusion and Recommendation The pooled estimated CCS is low. Factors like adequacy of knowledge of CCa, attitudes of women, and perception of susceptibility among women showed a significant association with cervical cancer screening uptake. Creating a platform where women can get adequate and focused information about cervical cancer and screening is crucial.

Gene Signatures and Prognostic Values of m6A RNA Methylation Regulators in Ovarian Cancer

Background: N6-methyladenosine (m6A) is the most common form of mRNA modification under the field of “RNA epigenetics.” However, its role in ovarian cancer (OC) development is poorly understood. In the current study, we aimed to identify gene signatures and prognostic values of m6A RNA methylation regulators. Method: Specifically, we downloaded Mutations and Copy number variant (CNV) data from the TCGA database for 579 OC patients, then analyzed gene expression and prognosis value using integrative bioinformatics. Thereafter, we verified the related biological processes of Wilms’ tumor 1-associating protein (WTAP) gene using Gene set enrichment analysis (GSEA). Results: Results showed that almost all ovarian cancer patients (99.31%) have CNVs with at least 1 m6A regulatory gene, whereas 83.76% of cases exhibited concurrence of CNVs in more than 4 m6A regulatory genes. Additionally, alteration of m6A regulators was associated with historical grade, whereas integrative bioinformatics and Cox multivariate model analysis revealed a significant correlation between high WTAP expression and worse ovarian cancer outcomes. Moreover, GSEA revealed that high WTAP expression was associated with cell cycle regulation and MYC targets. Conclusion: Overall, our findings demonstrate the significance of high-frequency genetic alterations of m6A RNA methylation regulators and WTAP’s poor prognosis value in OC. These findings provide valuable insights into the role of m6A methylation in OC, and will be vital in guiding development of novel treatment therapies.

Significance of p53-Binding Protein 1 Nuclear Foci in Cervical Squamous Intraepithelial Lesions: Association With High-Risk Human Papillomavirus Infection and P16INK4a Expression

As p53-binding protein 1 (53BP1) localizes to the sites of DNA double-strand breaks and rapidly forms nuclear foci (NF), and its presence may be an indicator of endogenous genomic instability (GIN). We previously showed that 53BP1 NF in cervical cells increase with neoplastic progression, indicating the significance of 53BP1 expression for the estimation of malignant potential during cervical carcinogenesis. This study aimed to further elucidate the impact of 53BP1 expression as a biomarker for cervical squamous intraepithelial lesion (SIL). A total of 81 tissue samples, including 17 of normal cervical epithelium, 22 of cervical intraepithelial neoplasia (CIN) 1, 21 of CIN2, and 21 of CIN3, from patients positive for high-risk human papillomavirus (HR-HPV) were used for double-label immunofluorescence of 53BP1 and Ki-67/p16INK4a expression and HR-HPV in situ hybridization. We analyzed associations between 53BP1 expression type with parameters such as CIN grade, HR-HPV infection status, p16INK4a expression, and CIN prognosis. Expression type of 53BP1 was significantly associated with histological grade of CIN and HR-HPV in situ hybridization signal pattern ( P < .0001). There was a significant correlation between 53BP1 and p16INK4a expression levels ( r = .73, P < .0001). However, there was no association between 53BP1 expression type and CIN prognosis. We propose that 53BP1 expression type is a valuable biomarker for SIL, which can help estimate the grade and GIN of cervical lesions reflecting replication stress caused by the integration of HR-HPV to the host genome.

Variations in Ovarian Cancer Survival Rates: Investigating Equity and Prognostic Factors Throughout Nova Scotia

Introduction There is large inter- and intra-country variability in ovarian cancer outcomes. Individuals diagnosed with advanced stage cancer in Nova Scotia have a 3-year net survival of 31.9%, the lowest in the country. This study aimed to identify factors impacting survival, and to investigate evidence of inequities in survival from the point of diagnosis moving forward. Methods This population-based retrospective study included all women diagnosed with ovarian cancer in Nova Scotia from Jan 1, 2007, to Dec 31, 2016. Administrative health data were linked to gather individual, tumor, and health system characteristics. Both prognostic and equity factors potentially contributing to variations and inequities in survival were assessed using descriptive and time to event techniques. Results This study found no regional differences in survival across Nova Scotia. It revealed that disparities in equity factors do not appear to be significantly associated with survival at the time of diagnosis moving forward. Instead, survival variations were attributed to legitimate prognostic factors, such as cancer stage, subtype, comorbidities, and frailty. However, notable inequities were identified between socioeconomic status and prognostic factors that may contribute to poor survival upstream, rather than at the time of diagnosis. Conclusion Though inequities do not appear to directly contribute to differences in ovarian cancer survival at the time of diagnosis, they may influence outcomes by increasing the development of prognostic factors that lead to poorer survival. Future research should capture equity factors not found in administrative data and begin making comparisons between other jurisdictions to determine why survival rates vary worldwide.

KIAA1199: A Novel Regulator of Chemoresistance in Human Cancer Cells

KIAA1199 (also known as CEMIP or HYBID), an archived gene listed in the Human Unidentified Gene-Encoded (HUGE) database, has been implicated in tumor progression and metastasis in a wide range of cancers, including breast, cervical, cholangiocarcinoma, pancreatic, colorectal, gastric, hepatocellular, lung, ovarian, prostate, papillary thyroid, and brain cancers. Overexpression of KIAA1199 is significantly correlated with poor prognosis and metastasis and has been clinically associated with chemoresistance. In addition, KIAA1199 may serve as a novel biomarker for cancer diagnosis and prognosis, particularly due to its role in maintaining cancer stem cell properties. However, the molecular mechanisms by which KIAA1199 regulates chemoresistance, prognosis, and cancer stem cell development remain incompletely understood. Therefore, this review aims to summarize the clinical relevance of KIAA1199 as a novel regulator involved in chemoresistance, cancer prognosis, and cancer stem cell biology.

Impact of Intraoperative Blood Transfusions on Survival Rates in Ovarian Cancer Patients

Introduction Ovarian cancer remains a leading cause of gynecologic cancer-related mortality worldwide. Identifying perioperative factors that influence survival outcomes is essential for optimizing care. This study evaluates the impact of perioperative factors such as intraoperative blood transfusions and hospital length of stay (LOS) on survival rates in ovarian cancer patients undergoing surgical debulking. Methods This retrospective study analyzed charts of 314 patients who underwent ovarian cancer surgery at a single institution between 2010 and 2018. Patients were grouped based on survival status: “Live” or “Death”. Variables included demographics, tumor size, comorbidity, anesthesia time, surgery time, estimated blood loss, transfusion, readmission, hospital stay length, and survival. Statistical analyses included log-rank tests and mean survival estimations: chi-square tests and Mann-Whitney U-test. Significance was set at P < .05. Results The mean follow-up was 50.5 months (95% CI, 47.8-53.2). Prolonged LOS (>3 days) was significantly associated with reduced survival (47.4 vs 52.4 months, P = .015). Patients requiring intraoperative blood transfusions had poorer survival outcomes (42.0 months 95% CI, 36.3-47.7 vs 53.1 months 95% CI, 50.3-55.9, P < .001). The “Death” group experienced greater blood loss, longer surgical/anesthesia times, and higher intraoperative fluid requirements. Conclusion Prolonged hospital stays and intraoperative blood transfusions are associated with worse survival outcomes in ovarian cancer patients undergoing surgery. These findings underscore the importance of perioperative optimization strategies, including minimizing transfusion requirements and reducing LOS through enhanced recovery protocols.

The Role of GPX1 (rs1050450) Variants in Ovarian Cancer Susceptibility Within a Turkish Population

Introduction Ovarian cancer (OC) remains one of the most lethal gynecological malignancies, primarily due to challenges in early detection and the consequent poor prognosis. Genetic predisposition plays a critical role in OC development, with the Glutathione Peroxidase 1 (GPX1) gene receiving increasing attention. The GPX1 gene polymorphism rs1050450 has been implicated in various cancers, potentially through its impact on oxidative stress mechanisms. Objective This study aimed to investigate the association between the GPX1 (rs1050450) polymorphism and the risk of developing OC in a Turkish population. Methods A retrospective case-control study was conducted involving 90 women diagnosed with OC and 90 healthy controls. Genotyping of the GPX1 (rs1050450) polymorphism was performed using real-time PCR (RT-PCR). Statistical analyses were conducted using the SPSS software, with chi-square and t-tests applied where appropriate. Results The CC genotype of the GPX1 (rs1050450) polymorphism was significantly associated with a reduced risk of OC ( P = 0.002; OR = 0.304; 95% CI = 0.161-0.577), whereas the TT genotype was linked to an increased risk, demonstrating a threefold elevation in susceptibility ( P = 0.036; OR = 3.308; 95% CI = 1.024-10.682). Additionally, the T allele was associated with an approximately threefold increased risk of developing OC ( P = 0.0002). Conclusion These findings suggest that the GPX1 (rs1050450) polymorphism may play a significant role in OC susceptibility, with the CC genotype offering potential protective effects and the TT genotype indicating increased risk. This genetic variant may serve as a useful marker for assessing OC risk; however, further studies involving larger and more diverse populations are needed to validate these results.

Survival Dynamics in Advanced Ovarian Cancer: R2 Resection Versus No-Surgery Paths Explored

Background Cytoreductive surgery is critical for optimal tumor clearance in advanced epithelial ovarian cancer (EOC). Despite best efforts, some patients may experience R2 (>1 cm) resection, while others may not undergo surgery at all. We aimed to compare outcomes between advanced EOC patients undergoing R2 resection and those who had no surgery. Methods Retrospective data from 51 patients with R2 resection were compared to 122 patients with no surgery between January 2015 and December 2019 at a UK tertiary referral centre. Progression-free survival (PFS) and overall survival (OS) were the study endpoints. Principal Component Analysis and Term Frequency – Inverse Document Frequency scores were utilized for data discrimination and prediction of R>2 cm from computed tomography pre-operative reports, respectively. Results No statistical significance was observed, except for age (73 vs 67 years in the no- surgery vs R2 group, P: .001). Principal Components explained 34% of data variances. Reasons for no surgery included age, co-morbidities, patient preference, refractory disease, patient deterioration or disease progression, and absence of measurable intra- abdominal disease). The median PFS and OS were 12 and 14 months for no-surgery, vs 14 and 26 months for R2 ( P: .138 and P: .001, respectively). Serous histology and performance status independently predicted PFS in both no-surgery and R2 cohorts. In the no-surgery cohort, serous histology independently predicted OS, while in the R2 cohorts, both serous histology and adjuvant chemotherapy were independent prognostic features for OS. The bi-grams “abdominopelvic ascites” and “solid omental” were amongst those best discriminating between R>2 cm and R1-2 cm. Conclusions R2 resection and no-surgery cohorts displayed unfavourable prognosis with a notable degree of uniformity. When cytoreduction results in suboptimal results, the survival benefit may still be higher compared to those who underwent no surgery.

A Review: Genetic Mutations as a Key to Unlocking Drug Resistance in Cervical Cancer

Cervical cancer is the fourth most common cancer in women. Advanced stage and metastatic disease are often associated with poor clinical outcomes. This substantiates the absolute necessity for high-throughput diagnostic and treatment platforms that are patient and tumour specific. Cervical cancer treatment constitutes multimodal intervention. Systemic treatments such as chemotherapy and/or focal radiotherapy are typically applied as neoadjuvant and/or adjuvant strategies. Cisplatin constitutes an integral part of standard cervical cancer treatment approaches. However, despite initial patient response, de novo or delayed/acquired treatment resistance is often reported, and toxicity is of concern. Chemotherapy resistance is associated with major alterations in genomic, metabolomic, epigenetic and proteomic landscapes. This results in imbalanced homeostasis associated with pro-oncogenic and proliferative survival, anti-apoptotic benefits, and enhanced DNA damage repair processes. Although significant developments in cancer diagnoses and treatment have been made over the last two decades, drug resistance remains a major obstacle to overcome.

Investigation of Polymorphisms in Global Genome Repair Genes in Patients With Ovarian Cancer in the Turkish Population

Introduction Ovarian cancer (OC) poses significant challenges due to its high mortality rate, particularly in advanced stages where symptoms may not be evident. DNA repair mechanisms, including nucleotide excision repair (NER), are crucial in maintaining genomic stability and preventing cancer. This study focuses on exploring the role of two NER-related genes, Xeroderma Pigmentosum Complementation Group C (XPC) and DNA Damage Binding Protein 2 (DDB2), in OC susceptibility. Objectives This study aims to investigate the association between variations in two NER-related genes, XPC rs2228001 and DDB2 rs830083, among a cohort of Turkish individuals with OC and control subjects. Methods Genotyping of XPC rs2228001 and DDB2 rs830083 was performed on 103 OC patients and 104 control subjects from the Turkish population using the Fast Real-Time 7500 PCR platform from Applied Biosystems. Results Individuals with the homozygous AA genotype of XPC rs2228001 exhibited a reduced likelihood of developing OC (OR 0.511; 95% CI 0.261 - 1.003; P-value 0.049), whereas those with the CC variant faced an elevated risk (OR = 2.32, 95% CI = 1.75-3.08; P-value 0.035). The presence of the A allele was associated with decreased OC occurrence ( P-value = 0.035). Similarly, for DDB2 rs830083, individuals with the homozygous CG genotype had a diminished risk of OC ( P-value 0.036), compared to those with the GG polymorphism (OR 1.895; 95% CI 1.033 - 3.476; P-value 0.038). Furthermore, the presence of the C allele was associated with a 1.89-fold decrease in the likelihood of OC. Conclusion These findings shed light on the genetic factors influencing OC susceptibility, emphasizing the importance of DNA repair systems in disease. Further research in larger and more diverse populations is warranted to validate these findings, facilitating precise risk assessment, and potentially guiding tailored treatment strategies for OC patients.

Research Advances in the Roles of N6-Methyladenosine Modification in Ovarian Cancer

Ovarian cancer (OC) is the most lethal gynecological tumor, characterized by its insidious and frequently recurring metastatic progression. Owing to limited early screening methods, over 70% of OC cases are diagnosed at advanced stages, typically stage III or IV. Recently, N6-methyladenosine (m6A) modification has emerged as a hotspot of epigenetic research, representing a significant endogenous RNA modification in higher eukaryotes. Numerous studies have reported that m6A-related regulatory factors play pivotal roles in tumor development through diverse mechanisms. Moreover, recent studies have indicated the aberrant expression of multiple regulatory factors in OC. Therefore, this paper comprehensively reviews research advancements concerning m6A in OC, aiming to elucidate the regulatory mechanism of m6A-associated regulators on pivotal aspects, such as proliferation, invasion, metastasis, and drug resistance, in OC. Furthermore, it discusses the potential of m6A-associated regulators as early diagnostic markers and therapeutic targets, thus contributing to the diagnosis and treatment of OC.

Ovarian Cancer Diagnosis and Prognosis Based on Cell-Free DNA Methylation

Background: Ovarian cancer stands as the deadliest malignant tumor within the female reproductive tract. As a result of the absence of effective diagnostic and monitoring markers, 75% of ovarian cancer cases are diagnosed at a late stage, leading to a mere 50% survival rate within five years. The advancement of molecular biology is essential for accurate diagnosis and treatment of ovarian cancer. Methods: A review of several randomized clinical trials, focusing on the ovarian cancer, was undertaken. The advancement of molecular biology and diagnostic methods related to accurate diagnosis and treatment of ovarian cancer were examined. Results: Liquid biopsy is an innovative method of detecting malignant tumors that has gained increasing attention over the past few years. Cell-free DNA assay-based liquid biopsies show potential in delineating tumor status heterogeneity and tracking tumor recurrence. DNA methylation influences a multitude of biological functions and diseases, especially during the initial phases of cancer. The cell-free DNA methylation profiling system has emerged as a sensitive and non-invasive technique for identifying and detecting the biological origins of cancer. It holds promise as a biomarker, enabling early screening, recurrence monitoring, and prognostic evaluation of cancer. Conclusions: This review evaluates recent advancements and challenges associated with cell-free DNA methylation analysis for the diagnosis, prognosis monitoring, and assessment of therapeutic responses in the management of ovarian cancers, aiming to offer guidance for precise diagnosis and treatment of this disease.

The Prognostic Significance of Adjuvant Chemotherapy in Adult Ovarian Granulosa Cell Tumors: A Systematic Review and Meta-analysis

Introduction This study aimed to evaluate the oncological and prognostic significance of adjuvant chemotherapy (CT) in patients with adult granulosa cell tumors of the ovary (AOGCT). Methods We searched the Chinese National Knowledge Infrastructure, Clinical Trials, Wanfang Database, Web of Science, Cochrane Library, and MEDLINE electronic databases for articles published up to May 2023. Reference lists of the enrolled studies, Google Scholar, and scientific meeting reports were also manually searched. Results We enrolled 5641 patients with AOGCT from 33 eligible studies, including 1674 (29.7%) and 3967 (70.3%) patients in the CT and non-CT groups, respectively. Based on the cumulative results, adjuvant CT did not affect the risk of recurrence or progression (R/P) (odds ratio [OR]: 1.67, 95% confidence interval [CI]: 1.01–2.78, I2 = 63%, P = .05) and 5-year overall survival (OR: .86, 95% CI: .70–1.04, I2 = 0%, P = .12) of patients with AOGCT. However, adjuvant CT might reduce the 5-year disease-free survival (OR: 2.90, 95% CI: 1.19–7.08, I2 = 55%, P = .02). Sub-group analysis revealed that adjuvant CT did not affect the risk of R/P in patients with early-stage AOGCT (OR: .78, 95% CI: .43–1.43, I2 = 2%, P = .43) and advanced or recurrent AOGCT (OR: .78, 95% CI: .43–1.43, I2 = 2%, P = .43). Conclusion This meta-analysis suggests that patients with AOGCT might not benefit from adjuvant CT, even those with advanced or recurrent disease. The results should be interpreted with caution because of the inherent limitations of retrospective studies.

Epidemiology of Breast, Corpus Uteri, and Ovarian Cancers in Lebanon With Emphasis on Breast Cancer Incidence Trends and Risk Factors Compared to Regional and Global Rates

Objectives This study explores the incidence and trends of breast (Bca), corpus uteri (CUca), and ovarian (Oca) cancer in Lebanon, a Middle Eastern country. It compares the Bca rates to regional and global ones and discusses Bca risk factors in Lebanon. Introduction Globally, Bca is the premier cause of cancer morbidity and mortality in women. Methods Data on female Bca, CUca, and Oca published by the Lebanese national cancer registry were obtained (ie, for the years of 2005 to 2016). The age-standardized incidence rates (ASIRw) and age-specific rates per 100,000 female population were computed. Results From 2005 to 2016, Bca, Oca, and CUca ranked first, sixth, and seventh, respectively, for cancer incidence among women in Lebanon. Bca alone accounted for 39.4% of all new female cancer cases. The ASIRw increased significantly for Bca and CUca (APC: 3.60 and 3.73, P < .05) but not for Oca (APC: 1.27, P > .05). The Bca ASIRw (per 100,000) increased significantly from 71.0 in 2005 to 115.6 in 2013 ( P < .05), then decreased steadily but non-significantly to reach 96.8 in 2016 ( P > .05). Lebanon’s Bca ASIRw is comparable to developed countries. This may reflect altered sociological and reproductive patterns as the country transitions from regional to global trends. The five-year age-specific rates analysis revealed that Bca rates rose steeply from 35-39 to 50-54, dropped slightly between 55 and 64, then rose till 75+. The five-year age-specific rates between 35 and 54 among Lebanese women were amongst the highest worldwide from 2008 to 2012, even higher than the rates in Belgium, which had the highest ASIRw of Bca worldwide in 2020. Conclusion Lebanon’s Bca ASIRw is among the highest globally. It’s important to investigate the contributing factors and develop a national Bca control strategy. This study supports the national recommendation in initiating Bca screening at age 40 for women.

RoBERTa-Assisted Outcome Prediction in Ovarian Cancer Cytoreductive Surgery Using Operative Notes

Introduction Contemporary efforts to predict surgical outcomes focus on the associations between traditional discrete surgical risk factors. We aimed to determine whether natural language processing (NLP) of unstructured operative notes improves the prediction of residual disease in women with advanced epithelial ovarian cancer (EOC) following cytoreductive surgery. Methods Electronic Health Records were queried to identify women with advanced EOC including their operative notes. The Term Frequency – Inverse Document Frequency (TF-IDF) score was used to quantify the discrimination capacity of sequences of words (n-grams) regarding the existence of residual disease. We employed the state-of-the-art RoBERTa-based classifier to process unstructured surgical notes. Discrimination was measured using standard performance metrics. An XGBoost model was then trained on the same dataset using both discrete and engineered clinical features along with the probabilities outputted by the RoBERTa classifier. Results The cohort consisted of 555 cases of EOC cytoreduction performed by eight surgeons between January 2014 and December 2019. Discrete word clouds weighted by n-gram TF-IDF score difference between R0 and non-R0 resection were identified. The words ‘adherent’ and ‘miliary disease’ best discriminated between the two groups. The RoBERTa model reached high evaluation metrics (AUROC .86; AUPRC .87, precision, recall, and F1 score of .77 and accuracy of .81). Equally, it outperformed models that used discrete clinical and engineered features and outplayed the performance of other state-of-the-art NLP tools. When the probabilities from the RoBERTa classifier were combined with commonly used predictors in the XGBoost model, a marginal improvement in the overall model’s performance was observed (AUROC and AUPRC of .91, with all other metrics the same). Conclusion/Implications We applied a sui generis approach to extract information from the abundant textual surgical data and demonstrated how it can be effectively used for classification prediction, outperforming models relying on conventional structured data. State-of-art NLP applications in biomedical texts can improve modern EOC care.

Optimisation of a Cervical Cancer Screening Model Based on Self-Sampling for Human Papillomavirus Testing

Introduction Cervical cancer remains a significant cause of morbidity and mortality among women globally, despite the availability of effective prevention tools. The use of self-sampling devices for human papillomavirus (HPV) testing is a promising strategy to increase screening participation, particularly in settings dominated by opportunistic models. Understanding women’s preferences regarding invitation methods and device design is essential to ensure effective and equitable programme implementation. This study explored the expectations, preferences, and perceived barriers of women aged 35 to 65 in the Valencian Community (VC), Spain, in anticipation of launching a population-based cervical screening program. Methods A qualitative study was conducted using four face-to-face focus groups involving 29 women, selected from the target population of the screening programme (healthy women aged 35-65 residing in the VC). The session combined an individual assessment (questionnaire and electronic response system of five self-sampling devices) with a structured group discussion. Preferences regarding invitation channels, test communication, and device usability were analyzed through descriptive statistics and thematic content analysis. Results Self-sampling was highly accepted, with 96.4% of women stating they would perform it at home. Preferred channels for both invitations and results were SMS and local health centers. Simplicity and ease of use were the key features of the device accepted by the largest number of women—FLOQSwab. Evalyn Brush was also positively valued for its attractive design and was the preferred option for some women. Participants expressed concerns about reliability and proper use, particularly among older women or those with limited body awareness. Familiarity with colorectal screening supported acceptance. Importantly, device selection emerged as a key factor in facilitating participation. The integration of digital technologies (SMS, health apps) was positively valued as a means of increasing accessibility, improving communication, and supporting equity in outreach efforts. Conclusion Self-sampling is a feasible and widely accepted strategy for cervical cancer screening. Effective implementation requires validated devices, culturally adapted information campaigns, and digital engagement tools to maximize participation and reduce inequalities.

Prognostic Role of Radiotherapy in Low-Grade Endometrial Stromal Sarcoma: A SEER-Based Study

Introduction Low-grade endometrial stromal sarcoma (LG-ESS) is a rare malignant mesenchymal neoplasm for which there is no consensus regarding the role of radiotherapy in treatment. This study aimed to evaluate the prognostic significance of external beam radiotherapy (EBRT) using data from the Surveillance, Epidemiology, and End Results (SEER) database. Methods This retrospective study evaluated the role of EBRT in 1254 patients with LG-ESS using SEER data (2000-2021). Propensity score matching (PSM) was applied to compare outcomes between EBRT and non-EBRT groups. Cox and competing risk models assessed overall survival (OS) and cancer-specific survival (CSS). Results EBRT showed no survival benefit in either unmatched or matched cohorts. Post-PSM, OS (HR = 1.21, 95% CI 0.61-2.39) and CSS (HR = 1.75, 95% CI 0.69-4.43) remained unaffected by EBRT ( P > 0.05). Lymphadenectomy and bilateral salpingectomy and oophorectomy (BSO) also demonstrated no significant associations with survival outcomes. Key prognostic factors included older age, larger tumor size, advanced stage, and chemotherapy use, all linked to poorer OS and CSS. Conclusion EBRT, lymphadenectomy, and BSO do not offer significant survival benefits for patients with LG-ESS. Prognosis was independently influenced by age, tumor size, stage, and chemotherapy use (associated with poorer outcomes). These findings support a more individualized, risk-adapted approach to LG-ESS management and highlight the need for prospective studies to define the optimal role of comprehensive treatment strategies.

Advancements in mRNA Vaccines: A Promising Approach for Combating Human Papillomavirus-Related Cancers

The human papillomavirus (HPV) is a typical sexually transmitted disease that affects different epithelial cells and can cause a number of health problems. HPV is mainly spread through sexual contact and is extremely contagious, even in the absence of obvious symptoms. It is linked to a number of malignancies, such as oropharyngeal, cervical, anal, vulvar, vaginal, and cutaneous as well as anogenital and cutaneous warts. Different vaccines targeting various HPV virus strains have been produced to prevent HPV infections. Vaccines can help prevent HPV-related illnesses, but they cannot cure malignancies that have already been caused by HPV. But new developments in mRNA vaccines have shown potential in combating malignancies linked to HPV. mRNA vaccines stimulate the immune system to identify and attack particular proteins present in viruses or tumour cells. The efficacy of mRNA vaccines in preventing HPV-related malignancies has been shown in preliminary experiments in mice. Additionally, in clinical trials aimed at individuals with HPV-related head and neck malignancies, personalised mRNA vaccines in combination with immune checkpoint drugs have demonstrated encouraging results. Even though mRNA vaccines have drawbacks and restrictions such as immunogenicity and instability, further research and development in this area has a great deal of promise for developing effective therapies for HPV-related malignancies.

The Potential Value of Ki-67 in Prognostic Classification in Early Low-Risk Endometrial Cancer

Purpose This study aims to determine the optimal cut-off value of Ki-67 to better predict the recurrence of early low-risk endometrial cancer (EC). Methods Seven hundred and forty-eight patients diagnosed with low-risk EC from West China Second Hospital of Sichuan University and the First Affiliated Hospital of Chongqing Medical University were retrospectively analyzed. The receiver operating characteristic curve (ROC) and Youden index were used to calculate the optimal cut-off value of Ki-67 expression. The clinicopathological indexes between two groups divided by cut-off value of Ki-67 were compared. The univariate and multivariate regression analyses were performed to investigate risk factors connected to the recurrence of early low-risk EC. The survival analysis was shown in Kaplan–Meier curve. Result Thirty-three patients were detected with tumor recurrence after primary surgery (4.4%); 33% was the optimal cut-off value of the Ki-67 index. A high Ki-67 was significantly associated with age ( P = .002), myometrial invasion ( P < .001), and the expression of P53 ( P = .007). The multivariate regression analysis verified that Ki67 ≥ 33% was an independent prognostic factor for predicting recurrence. The recurrence-free survival (RFS) and the overall survival (OS) in high Ki-67 group was significantly lower than that in low Ki-67 group ( P < .001 and P = .029, respectively). The prognostic values of ER, PR, and P53 in combination with Ki-67 were superior to each single predictor. Conclusions The optimal cut-off value of Ki-67 for predicting recurrence is 33%, which quantitatively defines the specific value of Ki-67 that causes high-risk recurrence in early low-risk EC.

Unique Considerations in Early Detection, Risk, and Awareness of Endometrial Cancer in Black Women

Endometrial cancer is the most common gynecologic cancer in the United States. Over the last several decades, the incidence of aggressive tumors, and thus the rate of death from disease, has increased significantly. The population most affected by these epidemiologic shifts are Black women. Symptom awareness, lack of treatment access, and failure of providers to provide guideline-concordant care are just some of the drivers behind these changes. Race as a social construct has historically categorized women into groups that are not reflective of the nuanced personalization that is required for cancer prevention strategies and targeted cancer treatments. There is, however, an increasing understanding that disaggregation by place of birth and social context are important to understand care-seeking behaviors, genetic drivers of disease, and factors that lead to deleterious outcomes. In this review, we will focus on specific individual-level influences that impact disease diagnosis and care-seeking among Black women, recognizing that the global disparities which exist in this disease encompass multiple domains. Such considerations are crucial to understanding drivers of self-efficacy and to develop programs for knowledge awareness and empowerment within a framework that is both useful and acceptable to these diverse communities at risk.

Upregulation of PKN1 as a Prognosis Biomarker for Endometrial Cancer

Background Several markers of survival among endometrial cancer (EC) patients have been proposed, namely, the oncoprotein stathmin, RAF kinase inhibitor (RKIP), Cyclin A, GATA-binding protein 3 (GATA3), and growth and differentiation factor-15 (GDF-15). Their elevated expression correlated significantly with a high stage, serous papillary/clear cell subtypes, and aneuploidy. In a previous study, we reported the elevated expression of the serine/threonine protein kinase N1 (PKN1) in cancerous cells. In the present paper, we studied PKN1 expression in EC tissues from a large cohort of patients, to determine whether PKN1 can serve as a marker for the aggressiveness and prognosis of EC, and/or as a marker of survival among EC patients. Methods Tissue samples from EC patients were examined retrospectively for tumor type, tumor size, FIGO stage and grade, depth of invasion in the myometrium, and presence of lymph node metastasis. The PKN1 protein expression in EC cells was assessed by immunohistochemistry. PKN1 mRNA levels were analyzed in publicly available databases, using bioinformatic tools. Results We found that expression of PKN1 at the mRNA and proteins levels tended to increase in high-grade EC samples (P = .0001 and P = .06, respectively). In addition, patients with metastatic disease had higher PKN1 mRNA levels (P = .02). Moreover, patients with high PKN1 expression could be characterized by poorer survival. Conclusions We have shown a trend of the higher PKN1 expression levels in EC patients with poor prognosis. Therefore, PKN1 might be considered as a candidate prognostic marker for EC.

HPV DNA Testing and Mobile Colposcopy for Cervical Precancer Screening in HIV Positive Women: A Comparison Between Two Settings in Ghana and Recommendation for Screening

Introduction Women living with HIV (WLHIV) have higher prevalence and persistence rates of high-risk human papillomavirus (hr-HPV) infection with a six-fold increased risk of cervical cancer. Thus, more frequent screening is recommended for WLHIV. Objectives This retrospective descriptive cross-sectional study was conducted to investigate and compare the prevalence of hr-HPV infection and abnormal findings on mobile colposcopy in two cohorts of WLHIV following cervical screening in rural and urban settings in Ghana. Methods Through the mPharma 10 000 Women Initiative, WLHIV were screened via concurrent hr-HPV DNA testing (MA-6000; Sansure Biotech Inc., Hunan, China) and visual inspection (Enhanced Visual Assessment [EVA] mobile colposcope; MobileODT, Tel Aviv, Israel) by trained nurses. The women were screened while undergoing routine outpatient reviews at HIV clinics held at the Catholic Hospital, Battor (rural setting) and Tema General Hospital (urban setting), both in Ghana. Results Two-hundred and fifty-eight WLHIV were included in the analysis (rural, n = 132; urban, n = 126). The two groups were comparable in terms of age, time since HIV diagnosis, and duration of treatment for HIV. The hr-HPV prevalence rates were 53.7% (95% CI, 45.3–62.3) and 48.4% (95% CI, 39.7–57.1) among WLHIV screened in the rural vs urban settings ( p-value = .388). Abnormal colposcopy findings were found in 8.5% (95% CI, 5.1–11.9) of the WLHIV, with no significant difference in detection rates between the two settings ( p-value = .221). Three (13.6%) of 22 women who showed abnormal colposcopic findings underwent loop electrosurgical excision procedure (LEEP), leaving 19/22 women from both rural and urban areas with pending treatment/follow-up results, which demonstrates the difficulty faced in reaching early diagnosis and treatment, regardless of their area of residence. Histopathology following LEEP revealed CIN III in 2 WLHIV (urban setting, both hr-HPV negative) and CIN I in 1 woman in the rural setting (hr-HPV positive). Conclusions There is a high prevalence of hr-HPV among WLHIV in both rural and urban settings in this study in Ghana. Concurrent HPV DNA testing with a visual inspection method (colposcopy/VIA) reduces loss to follow-up compared to performing HPV DNA testing as a standalone test and recalling hr-HPV positive women for follow up with a visual inspection method. Concurrent HPV DNA testing and a visual inspection method may also pick up precancerous cervical lesions that are hr-HPV negative and may be missed if HPV DNA testing is performed alone.

Risk Stratification for Underlying Cervical Intraepithelial Neoplasia Grade (CIN)3+ in Reproductive-Age Women With Biopsy-Confirmed CIN2: Implications for Fertility-Preserving Management

Introduction Managing biopsy-confirmed cervical intraepithelial neoplasia grade 2 (CIN2) in women of reproductive age poses clinical challenges. Immediate treatment with large-loop excision of the transformation zone (LLETZ) is associated with a substantial risk of adverse obstetric outcomes. This study aimed to identify the risk factors for predicting CIN3+ lesions in reproductive-aged women with biopsy-diagnosed CIN2, to inform personalized management strategies that are particularly relevant to China’s evolving fertility policies. Methods This retrospective cohort study analyzed the data from a regional cervical lesion screening database. Reproductive-aged women (<45 years) with biopsy-confirmed CIN2 who underwent subsequent LLETZ between 2016-2024 were included in the study (n=516). Pathological upgrade was defined as CIN3+ in the LLETZ specimen. Univariate and multivariate logistic regression analyses identified independent risk factors for pathological upgrade. Results Following LLETZ, 18.4% (95/516) of the women had CIN3+ lesions, indicating biopsy underestimation. HPV 16 (56.3%) and HPV 52 (27.5%) were the most prevalent genotypes in CIN3+ and CIN2- groups, respectively. Multivariable analysis identified three independent predictors: liquid-based cytology (TCT) ≥HSIL (OR = 6.308; 95% CI: 2.390-16.650; P <0.001); specific HR-HPV genotypes: HPV 16 infection (OR = 2.372; 95% CI: 1.165-4.831; P =0.017) and HPV 33 infection (OR = 3.263; 95% CI: 1.035-10.292; P =0.044); endocervical curettage (ECC) ≥CIN2 (OR = 3.067; 95% CI: 1.474-6.384; P =0.003). Age did not increase the risk of developing CIN3+ lesions. Conclusion This risk-stratification model offers evidence-based guidance for optimizing individualized treatment decisions in clinical settings where fertility preservation is prioritized.

Comparative Performance of Visual Inspection with Acetic Acid and Colposcopy for Detection of Cervical Precancer in Women with High-Risk Human Papillomavirus Infection: A Cross-Sectional Study

Introduction The World Health Organization recommends 4 triage strategies for women with high-risk human papillomavirus infection (hrHPV). These include visual inspection with acetic acid (VIA), colposcopy, reflex cytology, and HPV16/18 partial genotyping. However, in many low-resource settings, access to colposcopy remains limited. This study aimed to compare the diagnostic accuracy of visual inspection vs colposcopy for detecting cervical intraepithelial neoplasia grade 2 or worse (CIN2 + ). Methods Women who tested positive for hrHPV and were referred for colposcopy, with cytology results available as part of routine clinical care, underwent visual inspection with 3% acetic acid immediately before colposcopy. Colposcopic impressions were recorded, and images were scored using a modified Reid colposcopic index and a modified Swede score without iodine staining. We compared diagnostic performance for CIN2 + across visual inspection, colposcopic impression, modified Reid index (score ≥4), and modified Swede score (score ≥5). Statistical analysis used IBM SPSS Statistics and the Cochran Q test, with significance set at P < .05. Results Among 450 women, the median age was 38.0 years. A single hrHPV type was detected in 70.4% of cases; types 16, 52, and 18 were most common. Histopathological confirmation of CIN2 + occurred in 97 women (21.6%). Diagnostic accuracy for predicting CIN2 + was 78.2% with VIA and 77.5% with colposcopic impression. Accuracy was 78.4% for the modified Reid index ≥4 and 78.2% for the modified Swede score ≥5. No significant differences were observed among the 4 methods ( P = .941). Conclusions VIA demonstrates diagnostic accuracy comparable to colposcopy-based assessments in hrHPV-positive women evaluated within a cytology-informed clinical pathway, supporting its potential role in resource-limited settings.

Influence of Race, Ethnicity, and Nativity on Distribution and Outcomes Among Women With Choriocarcinoma in Florida

Introduction While race/ethnicity are established factors of risk and outcomes for multiple cancers in women, nativity may more precisely estimate cancer risk and survival. The role of nativity in choriocarcinoma, a form of gestational trophoblastic neoplasia arising from the placenta, is unexplored. Our objective was to examine how race, ethnicity, and nativity influence disease presentation and survival in women with choriocarcinoma in Florida. Methods Using the Florida Cancer Data System (FCDS), we identified women diagnosed with choriocarcinoma from 1981-2020. Clinicodemographic data were extracted, including nativity (US-born/Non-US-born). Statistical analyses included chi-square, Cox proportional hazards models, and Kaplan-Meier method, with significance set at P < 0.05. Results 262 eligible patients were included. Black women more frequently presented with distant disease vs White women (63.8% vs 46.2%, P = 0.05). Non-US-Born women were older at diagnosis than US-born (32.8 vs 26.7 years, P < 0.01) and received fewer surgical and radiation treatments ( P < 0.05). Nativity, ethnicity, and race were not associated with overall survival (OS) (all P > 0.05). Multivariable analyses adjusted for race and birthplace showed increasing age (HR 1.05 [1.02-1.09], P = 0.023) and surgical treatment (HR 0.28 [0.09-0.79], P = 0.016) were associated with OS. Despite favorable OS, survival curves diverged after initial treatment, favoring White over Black patients, and Hispanic over Non-Hispanic patients, though neither were statistically significant ( P > 0.05). Conclusion Race and nativity are associated with variations in choriocarcinoma presentation and treatment course but do not affect survival. Race and ethnicity may predict post-treatment, long-term survival, though whether this reflects choriocarcinoma biology or broader disparities remain unclear.

Exploratory Analysis of Candidate Gene SNPs in Relation to Cervical Cancer Susceptibility in Georgian Women

Introduction Cervical cancer (CC) is the third most prevalent malignancy among women worldwide. Candidate gene studies have identified multiple single nucleotide polymorphisms (SNPs) that are associated with an increased risk of CC. The objective of this study was to examine the relationship between 8 specific single-nucleotide polymorphisms (SNPs) and the risk of cervical cancer in the Georgian population. Methods The present study employed a prospective case-control design, with 40 patients diagnosed with CC and 45 healthy women. A total of 8 single-nucleotide polymorphisms (SNPs) were genotyped using the TaqMan genotyping assay: rs7579014, rs11263763, rs7726159, rs6897196, rs2853672, rs635634, rs231775, and rs2304204. Results Our analysis demonstrated that rs7579014 ( BCL11A, G/A), rs7726159 ( TERT , C/A), and rs6356634 ( ABO , T/A) were associated with an increased risk of cervical cancer in Georgian patients. However, following the implementation of the Benjamini–Hochberg correction, only rs6356634 ( ABO T/A) and rs7579014 ( BCL11A G/A) remained statistically significant. A lack of statistically significant correlation was identified between the genetic variants rs11263763, rs6897196, rs2853672, rs2304204, and rs231775 and susceptibility to cervical cancer. Conclusions This study represents the first attempt to investigate SNP associations in women with cervical cancer in Georgia. The findings indicate that SNP-based analysis may hold promise for the early identification of susceptibility to cervical cancer, and potentially to other cancers. Nevertheless, further research involving larger sample sizes is required to validate and strengthen these preliminary observations.

Prevalence of Human Papillomavirus Subtypes and Related Cytology in Estonian Cervical Cancer Screening Population in 2021

Introduction Prevalence of high risk human papillomavirus (hrHPV) and its subtypes by sociodemographic factors and the related cytological findings in the Estonian cancer screening population were examined, with the aim to improve cancer prevention. Methods This cross-sectional study included all women who participated in the Estonian cervical cancer screening programme from January 1, 2021 to January 31, 2022 and had a valid HPV test result reported to the Estonian Cancer Screening Registry (n = 37 537, aged 30, 35, 40, 45, 50, 55, 60, and 65). Limited sample (N = 18 784) within the total sample consisted of women who used self-sampling (N = 3535) or whose clinician collected sample was analysed using lab methodology that differentiates HPV16, 18, and 45. Data on HPV and cytology results were obtained from the Estonian Cancer Screening Registry, whereas data on education, nationality, and marital status were obtained from the Estonian Population Registry. Results hrHPV was detected in the samples of 3307 (8.8%) women, and the prevalence was significantly higher in age groups under 40, in women with lower education, of Estonian nationality, and with no partner. The overall prevalence of HPV16 was 1.8%, ranging from 4.4% in 30-year-old women to 0.9% in 55-year-old women. The proportion of normal cytology was 50% among all hrHPV positive women and 35% in all HPV16 positive women, while it was 47% for HPV16 alone and 24% for HPV16 plus other hrHPV subtypes. The probability of normal cytology was significantly higher in women aged 50 and older compared to women aged 30 and 35 for total hrHPV and HPV16. Conclusion All countries should monitor HPV prevalence across different age groups. As different HPV genotypes have a different oncogenic risk profile, extended or complete genotyping would help personalised risk-based screening approaches, with less health care costs, less harms, and a bigger net benefit. In addition, lab methodology should be harmonised.

Challenges and Opportunities for Cervical Cancer Prevention Through HPV Vaccination in Ghana: A Public Health Policy Analysis

Introduction Cervical cancer constitutes a critical public health challenge in Ghana, with high morbidity and mortality despite the global availability of effective prophylactic Human Papillomavirus (HPV) vaccines. This study examines the policy discourse surrounding the implementation of a nationwide HPV vaccination program in Ghana, analyzes stakeholders’ perspectives on programmatic promotion, and assesses the extent of institutional prioritization. Methods Eight key informant interviews were thematically analyzed using NVivo; and a cross-sectional online survey of 215 participants was descriptively analyzed using SPSS. Results Thematic analysis of interviews revealed core policy challenges: weak prioritization, inadequate resource allocation, and policy framings that lacked discourse on the right to health. Survey data demonstrated marked improvement in HPV awareness (76.6%) and substantial interest in vaccination (64.2%), suggesting a shifting public health landscape influenced by media engagement and growing health literacy. Conclusion Findings underscore insufficient prioritization stalled the institutionalization of a national cervical cancer prevention strategy creating a critical implementation gap. However, the relatively late average age of sexual debut offers a strategic window for effective HPV vaccine delivery. Importantly, the convergence of increased public awareness, heightened receptivity to vaccination, and the availability of external funding mechanisms, such as support from Gavi, presents a timely and actionable opportunity for policy advancement. This study highlights the imperative for renewed governmental commitment to cervical cancer prevention, emphasizing the imperative to operationalize HPV vaccination as a core component of Ghana’s public health infrastructure.

Assessment of the Quality of Cervical Cancer Prevention Services in Southwest Nigeria: A Cross-Sectional Study Using Donabedian’s Quality Framework

Introduction Cervical Cancer (CC) is the second leading cause of cancer-related deaths among women in Nigeria, after breast cancer. However, there is a significant gap in evaluating prevention services due to the absence of organized and sustained programs. Immediate action is essential to address this critical issue. Objective The study assessed the quality of CC prevention services (CCPS) in selected Southwest Nigerian states using Donabedian’s quality framework. Methods The study employed a cross-sectional descriptive research design, selecting 24 Secondary Health Facilities (SHFs) and 72 reproductive-aged women (aged 30-49) from two states to evaluate the quality of CCPS. Based on the median score and interquartile range, the Donabedian quality framework categorizes CCPS as high, moderate, or poor. A paired independent t-test was conducted to compare the quality of existing CCPS in the two states. Results The study found that 42% of selected healthcare facilities in Osun State and 34% in Lagos State offer CCPS. The facilities have basic screening materials, with Visual Inspection with Acetic Acid (VIA) being the most used. The availability of materials resources in facilities varied based on the type of CCPS. The median score ranged from 124 to 185, with 54% of facilities rated good quality, 8.3% moderate, and 37.5% poor. However, there was no significant difference in CCPS quality between the two states at t = −1.96, P = 0.062. Conclusion Quality assessment of CCPS is crucial for providing effective and equitable healthcare. Donabedian’s framework enables systematic evaluation of the services’ structural, procedural, and outcome aspects. Addressing gaps and enhancing the quality of CCPS can effectively reduce the burden of CC.

Feasibility of Intravaginal Artesunate as an Adjuvant HPV & Cervical Precancer Treatment Among Women Living With HIV in Kenya: Study Protocol for a Phase II Clinical Trial

Introduction Cervical cancer disproportionately affects women in low- and middle-income countries (LMICs), who account for 90% of deaths from the disease. Human papillomavirus (HPV) is responsible for 99% of cervical cancer cases. Women living with HIV (WLWH) have a higher risk of persistent HPV infection and a greater likelihood of developing cervical cancer. Prevention of cervical cancer requires effective screening and precancer treatment programs. In LMICs, the common treatment method for cervical precancer is thermal ablation. However, for WLWH, thermal ablation is associated with high rates of persistent HPV infection following treatment, a key risk factor for precancer recurrence. Adjuvant topical treatments with cytotoxic or antiviral properties may reduce HPV persistence following ablation. Preclinical and early-phase clinical trials indicate that topical artesunate is active against HPV-associated anogenital lesions, including cervical precancer, and can induce HPV clearance. Consequently, intravaginal artesunate may improve HPV clearance following thermal ablation, although no clinical trials have investigated this. Methods We are conducting a phase II, double-blind, randomized, placebo-controlled trial among 120 HIV seropositive women in Kenya to investigate the feasibility of self-administered intravaginal artesunate pessaries as adjuvant therapy following thermal ablation treatment for cervical precancer. The primary outcome is type-specific HPV clearance 6 months after randomization. Secondary outcomes are safety, adherence, acceptability, uptake, and retention. Participants will be enrolled at least 4 weeks after ablation and will self-administer pessaries on weeks 1, 3, and 5, with alternating drug-free weeks. Study follow-up will extend to 24 weeks after randomization. Conclusion High rates of persistent HPV infection in WLWH is a key limitation of thermal ablation, the most accessible cervical precancer treatment in LMICs. This trial will investigate the feasibility of repurposing topical artesunate as an adjuvant therapy to improve HPV clearance following thermal ablation in WLWH. Trial Registration ClinicalTrials.gov identifier: NCT06519994

Assessing the Quality of the Endocervical Component: Pitfalls to Cervical Cancer Screening in Limpopo Province, South Africa

Background Specimen adequacy is an essential indicator of screening programme performance. The effectiveness and efficiency of Pap tests are classified in the laboratory based on their adequacy for interpretation as satisfactory or unsatisfactory. Purpose The purpose of the study was to determine the processes of collecting, storing, transporting, and evaluating Pap smears in rural health facilities in Limpopo Province, South Africa. Method A mixed-method research approach was used for the study. An exploratory sequential mixed-methods design was employed to collect and analyse qualitative data, and then use the findings to develop an instrument in a subsequent quantitative phase, thereby increasing the breadth and depth of understanding of the phenomena under study. The population comprised professional nurses, operational managers, and laboratory technicians. The qualitative strand explored challenges to cervical cancer screening, while the quantitative strand described factors contributing to the inadequacy of the cervical component. The study was conducted from July 2019 to February 2020. The results were merged for triangulation. Findings The inadequacy rates reported by districts ranged between 38% and 50%. The findings revealed that professional nurses lacked adequate knowledge of the skills required for collecting, labelling, and storing Pap smears before dispatch. Furthermore, the in-service training provided was poorly coordinated and unstructured, and other professional nurses were not keen on screening for cervical cancer, resulting in poor health outcomes for women in the community who had to return for repeat smears. Conclusion Inadequacy of the transformation zone component and unsatisfactory smears have a higher risk of progression to cervical cancer or pre-cancer lesion than adequacy of the transformation zone.

Self-Reported Cervical Cancer Screening Uptake Among Women of Reproductive Age in Zambia: Evidence from the 2021 Zambia Population-Based HIV Impact Assessment (ZAMPHIA) Survey

Background Despite Zambia implementing the World Health Organisation's (WHO) tri-pillar cervical cancer prevention goals 90-70-90 Prevent, Screen, and Treat, cervical cancer claims 2000 lives annually and reigns as the most common cancer among women, especially those living with HIV (WLHIV). Our study describes the national uptake of screening and treatment from the ZAMPHIA 2021 survey. Methods Utilising a two-stage cluster sampling approach, the study included participants aged 15 years and older across Zambia’s ten provinces. Data were collected on demographic traits, reproductive history, sexual behaviour, and cervical cancer prevention using a structured questionnaire, and HIV was diagnosed from biological samples. Women aged 15-49 were eligible for inclusion in the analysis. The primary outcome of interest was whether a woman self-reported being screened for cervical cancer. Sociodemographic characteristics were calculated for categorical variables using the SAS proc surveyfreq procedure, producing both raw and weighted estimates. The weighted estimates and their variance were generated using jackknife replicate weights for each record. Results Of the 8801 surveyed women, 22.2% reported undergoing cervical cancer screening, the majority being aged between 35-49 years. Cervical cancer screening uptake was more likely among compared to HIV negative counterparts (aOR = 3.92, 95% CI: 3.10, 4.95), those aged 25-34 years (aOR = 1.76, 95% CI: 1.42, 2.21) or 35-49 years (aOR = 2.65, 95% CI: 2.11, 3.33) than younger and those with 1-4 (aOR = 2.16, 95% CI: 1.54, 3.02) or more than 5 live births (aOR = 1.98, 95% CI: 1.37, 2.87) than none. Marital status, WLHIV, education, and parity were other factors significantly associated with screening. Conclusion We report low cervical cancer screening uptake compared to the 70% target of WHO. The WHO’s call for bolstered strategies and efforts to increase cervical cancer screening and treatment is timely and urgent. Therefore, ongoing messaging and health education among all women is key.

Advances and Challenges in Cervical Cancer: From Molecular Mechanisms and Global Epidemiology to Innovative Therapies and Prevention Strategies

Background In the global scenario of public health, cervical cancer poses a major threat with high mortality rates, especially in women. New incidence cases and prevalence vary across different regions, as recently shown by GLOBOCAN data. The development of cervical cancer is primarily due to persistent infection by high-risk genotypes of human papillomavirus (HPV), which is a multifaceted process that is influenced by genetic, environmental, and lifestyle factors. Purpose The goal of this study is to thoroughly investigate cervical cancer, including its etiology, molecular mechanisms, progression, diagnosis strategies, and current therapies. This review further highlights the transformative power of HPV vaccination and screening programs in curbing the disease’s burden and potentially promising novel approaches like immunotherapy and targeted therapy. Research Design This is a narrative review article that summarizes previous literatures regarding cervical cancer in terms of molecular mechanism, etiology, clinical developments, and prevention. Study Sample The review encompassed studies from diverse sources, including experimental, observational, and clinical research published between 1992 and 2025. Data Collection and/or Analysis Data were collected through comprehensive literature searches using databases such as PubMed, Scopus, and the Cochrane Library with defined inclusion and exclusion criteria. Results Nonetheless, there are gaps in research and controversies regarding vaccine coverage, screening practices, and treatment accessibility for poor populations. Precision medicine trends are emerging along with new biomarkers for early detection and personalized treatment, which also form part of this discussion. Key findings include the critical role of prevention measures in controlling the global impact of cervical cancer. Conclusions The paper synthesizes the existing knowledge and identifies gaps that require further research, which is significant in augmenting prevention, diagnosis, and treatment of cervical cancer towards addressing its public health implications worldwide.

Comparison of Clinical Efficacy of Liquid-Based Cytology and High-Risk Human Papillomavirus Testing With Partial Genotyping in Cervical Screening of Women Below 30 Years Old

Introduction We evaluated the clinical efficacy of primary Human Papillomavirus (HPV) testing and liquid-based cytology (LBC) for cervical screening in women below 30 years old. Methods This was a retrospective analysis of data collected prospectively from women 25 years or older who attended hospital-based gynaecology clinics for cervical screening. Simultaneous high-risk HPV testing with partial genotyping and LBC testing was performed. Comparison of clinical efficacy of HPV testing and LBC was performed for routine screening discharge rate, colposcopy referral rate, and number of colposcopies needed for each CIN2+ detected. Results Of 6398 women included, 503 women (7.9%) tested positive for HPV DNA. The positivity was higher for 25-to-29 years old than for women ≥30 years old (12.6% vs 7.3%, P < .001). The rate was markedly skewed by a low rate for women ≥45 years old. Similarly, more women below 30 years old (10.6%) had abnormal LBC results compared to women ≥30 years old (6.0%). Comparing LBC and HPV testing, the observed difference was not significant for discharge rate to interval screening (89.5% vs 87.4%). A higher referral to coloscopy rate (6.6 % vs 7.8%) was observed for HPV screening but the number of colposcopies for each detected CIN2+ (5 vs 7) was not significantly different. Clinical efficacy of HPV and LBC testing was similar in comparisons of women in 5-year groupings between 25 and 44 years old. Conclusions Our data indicated that cervical screening for women between 25 and 29 years old could adopt HPV screening as the older women.

Implementing High-Risk Human Papillomavirus Self-Sampling for Cervical Cancer Screening in Ghana: A Study (CarciSCAN) Protocol

Background: The World Health Organization (WHO) aims to eliminate cervical cancer by 2030 through a global strategy, centred on high-risk Human papillomavirus (hrHPV)-based screening and treatment. Implementing these strategies in low-resource settings remains challenging, due to barriers associated with limited healthcare infrastructure and patient awareness. Self-sampling for hrHPV has shown higher acceptability and similar diagnostic accuracy compared to clinician-taken samples. This study proposes a protocol to evaluate the clinical efficacy of a cervical cancer screening program utilising hrHPV self-sampling in Ghana. Methods and Analysis: 1000 non-pregnant women aged 30-65 years will be invited to self-collect hrHPV samples. Those testing hrHPV positive will undergo visual inspection with acetic acid. Those diagnosed with high-grade squamous intraepithelial lesions will be offered ablation. In any case where there is a suspicion of invasion, or equivocal diagnosis, biopsies will be taken. Follow-up for women who are test positive for hrHPV and/or undergo treatment, will involve hrHPV self-sampling after 6 months. HrHPV-negative women will rescreen after 3 years. Biopsies will be taken where immediate treatment is not suitable, and women with confirmed or suspected invasive cervical carcinoma will be referred for surgical and/or oncological care. The primary outcome will be the proportion of women successfully screened, defined as the proportion of women with a valid HPV test result out of those invited to attend cervical screening. Secondary outcomes include screening uptake, disease detection rate, hrHPV genotype prevalence, treatment acceptance rate, successful treatment response, missed disease during treatment, number lost to follow-up, and disease recurrence. Discussion: In low-resource settings, hrHPV self-sampling offers an accessible method to increase screening uptake. This study will inform strategies for broader implementation of cervical cancer screening and contribute to achieving the WHO’s goal of elimination by 2030. Trial Registration: Ethical approval for this study was obtained from the Kintampo Health Research Centre Institutional Ethics Committee (IEC), Bono East, Ghana, West Africa, on 24 May 2024 (IEC IRB Registration No. 0004854; Study ID: KHRCIEC/2024-03).

A Retrospective Observational Study on the Impact of Digital Strategies to Boost Cervical Screening Uptake in Primary Care

Introduction Cervical cancer is largely preventable through regular screening, yet uptake in the UK remains below national targets, particularly among harder-to-reach groups. Despite national efforts, barriers such as fear, embarrassment, and low health literacy continue to hinder participation. This retrospective study evaluates the impact of delivering information and education regarding cervical screening (CS) to hard-to-reach populations, with the aim of increasing CS uptake in line with the national target of 80% coverage. Methods Using a multidisciplinary team approach, women who had previously missed screenings were identified through electronic records. Remote interventions, including educational videos delivered via email and SMS, and an online booking system, were implemented to provide accessible information and flexible appointment options. These interventions aimed to address common barriers and encourage informed participation. Results Over 3 months, screening rates increased significantly. Uptake among women aged 25-49 rose from 77% to 80.5%, while rates among women aged 50-64 improved from 81% to 97%. Conclusion This study highlights the potential effectiveness of remote communication tools in increasing cervical screening participation, particularly among populations historically less likely to engage. Integrating digital resources into routine practice also has the potential to reduce administrative burdens, improve patient education, and make screening more accessible. By addressing key barriers and providing flexible booking options, primary care clinics can enhance screening uptake, supporting earlier cervical cancer detection and ultimately improving patient outcomes.

Cultural and Linguistic Adaptation of an Evidence-Based Tailored Navigation Intervention to Increase Cancer Screening Uptake Among Southeast Asian Women

Background Southeast Asian immigrant women in the U.S. have high rates of breast and cervical cancer, yet they are the least likely of all racial/ethnic groups to get screened. To address this disparity, we adapted the evidence-based Tailored Intervention Messaging System © (TIMS © ), which uses tailored messages and navigation by culturally and linguistically matched community health advisors to overcome barriers to cancer screening. Objectives This study describes the cultural and linguistic adaptation of TIMS © to improve breast and cervical cancer screening among Southeast Asian immigrant women in the U.S. Methods Guided by Stirman et al.’s adaptation framework, we conducted focus groups and in-depth interviews to identify key constructs related to cancer screening (knowledge, perceived barriers, perceived risk, benefits, self-efficacy). Using the TIMS © and the thematic content from qualitative data, we modified messages for content and context. Messages were divided into three categories: 1) existing messages identified in thematic analyses, 2) existing messages not identified in thematic analyses, and 3) new messages that emerged from thematic analyses. Results Contextual and content modifications were made to the TIMS © message library. Messages were translated into Lao, Khmer, and Vietnamese. Through an iterative process, the investigator, community health advisors, and cultural community advisory board members reviewed and revised the messages for translation accuracy, relevance, and clarity. Conclusion Using relatable language and context is critical to engaging women from Southeast Asian communities in improving breast and cervical cancer screening uptake. This adaptation approach can be applied to tailor interventions for other languages, cultures, and underrepresented groups.

Knowledge of Human Papillomavirus, Risk Factors and Screening for Cervical Cancer Among Women in Ghana

Background Cervical cancer ranks as the fourth most common cancer among women, with 662,301 new cases and 348,874 deaths reported in 2022. The majority of the disease burden occurs in low- and middle-income countries. In Ghana, there were 3072 new cases and 1815 deaths reported in 2022. While human papillomavirus (HPV) infection, a key cause for cervical cancer, resolves in most individuals, it can progress to cancer in some. This has led to research into other factors that may, in conjunction with HPV, increase the risk of cervical cancer progression. Improving knowledge of HPV, risk factors, and screening will be important in reducing the burden of cervical cancer. In this study, we investigate the knowledge on HPV, risk factors, and cervical screening among women in Ghana. Methods A hospital-based case-control study was conducted among women aged 18 to 95 years. This involved Ghanaian women diagnosed with cervical cancer and hospital controls. Data were collected using a structured questionnaire, and basic descriptive analyses were performed. Results Results from the 206 cases and 230 controls revealed limited knowledge about HPV and its role in cervical cancer development, with minimal disparity between women with (2.4%) and without (6.5%) cervical cancer. The majority of participants lacked awareness of HPV transmission (95.9%), and awareness of HPV vaccination was low (3.5%). Barriers to HPV vaccination included insufficient awareness about HPV, limited access to vaccination centers, and cost concerns. Respondents expressed a preference for educational programs delivered through church, radio, and television channels. Conclusions Knowledge of HPV, risk factors, and cervical screening was found to be very low among Ghanaian women. These findings underscore the need for a comprehensive cervical cancer educational initiative within Ghana’s national cervical cancer control policy to mitigate the disease’s impact.

Research Status of Clustered Regulary Interspaced Short Palindromic Repeats Technology in the Treatment of Human Papillomavirus (HPV) Infection Related Diseases

Background: CRISPR/Cas9 technology has rapidly advanced as a pivotal tool in cancer research, particularly in the precision targeting required for both detecting and treating malignancies. Its high specificity and low off-target effects make it exceptionally effective in applications involving Human Papillomavirus (HPV) related diseases, most notably cervical cancer. This approach offers a refined methodology for the rapid detection of viral infections and provides a robust platform for the safe and effective treatment of diseases associated with viral infections through gene therapy. Purpose: Gene therapy, within this context, involves the strategic delivery of genetic material into target cells via a vector. This is followed by the meticulous modulation of gene expression, whether through correction, addition, or suppression, specifically honed to target tumor cells while sparing healthy cells. This dual capacity to diagnose and treat at such a precise level underscores the transformative potential of CRISPR/Cas9 in contemporary medical science, particularly in oncology and virology. Research Design: This article provides an overview of the advancements made in utilizing the CRISPR-Cas9 system as a research tool for HPV-related treatments while summarizing its application status in basic research, diagnosis, and treatment of HPV. Data Collection: Furthermore, it discusses the future prospects for this technology within emerging areas of HPV research and precision medicine in clinical practice, while highlighting technical challenges and potential directions for future development.

Knowledge and Practice of Women With HIV on Cervical Cancer Prevention and Control and their Attributes to Utilize the Screening Services in Ethiopia: A Cross Sectional Study

Background Previous studies underscore the crucial link between awareness and timely cervical cancer screening and treatment, particularly among women of reproductive age. Yet, insights remain limited when it comes to women living with HIV in Addis Ababa. This study examined the knowledge and practices of these women regarding cervical cancer screening and treatment, illuminating the factors that both enable and hinder their uptake. Methods This cross-sectional study took place in six public hospitals in Addis Ababa, Ethiopia, involving 578 women with HIV. The recruitment spanned 10 months, from January 1st to October 31st, 2021. Trained clinicians utilized the Open Data Kit for data collection, ensuring real-time submission to the server. Statistical analysis was performed using SPSS version 25, employing descriptive and inferential statistics. The logistic regression model identified predictors of outcome variables, and open-ended questions were thematically narrated for qualitative insights. Results A notable 51.2% of women with HIV exhibited inadequate knowledge regarding cervical cancer prevention and control programs. Furthermore, a substantial 68.5% had never undergone cervical examination, citing reasons such as considering themselves healthy (49.6%), perceiving the examination as painful (28.4%), and feeling shy to undergo screening (23.3%). Notably, participants with non-formal education were 70% less likely to possess knowledge about cervical cancer prevention and control (AOR = 0.30; 95% CI = 0.13-0.71). Income emerged as an independent predictor for both knowledge and practice in women’s approach to cervical cancer prevention and control ( P < 0.05). Additionally, occupation and duration of HIV diagnosis independently predicted practice, even after adjusting for confounding factors. Conclusion Half of the participating HIV-positive women lacked adequate awareness about cervical cancer prevention and control, underscoring the urgent need for comprehensive awareness initiatives tailored to this population. Relevant ministries, health care providers, and advocacy groups must collaborate to implement targeted education programs, utilizing diverse channels like community outreach, health care settings, and media campaigns.

Parents’ Intentions of Human Papillomavirus Vaccination for Students in Vietnam: A Cross-Sectional Study

Background Human papillomavirus (HPV) is known as a common agent of sexually transmitted infections and cervical cancer. One of the most effective ways for parents to protect their children from HPV is by ensuring they receive vaccinations. Aim To determine the percentage of parents who intend to vaccinate their children against HPV and associated factors. Method A cross-sectional study was conducted on 365 parents who had children attending high school in Ha Tinh province, Vietnam, from April to May 2023, using stratified and random sampling methods. Data were collected by a self-administered questionnaire designed based on previous studies and the domains of the Theory of Planned Behavior and Health Belief Model. A multivariable logistic regression was performed to determine the association between several factors and vaccination status. Result A total of 365 participants took part in the study. The rate of parents intending to vaccinate their children against HPV was 55.9%. Knowledge about the HPV disease and vaccine (all P < .05) and the attitude of parents ( P < .001) were determined as the motivation factors that affect the intention to vaccinate children against HPV. Conclusion Many parents still do not have the intention to vaccinate children against HPV. Health education communication should focus on the motivation factors, not only to improve the parents’ knowledge and perspective but also to increase the coverage of the vaccine to prevent cancers caused by HPV.

Integrating Single-Cell RNA-Seq and Bulk RNA-Seq to Construct a Novel γδT Cell-Related Prognostic Signature for Human Papillomavirus-Infected Cervical Cancer

Background Gamma delta (γδ) T cells play dual roles in human tumors, with both antitumor and tumor-promoting functions. However, the role of γδT cells in HPV-infected cervical cancer is still undetermined. Therefore, we aimed to identify γδT cell-related prognostic signatures in the cervical tumor microenvironment. Methods Single-cell RNA-sequencing (scRNA-seq) data, bulk RNA-seq data, and corresponding clinical information of cervical cancer patients were obtained from the TCGA and GEO databases. The Seurat R package was used for single-cell analysis, and machine learning algorithms were used to screen and construct a γδT cell-related prognostic signature. Real-time quantitative PCR (RT-qPCR) was performed to detect the expression of prognostic signature genes. Results Single-cell analysis indicated distinct populations of γδT cells between HPV-positive (HPV+) and HPV-negative (HPV-) cervical cancers. A trajectory analysis indicated γδT cells clustered into differential clusters with the pseudotime. High-dimensional Weighted Gene Co-expression Network Analysis (hdWGCNA) identified the key γδT cell-related gene modules. Bulk RNA-seq analysis also demonstrated the heterogeneity of immune cells, and the γδT-score was positively associated with inflammatory response and negatively associated with MYC stemness. Eight γδT cell-related hub genes (GTRGs), including ITGAE, IKZF3, LSP1, NEDD9, CLEC2D, RBPJ, TRBC2, and OXNAD1, were selected and validated as a prognostic signature for cervical cancer. Conclusion We identified γδT cell-related prognostic signatures that can be considered independent factors for survival prediction in cervical cancer.

A Diagnostic Nomogram Incorporating Prognostic Nutritional Index for Predicting Vaginal Invasion in Stage IB – IIA Cervical Cancer

Introduction With the advancements in cancer prevention and diagnosis, the proportion of newly diagnosed early-stage cervical cancers has increased. Adjuvant therapies based on high-risk postoperative histopathological factors significantly increase the morbidity of treatment complications and seriously affect patients’ quality of life. Objectives Our study aimed to establish a diagnostic nomogram for vaginal invasion (VI) among early-stage cervical cancer (CC) that can be used to reduce the occurrence of positive or close vaginal surgical margins. Methods We assembled the medical data of early-stage CC patients between January 2013 and December 2021 from the Fujian Cancer Hospital. Data on demographics, laboratory tests, MRI features, physical examination (PE), and pathological outcomes were collected. Univariate and multivariate logistic regression analyses were employed to estimate the diagnostic variables for VI in the training set. Finally, the statistically significant factors were used to construct an integrated nomogram. Results In this retrospective study, 540 CC patients were randomly divided into training and validation cohorts according to a 7:3 ratio. Multivariate logistic analyses showed that age [odds ratio (OR) = 2.41, 95% confidence interval (CI), 1.29-4.50, P = 0.006], prognostic nutritional index (OR = 0.18, 95% CI, 0.04-0.77, P = 0.021), histological type (OR = 0.28, 95% CI, 0.08-0.94, P = 0.039), and VI based on PE (OR = 3.12, 95% CI, 1.52-6.45, P = 0.002) were independent diagnostic factors of VI. The diagnostic nomogram had a robust ability to predict VI in the training [area under the receiver operating characteristic curve (AUC) = 0.76, 95% CI: 0.70-0.82] and validation (AUC = 0.70, 95% CI: 0.58-0.83) cohorts, and the calibration curves, decision curve analysis, and confusion matrix showed good prediction power. Conclusion Our diagnostic nomograms could help gynaecologists quantify individual preoperative VI risk, thereby optimizing treatment options, and minimizing the incidence of multimodality treatment-related complications and the economic burden.

Retinoids: Molecular Aspects and Treatment in Premalignant Lesions and Cervical Cancer

Persistent infection with high-risk human papillomavirus remains the primary factor associated with the progression of cervical squamous intraepithelial lesions and the development of cervical cancer. Nevertheless, a combination of factors, including genetic predisposition, immune response, hormonal influences, and nutritional status, contribute synergistically to the development of cervical cancer. Among the various factors involved in the pathogenesis and therapy of cervical cancer, retinoids have gained considerable attention due to their multifaceted roles in different cellular processes. This review investigates defects within the vitamin A metabolism pathway and their correlation with cervical cancer. Additionally, it integrates epidemiological and experimental findings to discuss the potential utility of retinoid-based therapies, either alone or combined with other therapies, as agents against premalignant lesions and cervical cancer.

Management of Gynecologic Cancer During COVID-19 Pandemic: South Asian Perspective

Management of gynecological cancers has suffered during the pandemic, partly due to lockdown and partly due to directing resources to manage COVID-19 patients. Modification of gynecological cancer management during this pandemic is recommended. Cervical cancer patients who present with stage IA1 disease can have a delay of up to 8 weeks for surgical treatment, considering the slow tumor growth rate. Women with stages IA2, IB1, IB2, IIA1 must undergo radical hysterectomy and lymphadenectomy within 6 to 8 weeks. In areas where surgical treatment is not available, patients should be referred for radiation therapy/areas with adequate surgical expertise. The surgical option is attractive for early cancers during the COVID era, as it involves a single visit compared to the multiple visits required for chemoradiation. The value of lymph node staging needs to be reconsidered. Neoadjuvant chemotherapy should be given preference over primary cytoreductive surgery for advanced ovarian cancers. Surgeries, which demand extended surgical time such as Hyperthermic Intraperitoneal Chemotherapy and pelvic exenterations, should be avoided during this pandemic. For patients scheduled for interval surgery after two or three neoadjuvant cycles, six cycles of chemotherapy should be considered before surgery is performed. For early-stage, low-grade endometrial cancer, consideration should be given to medical management until surgery is possible. The above recommendations have been made keeping in mind the geography, patient load, and availability of resources available to health care providers from southeast Asia. They might not be applicable globally and every practitioner should take call regarding patient’s management as per availability of resources and loco-regional circumstances. The implementation of recommended international guidelines for the management of gynecologic cancers should take precedence. Each modification to the standard approach should be approved by a multidisciplinary team depending on the condition of the patients and the locoregional circumstances.

HPV Vaccine Beliefs and Correlates of Uptake Among Hispanic Women and Their Children on the US-Mexico Border

Introduction: Human Papilloma Virus (HPV) is the most common sexually transmitted infection nationally. Although preventable, uptake of the HPV vaccine is low. The purpose of this study was to describe HPV vaccine knowledge and beliefs and psychosocial correlates of vaccine uptake among adult females and their children in a US-Mexico border community. Materials and Methods: We conducted a survey of uninsured women aged 21-65 years living in Texas who were due for cervical cancer screening. We utilized descriptive statistics to report demographic and psychosocial variables. We used logistic regression analysis to identify correlates of prior vaccine uptake. Results: 599 women completed surveys: mean age was 44.69 years, 97.8%, were Hispanic and 86% were Spanish speaking; 5% had been vaccinated. Awareness of HPV infection & HPV vaccine was 81.6% & 68.6% respectively. Scores for mean perceived susceptibility was low and mean perceived benefits was high; the mean score for knowledge was 3.69 out of 6. Common parental barriers to child vaccination were cost, lack of accessibility and lack of information. Correlates of past HPV vaccine uptake among adult women were younger age, monthly income of $2,500-$5,000, full-time employment, US birth, and higher perceived severity of HPV. Older age was a correlate of vaccine uptake for daughters. Discussion and Conclusion: Findings revealed low HPV vaccine uptake among adult Hispanic women, but high vaccine acceptability for their sons and daughters. Culturally tailored educational interventions are needed to improve HPV knowledge and HPV vaccine uptake among adults and their children.

Cervical Cancer Screening Utilization and Associated Factors Among Women Aged 30 to 49 Years in Dire Dawa, Eastern Ethiopia

Background: Cervical cancer is a public health problem and one of the leading causes of death in women worldwide. In Ethiopia, the government expands cervical cancer screening centers and recommends services to age-eligible and high-risk groups of women. However, evidence indicates that the utilization of services among eligible and high-risk women in the country has remained very low, and data are scarce in Dire Dawa. Therefore, this study aimed to assess cervical cancer screening service utilization and associated factors among women aged 30 to 49 years in Dire Dawa, eastern Ethiopia. Methods: A facility-based cross-sectional study was undertaken in Dire Dawa from February 01 to March 01, 2017. Only two facilities provided the screening service in Dire Dawa Administration. Six- hundred and one women aged 30 to 49 years were selected using a systematic sampling method. Data were collected using a pretested face-to-face interview administered questionnaire. Data were entered using EpiData 3.1, and analyzed using the Statistical Package for Social Science Version 21. Multivariable logistic regression was used to examine the factors associated with cervical cancer screening utilization. An adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used, and a p-value <0.05 was considered statistically significant. Results: In this study, the magnitude of cervical cancer screening service utilization was 4.0% (95% CI: 2.5-5.7). The factors associated with cervical cancer screening service utilization were older age (AOR = 4.2; 95% CI:1.3-13.8), attending private health facilities (AOR = 8.9; 95% CI: 2.8-28.0), being employed (AOR = 3.3; 95% CI: 1.3-8.8), visiting the gynecology departments (AOR = 3.8; 95% CI: 1.5-9.8), being knowledgeable (AOR = 4.8; 95% CI: 1.5-15.5), being counseled by health professionals (AOR = 4.1; 95% CI: 1.5-11.3), and user’s of family planning (AOR = 4.9; 95% CI: 1.2-20.0). Conclusion: The magnitude of cervical cancer screening utilization was very low. Hence, to improve the screening service utilization of cervical cancer, a campaign on community awareness, strengthening service linkage among departments, expansion of the centers for cervical cancer screening, and promotion of family planning method utilization are recommended.

The Prevalence of Genital Human Papillomavirus Subtypes in a Cohort of Hispanic Women Presenting for Cervical Cancer Screening Along the US-Mexico Border

Introduction : Hispanic women residing along the US-Mexico border have the highest cervical cancer incidence rates in the US. Genital human papillomavirus (HPV) is the major causative agent, but more information is needed about the prevalence and distribution of genital HPV subtypes in this high-risk population. Methods : A population-based cross-sectional study of uninsured Hispanic women along the US-Mexico border was conducted and participants had their cervical specimens undergo DNA extraction followed by HPV genotype testing using the Linear Assay from Roche® Diagnostics, to identify 37 genital HPV subtypes. Results : Among the 585 women aged 21-65 years, 584 self-identfied as Hispanic. Any HPV subtype prevalence was 53.2% (95% CI: 49.0%-57.3%) and of these 52% (i.e. 27.5% of the total) had single infections and 48% (i.e. 25.6% of the total) had multiple infections. High-risk HPV prevalence was 15.6% (95% CI: 24-31.3%). The mean number of subtypes among those testing positive was 2.1 (SD 1.6). The prevalence of any HPV and high-risk HPV showed a U shaped pattern with age; and prevalence of 16/18 and non-16/18 high-risk subtypes (e.g. 31, 33, 35, 39, 45, 51, 52, 58); also varied with age. Forty-one percent of high-risk HPV occurrences were of a subtype not covered by the current nonavalent HPV vaccine. Discussion : Our findings suggest a different high-risk HPV subtype pattern and age distribution among Hispanic women in the USA, which could have implications for future cervical cancer prevention strategies.

Effect of an IMB Model-Based Education on the Acceptability of HPV Vaccination Among College Girls in Mainland China: A Cluster RCT

Objective Despite the fact that the human papillomavirus vaccine (HPVV) has been approved in mainland China since 2016, there is a lack of inoculation among Chinese college women. This multi-center, online interventional RCT based on the information-motivation-behavioral skills (IMB) model intended to investigate if the intervention may improve human papillomavirus vaccine acceptance and awareness among target women. Methods Participants were selected from comprehensive universities and allocated to 1 of 2 groups: intervention or control. After the baseline survey, participants in the intervention group were given 10-minute online IMB model-based education every day for 7 days. Self-administered questionnaire surveys on Human papillomavirus knowledge, HPVV acceptability, and IMB construct toward HPV vaccination were performed at pre- and post-intervention. Results The baseline survey was completed by 3739 female university students from the intervention (n = 1936) and control groups (n = 1803) between February and April 2020. The average score of students on 11 HPV-related questions was 5.225 ± 2.739, and only 32.07% (1199/3739) of them showed a willingness to be vaccinated against HPV. After the intervention, the intervention group had a higher willingness to vaccinate themselves and encourage their friends to get the HPVV compared to the control group (40.39% vs 31.56%, 82.67 vs 73.18%, P < .001), and the difference in knowledge scores between the 2 groups was significant (7.917 ± 1.840 vs 5.590 ± 2.859, P < .001). In addition, 8 students in the intervention group self-reported receiving HPVV during the research period. Conclusions This IMB model-based intervention showed positive effects on the participants’ knowledge, motivation, and perceived objective skills toward HPV vaccination and has the potential to improve the vaccination among Chinese college women.

Clinicopathological Features and Survival of Adolescent and Young Adults with Cervical Cancer

Purpose To explore clinicopathological characteristics and their prognostic value among young patients with cervical cancer (who are aged ≤25 years old). Methods The Surveillance, Epidemiology, and End Results Program (SEER) database was used to extract data on cervical cancer patients. They were then stratified by age as young women (≤25 years old) and old women (26–35 years old) and analyzed for clinicopathology characteristics and treatment modalities. Prognosis was analyzed using Kaplan–Meier survival curve, as well as hazard ratios using Cox regression modeling. The nomogram was developed based on Cox hazards regression model. Results Compared to 26–35 years old women, patients aged ≤25 years tended to be white ethnicity, unmarried, had earlier stage of disease. There was also a better prognosis among younger cohort. Grade, FIGO stage, histologic subtypes, and surgical modalities influenced the survival outcomes of young patients. Among young cohorts, surgery prolonged the survival time of IA-IIA stage patients while surgical and non-surgical management presented no statistically prognostic difference among patients at IIB-IVB stage. Besides, the nomogram which constructed according to Cox hazards regression model which contained independent prognosis factors including FIGO stage, surgery type, and histologic type of tumor can robustly predict survival of young patients. Conclusion Cervical cancer patients ≤25 years old were uncommon and lived longer than the older patients. Among these young patients at IA-IIA stage, surgical treatment could be more effective at preventing death than non-surgery. The nomogram could perfectly predict the prognosis of young adults and adolescents with cervical cancer.

Fundamental Elements in Training Patient Navigators and Their Involvement in Promoting Public Cervical Cancer Screening Knowledge and Practices: A Systematic Review

Background: Cervical cancer screening remains unsatisfactory in some regions due to hindrances. This study aims to explore fundamental elements in training patient navigators and their involvement in promoting screening knowledge and practices. Methods: This systematic review study included only English published articles between 2014 and 2019 from PubMed/Medline, EBSCO, Science Direct, and Wiley online library. Results: Healthcare professionals trained patient navigators in 3 days regarding screening basics, along with group discussions and role-plays. They delivered effective health education and navigation assistance. Conclusion: The group education session facilitated by patient navigators, coupled with navigation care, resulted in a high screening rate.

Evaluation and Prediction Analysis of 3- and 5-Year Relative Survival Rates of Patients with Cervical Cancer: A Model-Based Period Analysis

Background Cervical cancer remains a threat to female health due to high mortality. Clarification of the long-term trend of survival rate over time and the associated risk factors would be greatly informative to improve the prognosis of cervical cancer patients. Methods This retrospective study was based on data extracted from the Surveillance, Epidemiology, and End Results (SEER) database of the United States. The 3-year and 5-year overall survival rates of patients with cervical cancer during 2002–2006, 2007–2011, and 2012–2016 were analyzed. Period analysis was used to assess the variation in survival rate stratified by age, race, and socioeconomic status during the 15-year study period and then predicted the relative survival rate in the following period from 2017 to 2021. Results During 2002–2016, the 3-year relative survival rate of cervical cancer patients increased from 73.1% to 73.5% with a high jump between 2007 and 2011. This upward trend is expected to continue to 74.3% between 2017 and 2021. Patients older than 60 years, black ethnicity, or medium and high poverty status were likely to have a lower relative survival rate. Conclusion This study confirmed the increased relative survival rate of cervical cancer patients over years and identified relevant risk factors. Targeted initiatives for elderly and socially underprivileged individuals may be able to mitigate inequality.

Inequalities in Cervical Cancer Screening Uptake Between Chinese Migrant Women and Local Women: A Cross-Sectional Study

Introduction: Uptake of cervical cancer screening services in Chinese migrant workers is unknown and may be lower than non-migrant workers in China. Methods: We conducted a cross-sectional study among migrant and non-migrant women aged 21-65 at 7 provinces across China and administered a questionnaire investigating knowledge and attitudes regarding cervical cancer, human papillomavirus (HPV), and HPV vaccine. We used multivariable logistic regression to evaluate odds of previous cervical cancer screening in migrant workers. Results: 737 women participated in the study. Mean age was 41.9 ± 7.2 years. 50.2% of the participants were migrant workers. 27.6% of the migrant workers reported previous cervical cancer screening compared to 33.2% of local participants. 36.6% migrant workers reported awareness of HPV compared to 40.2% of local participants. In adjusted analysis migrant status was not associated with increased odds of previous cervical cancer screening (aOR = 1.11 95%CI: 0.76-1.60). High school or higher education compared to less than high school education and employer-sponsored insurance compared to uninsured were associated with increased odds of previous cervical cancer screening (aOR = 2.15 95%CI: 1.41-3.27 and aOR = 1.67 95% CI: 1.14-2.45, respectively). Having heard of HPV compared to no awareness of HPV was associated with increased odds of cervical cancer screening (aOR = 2.02 95%CI: 1.41-2.91). Awareness of HPV among migrant workers was associated with increased odds of cervical cancer screening compared to migrant and local participants without awareness (aOR = 2.82 95% CI: 1.70-4.69 and 2.97 95%CI: 1.51-5.83, respectively). Conclusions: Efforts to increase education opportunities, provide insurance, and promote HPV awareness could increase cervical cancer screening uptake in migrant women in China.

Quality Assessment of Cervical Cytology Practices in Estonia From 2007 to 2018

Background Cervical cancer incidence and mortality in Estonia are among the highest in Europe, although the overall coverage with cervical cytology is high. This indicates potential issues with the quality of collection and/or laboratory evaluation of cervical cytology. Objectives The aim of the retrospective observational study was to assess the quality of cervical cytology specimen collection, evaluation, and reporting using laboratory reports in Estonia. Methods The study included women with a cervical cancer diagnosis in 2017−2018. Cervical cytology and histology reports for these women in 2007−2018 were obtained from ten laboratories. We described the quality of cytology specimen collection and reporting of cytology results. Multivariate logistic regression was used to calculate odds ratios (OR) with 95% confidence intervals (CI) to identify factors associated with NILM as the last cervical cytology result within 5 or 2 years before the cervical cancer diagnosis. Also, we calculated cytology-histology correlation (CHC). Results We identified 503 cytology and 100 histology reports from 138 women. The laboratories differed greatly regarding human resources, work capacity and volume. Differences between local and regional laboratories were observed in reporting specimen adequacy (P < .001). We found that local laboratories had 3 times higher odds (OR = 2.95, 95% CI: 1.05−8.33) of reporting normal results 2 years before cancer diagnosis than regional laboratories. According to the CHC, 58.9% of pairs were in agreement. Conclusions The study showed considerable heterogeneity and suboptimal performance of cervical cytology practices in Estonia, particularly at local laboratories. Efforts to improve laboratory quality assurance are crucial.

Cervical Cancer-Related Knowledge, Attitudes, Practices and Self-Screening Acceptance Among Patients, Employees, and Social Media Followers of Major Brazilian Hospital

Background Brazil has a high burden of cervical cancer, even though it is preventable, traceable and treatable. Hence, this study evaluated levels of knowledge, attitudes and practices (KAP) related to cervical cancer screening and diagnosis and acceptance of self-screening techniques among women aged 24 and greater. Methods A cross-sectional KAP survey was administered to n = 4206 women and spanned questions relating to cervical cancer, HPV, speculum, Pap test and colposcopy. Questionnaire was disseminated through a major hospital’s social media platforms, intranet and gynecologic-oncology clinics. Logistic regressions evaluated associations between sociodemographic characteristics and knowledge, attitudes, and preventative behaviors against cervical cancer. Participants indicated willingness to try DNA-HPV self-sampling and cervix self-visualization (self-colposcopy). Findings Participants were mostly white individuals (70.5%) with higher education and from social classes A and B. They demonstrated superior levels of KAP than described in the literature, with over 57.8% having answered 80+% of questions correctly. KAP scores were predicted by social class, educational attainment, race, history of premalignant cervical lesions and geographic location. About 80% and 63% would be willing to try DNA-HPV self-sampling and cervix self-visualization, respectively. Interest in self-screening was associated with adequate attitude (OR = 1.85) and inadequate practice (OR = .83). Interpretation Adequate KAP are fundamental for the successful implementation of a self-screening program. Participants were interested in methods that provide them with greater autonomy, control and practicality. Self-screening could address barriers for under-screened women such as shame, discomfort, distance from clinics and competing commitments, enabling Brazil to reach the WHO’s cervical cancer elimination goals. It could also decrease excess medical intervention in over-screened populations by promoting shared decision-making.

Determinants of Cervical Cancer Screening Service Utilization Among HIV-Positive Women Aged 25 Years and Above Attending Adult ART Clinics in Southern Tigray, Ethiopia

Background Cervical cancer and human immunodeficiency virus prevention are public health priorities in Ethiopia. Despite cervical cancer being preventable with the Human Papilloma Virus vaccine and cervical cancer screening, HIV-infected women still have a low rate of screening, and data are scarce in this country. Thus, this study aimed to assess the prevalence of cervical cancer screening service utilization and associated factors among HIV-positive women in Southern Tigray, Ethiopia, 2018. Methods A facility-based cross-sectional study was performed from March 1st to May 15th, 2018. We recruited 465 HIV-positive women using a systematic random sampling method. Data were collected using a pre-tested structured interviewer-administered questionnaire. Descriptive statistics, followed by multivariable logistic regression analysis were performed. Crude odds ratios, adjusted odds ratios, and 95% confidence intervals (CIs) were reported. Results In this study, only 8% of HIV-positive women were screened for cervical cancer. The most frequently cited barrier by participants to getting screened was feeling healthy 282 (65.9%). Multiparity {AOR = 4.12, 95% CI = (1.70, 9.95)}, provider recommendation to get screened {AOR = 3.20, 95%CI = (1.34, 7.65)}, having good knowledge {AOR = 4.33, 95%CI = (1.66-11.29)}, and high perceived susceptibility for cervical cancer {AOR = 3.10, 95% CI = (1.31-7.33)} were the factors significantly associated with cervical cancer screening service utilization. Conclusions The prevalence of cervical cancer screening service utilization was quite low. Provider’s recommendation to get screened, multiparity, knowledge, and perceived susceptibility were factors strongly associated with the service utilization. There is a need of routine counseling of health care providers for all HIV-positive women to get screened. Women’s lack of knowledge also needs to be addressed by informing every HIV-positive woman that they are more susceptible to cervical cancer, and that screening is critical to fighting against the disease.

Precancerous Lesion of the Cervix and Associated Factors Among Women of West Wollega, West Ethiopia, 2022

Background Precancerous cervical lesion is an abnormality in the cells of the cervix that could eventually develop into cervical cancer. Cervical cancer is a public health problem that contributes to the death of women worldwide. In line with the high burden of the issue, the Ethiopian government had attempted to expand cervical cancer screening centers and recommendation of services to age-eligible as well as high-risk groups of women. Therefore, the study aimed to assess the prevalence of precancerous lesions of cervix cancer among women aged 30-49 years and associated factors in West Wollega. Method Facility-based analytic cross-sectional study design was conducted in selected hospitals of West Wollega from January 1- February 20, 2022, among 339 women. A face-to-face interview was conducted and the presence or absence of precancerous cervical lesion was tested by visual inspection with acetic acid. Data were analyzed by SPSS version 25. Variable with P-value <.25 in the bi-variable analysis were entered into multivariable logistic regression. Results with a P-value ≤ .05 at 95% confidence level were considered for statistical significance. Result The prevalence of precancerous cervical lesions was 27.4% (95% CI: 22.7%32.1%). The mean standard deviation of participants was 35.22 +6.32 years. More than half (63.4%) and 67.6% of them were regarded as having good knowledge and a favorable attitude towards precancerous cervical lesions respectively. History of menstrual irregularity had two folds higher odds of being diagnosed with the precancerous cervical lesion when compared with counterparts at, [AOR = 2.29(95% CI:1.29-4.04]. Women with a history of STI had 3.5 times higher odds of developing precancerous cervical lesion compared to women with no history of STI [AOR)=3.46(95% CI:1.94-6.18)], history of bleeding after sexual intercourse was 2.88 times more likely to have precancerous cervical lesion compared to those without it at [AOR=2.88(95% CI:1.43-5.78)]. Parity greater than or equal to five had 2.4 times higher odds of developing precancerous cervical lesions compared to women with parity less than five at [AOR=2.41(95% CI: 1.23-4.75)]. History of steroid use had 3.5 times higher odds of developing precancerous cervical lesion compared with opponents at [AOR=3.5(95% CI: 1.32-9.34) and women with an Unfavorable attitude towards screening for Cervical cancer screening, prevention, and control methods had 2.2 times higher odds of developing precancerous cervical lesion compared their counterpart at [AOR=2.15(95% CI: 1.21-3.83)]. Conclusion The precancerous cervical lesions continue to be a significant public health concern in Ethiopia. It will remain a significant cause of death of women unless effective screening methods like VIA and vaccination against HPV are scaled up. Furthermore, having a history of menstrual irregularities, STI, bleeding after coitus, parity greater than ≥5, steroid use, and having an unfavorable attitude towards screening factors are significantly associated with the occurrence of the precancerous lesion. Therefore, effective prevention approaches have to consider these factors for the control of cervical cancer in the early phase of the lesion.

Prevalence and Distribution of Human Papillomavirus Genotypes (1997–2019) and Their Association With Cervical Cancer and Precursor Lesions in Women From Southern Mexico

Background Cervical cancer (CC) is the fourth most common malignancy of the female genital tract. Human Papillomavirus (HPV) is the main cause of precancerous lesions and CC cases worldwide Objective We assessed the prevalence and distribution of HPV types and their association with precancerous lesions and CC. Methods HPV genotypes were detected by 3 methods depending on the year of in which the sample was analyzed: MY09/11 RFLPs (1997 to 2010), GP5+/6+ primer systems (2005 to 2010) and INNO-LiPA HPV Genotyping Extra (2010 to 2019) in cervical samples (No-IL: 4445; LSIL: 2464; HSILs: 151 and CC: 253) from women from southern Mexico. Results The overall HPV prevalence was 54.17%, and hpv-16 was the most common genotype. In single infection, the high-risk HPV genotypes (group 1) were associated with squamous intraepitelial lesions (LSIL: HPV–39 (OR = 10.58, 95% CI 4.09–27.36, P < .001); HSIL: HPV-31 (OR = 14.76, 95% CI 6.56–33.20, P < .001); and CC: HPV-16 (OR = 25.01, 95% CI 18.83–33.21, P < .001). In multiple infections, the HPV genotypes (HPV-16 and HPV-18) were also associated with a high risk of lesions [LSIL: HPV-18 (OR = 3.45; 95% CI 1.36–8.91; P = .009); HSIL: HPV-18 (OR = 5.12; 95% CI 1.21–21.68; P = .026); and CC: HPV-16 (OR = 3.03; 95% CI 1.72–5.32; P < .001)] compared to single infection. In the analysis adjusted for age, giving birth, and cigarette smoking, a significant increase in the risk of LSIL, HSIL, and CC was maintained. Conclusions This study provides current data on the prevalence and distribution of HPV genotypes in women from southern Mexico, which could serve as a valuable reference to guide nationwide CC screening programs and provide scientific evidence that could be useful for vaccine development efforts. Likewise, it was identified that infection with carcinogenic HPV genotypes is an independent risk factor for LSIL, HSIL, and CC.

Serum Human Epididymis Protein 4 as a Prognostic Marker in Cervical Cancer

Objectives The objective is to evaluate the prognostic value of serum human epididymis protein 4 (HE4) as a tumor marker in patients with cervical cancer. Methods Sixty-seven patients with cervical cancer treated at Seoul National University Bundang Hospital from September 2014 to May 2018 were retrospectively reviewed. Serum HE4 levels were measured by immunoassay before starting primary treatment. A mean serum HE4 level of 72.6 pmol/L was used to divide the patients into low and high HE4 groups. Patient characteristics, clinicopathological variables, and survival outcomes were compared between the two groups. Results The low and high HE4 groups included 55 (82.1%) and 12 (17.9%) patients at diagnosis, respectively. Higher HE4 levels were significantly associated with older age at diagnosis (age <50: .0% vs age ≥50: 100.0%; P = .002), menopause (premenopause: 8.3% vs postmenopause: 91.7%; P = .009), higher FIGO stage (stage I–II: 33.3% vs III–IV: 66.7%; P = .017), large tumor size (<4.0 cm: 41.7% vs ≥4.0 cm: 58.3%; P = .029), positive lymph node metastasis (negative: 41.7% vs positive: 58.3%; P = .049), and involvement of the parametrium (negative: 25.0% vs positive: 75.0%; P = .002). Higher HE4 level was a predictive factor for worse overall survival but not for progression-free survival. Elevated HE4 levels were not independent factors for the prediction of either overall survival or progression-free survival. Subgroup analysis by histological type revealed similar results for patients with squamous cell carcinoma. Conclusions High levels of HE4 expression correlated with poor overall survival, indicating that elevated HE4 levels are associated with a poor prognosis for patients with cervical cancer.

Preventative Cancer Screening Rates Among Uninsured Patients in Free Clinics: A Retrospective Cohort Study of Cancer Survivors and Non-cancer Survivors

Background There is limited research on screening rates among uninsured cancer survivors. Uninsured cancer survivors are at higher risk of poorer health outcomes than the insured due to limited access to preventative screening for secondary cancers. This study examines the rates of surveillance and screening of uninsured cancer survivors and compares to uninsured patients without a cancer history seen in free clinics. Methods Data were collected retrospectively from electronic medical records and paper charts of patients from 10 free clinics between January 2016 and December 2018 in the Tampa Bay area. The prevalence of socioeconomic characteristics, cancer diagnoses, and screening practices were compared for cancer survivors and free clinic patients without a history of cancer. Study participants were determined to be eligible for cancer screenings based on the United States Preventive Services Task Force guidelines. Results Out of 13 982 uninsured patients frequenting free clinics between 2016 and 2018, 402 (2.9%) had a documented history of cancer. Out of the 285 eligible cancer survivors, 44 (15.4%) had completed age-appropriate colon cancer screening. Among the 170 female cancer survivors, 75 (44.1%) had completed breast cancer screenings, and only 5.9% (59/246) had completed cervical cancer screenings. After adjusting for age, gender, race, salary, employment status, and household size, cancer survivors were more likely to undergo colorectal cancer screening (OR: 3.59, 95% CI: 2.10–6.15) and breast cancer screening (OR: 2.13, 95% CI: 1.30–3.84) than patients without a cancer history. This difference was not seen for cervical cancer screening (OR: 0.99, 95% CI: .62–1.58). Conclusions Uninsured cancer survivors frequenting free clinics represent a unique population that is underrepresented in the medical literature. Our results suggest that uninsured survivors use screening services at higher rates when compared to uninsured patients without a reported cancer diagnosis. However, these rates are suboptimal when compared to national screening rates of insured cancer survivors.

Usefulness of Short-Term Imaging and Squamous Cell Carcinoma Antigen to Early Predict Response to Concurrent Chemoradiotherapy in Patients With Cervical Cancer

Objective The objective is to investigate the factors that can predict early treatment response in patients receiving concurrent chemoradiotherapy (CCRT) for cervical cancer. Methods We assessed clinical factors and treatment response in patients who underwent CCRT for cervical cancer at four time points: initial, 2.5 weeks, 6 weeks after starting CCRT, and 3 months after completing CCRT. The final treatment response was determined by positron emission tomography-computed tomography (PET-CT) 3 months after completion of CCRT. Patients were divided into two groups according to the final treatment response: complete response (CR) group or non-CR group. And the early CCRT response prediction model was developed using stepwise multivariate logistic regression analysis. Results Of the 62 patients who underwent CCRT for cervical cancer, 57 patients who completed all 4 time points examinations were included in the analyses and classified as CR (n = 32) and non-CR (n = 25) group. Tumor volume and serum squamous cell carcinoma antigen (SCC Ag) of the initial, 2.5 weeks, and 6 weeks after CCRT were significantly associated with the final treatment response. For the early treatment response prediction model, we selected patient age, tumor volume, and SCC Ag measured at initial and 2.5 weeks of CCRT as variables, and the equation of the final model was yielded. Using a cutoff of 0.433, this model had a sensitivity of 72.0%, a specificity of 84.4%, and a probability of 0.8225 ( P < .0001). Conclusion Short-term (at 2.5 weeks after starting CCRT) measurements of tumor volume and serum SCC Ag were significant predictors of response to CCRT in patients with cervical cancer.

Postoperative Adjuvant Chemoradiotherapy Versus Chemotherapy Alone for Stage III Endometrial Cancer: A Multicenter Retrospective Study

Introduction We aimed to evaluate the efficacy and toxicity of the combination of 6 cycles of chemotherapy and radiation therapy compared with chemotherapy alone as postoperative adjuvant therapy for patients with stage III endometrial cancer. Methods This retrospective cohort study included patients with stage III endometrial cancer who received postoperative chemoradiotherapy or chemotherapy alone at 6 hospitals between January 2009 and December 2019. The progression-free survival (PFS) and overall survival (OS) for each treatment group were analyzed using the Kaplan–Meier method. We also assessed differences in toxicity profiles between the treatment groups. Results A total of 133 patients met the inclusion criteria. Of these, 80 patients (60.2%) received adjuvant chemoradiotherapy and 53 (39.8%) received chemotherapy alone. The PFS and OS did not differ significantly between the groups. For patients with stage IIIC endometrioid subtype, the chemoradiotherapy group had significantly longer PFS rate than did the chemotherapy alone group (log-rank test, P = .019), although there was no significant difference in the OS (log-rank test, P = .100). CRT was identified as a favorable prognostic factor for PFS in multivariate analysis (adjusted HR, .37; 95% CI, .16-.87; P = .022). Patients treated with chemoradiotherapy more frequently suffered from grade 4 neutropenia (73.8% vs 52.8%; P = .018) and grade 3 or worse thrombocytopenia (36.3% vs 9.4%; P = .001) compared with the chemotherapy alone group. There were no differences between the 2 treatment groups in the frequency of toxicity-related treatment discontinuation or dose reduction. Conclusion We confirmed that chemoradiotherapy yields longer progression-free survival than does chemotherapy alone for patients with stage IIIC endometrioid endometrial cancer, with an acceptable toxicity profile.

Uptake of Human Papilloma Virus Vaccination and Associated Factors Among Female Students Attending Secondary Schools in South West Shoa, Oromia, Ethiopia, 2022

Background Human papillomavirus (HPV) vaccination is one of the key preventative measures for cervical cancer, provided that effective vaccine uptake is employed. However, HPV vaccine uptake is low in settings with limited resources such as low- and middle-income countries. Objectives To assesses the uptake of HPV vaccine and associated factors among female students attending secondary schools in South West Shoa Zone, Oromia, Ethiopia, 2022. Methods A cross-sectional study was conducted in secondary schools of South West Shoa Zone between November 1st to November 30th 2022. A multi-stage sampling technique was employed among 634 female students attending secondary schools. Data were collected by self-administered structured questionnaires, entered into Epi-info version 7.2.2.6, and exported to SPSS version 25 for statistical analysis. Bivariable analyses were considered for Multivariable analysis. Adjusted odds ratio (AOR) along with 95% confidence levels were estimated to assess the strength of the association, and a P value <0.05 was considered to indicate statistical significance. Results The proportion of HPV vaccine uptake was 31.65% (95% CI, 25-38). Having adequate knowledge AOR = 8.51 (95% CI = 4.57-15.84), living in rural area AOR = 0.25 (95% CI = 0.15-0.42), having older sibling AOR = 4.07(95% = 2.50-6.63), mother’s educational level (Diploma and above) AOR = 4.08 (95% CI = 1.75-9.49), and secondary education AOR = 3.98 (95% CI = 1.87-8.48) were significantly associated with HPV vaccine uptake among female students attending secondary schools in South West Shoa Zone, Oromia, Ethiopia. Conclusions The study revealed that HPV vaccine uptake was very low among female students attending secondary schools in South West Shoa Zone, Oromia, Ethiopia. Adequate knowledge, having older sibling, living in rural area, and having mothers with higher educational level were significantly associated with HPV vaccine uptake. All concerned bodies should work jointly to enhance the uptake of HPV vaccination among female students.

The Future of AI in Ovarian Cancer Research: The Large Language Models Perspective

Conversational large language model (LLM)-based chatbots utilize neural networks to process natural language. By generating highly sophisticated outputs from contextual input text, they revolutionize the access to further learning, leading to the development of new skills and personalized interactions. Although they are not developed to provide healthcare, their potential to address biomedical issues is rather unexplored. Healthcare digitalization and documentation of electronic health records is now developing into a standard practice. Developing tools to facilitate clinical review of unstructured data such as LLMs can derive clinical meaningful insights for ovarian cancer, a heterogeneous but devastating disease. Compared to standard approaches, they can host capacity to condense results and optimize analysis time. To help accelerate research in biomedical language processing and improve the validity of scientific writing, task-specific and domain-specific language models may be required. In turn, we propose a bespoke, proprietary ovarian cancer-specific natural language using solely in-domain text, whereas transfer learning drifts away from the pretrained language models to fine-tune task-specific models for all possible downstream applications. This venture will be fueled by the abundance of unstructured text information in the electronic health records resulting in ovarian cancer research ultimately reaching its linguistic home.

A Multi-Institutional Retrospective Analysis of Oncologic Outcomes for Patients With Locally Advanced Cervical Cancer Undergoing Platinum-Based Adjuvant Chemotherapy After Concurrent Chemoradiotherapy

Objective: To evaluated the oncologic outcomes associated with platinum-based adjuvant chemotherapy following concurrent chemoradiotherapy (CCRT) in the management of patients with locally advanced cervical cancer (LACC). Methods: A total of 695 patients with FIGO stage IB2, IIA2, IIB-IVA LACC treated at 6 medical facilities were enrolled and divided into 2 groups: 478 were assigned to CCRT alone (CCRT group) and 217 to adjuvant chemotherapy after CCRT (CCRT-ACT group). The treatment outcomes were retrospectively compared and reported after the propensity score matching (PSM) analysis. Results: With a median follow-up of 56.4 months, no statistically significant differences were found in overall survival (OS), disease-free survival (DFS), progression-free survival (PFS) and distance metastasis-free survival (DMFS) between 2 groups. In CCRT-ACT group, patients with lymph nodes involvement or squamous cell carcinoma (SCC) had significantly longer DMFS, but no significant benefit in survival outcomes were observed with more than 2 cycles of adjuvant chemotherapy. Moreover, patients with a high level of CA125 (>20.5U/mL) or SCC-Ag (>22.8μg/L) had a relatively better DFS or PFS, and grade 3-4 acute hematological toxicity, late urinary and lower gastrointestinal complications and diarrhea symptom were more frequent in CCRT-ACT group. Conclusions: Adjuvant chemotherapy after CCRT has a potential role in further improving disease control for LACC patients with lymph nodal-metastasis or SCC with a high level of CA125 or SCC-Ag. Due to increased treatment-related complications and diarrhea symptom affecting the quality of life, post-CCRT adjuvant chemotherapy with excessive cycles was not be considered as the most appropriate choice in general.

Immune-Related Genes’ Prognostic, Therapeutic and Diagnostic Value in Ovarian Cancer Immune-Related Gene Biomarker in Ovarian Cancer

Objectives The abnormal expression of immune-related genes (IRGs) plays an important role in the occurrence and progression of ovarian cancer (OC), which is the main cause of mortality among gynecological cancer patients. This study aims to establish a prognostic risk model and comprehensively analyze the relationship between OC risk score and prognosis, immune cell infiltration (ICI) and therapeutic sensitivity in OC. Methods We retrospectively evaluated the clinicopathological characteristics of consecutive OC patients in the Cancer Genome Atlas (TCGA) database. First, the prognostic risk model was constructed by bioinformatics methods. And then, we systematically assessed model robustness, and correlations between risk score and prognosis, and immune cell infiltration. The ICGC cohort was used to verify the prognostic risk model. Finally, we evaluated their value in the treatment of OC immunotherapy and chemotherapy. Results A total of 10 IRGs were identified to construct the prognostic risk model. Survival analysis revealed that patients in the low-risk group had a better prognosis ( P < .01), and the risk score might be considered an independent predictor for predicting the prognosis. In addition, risk scores and patient clinical information were used to construct clinical nomograms, improving the prediction’s precision. We also explored the relationship between the risk score and ICI, immunotherapy and drug sensitivity. Conclusions Collectively, we identified a novel ten IRGs signature that may be applied as a prognostic predictor of OC, thereby benefiting clinical decision-making and personalized treatment of patients.

Is Prophylactic Radiotherapy to the Lymphatic Drainage Area Necessary for Patients With Stage III Ovarian Cancer After Chemotherapy Following Surgery?

Background For patients with stage III epithelial ovarian cancer, there are limited studies on the effects of postoperative adjuvant radiotherapy (RT). Here we assessed the therapeutic efficacy and toxicity of postoperative radiotherapy to the abdominal and pelvic lymphatic drainage area for stage III epithelial ovarian cancer patients, who had all received surgery and chemotherapy (CT). Methods We retrospectively collected patients with stage III epithelial ovarian cancer after cytoreductive surgery (CRS) and full-course adjuvant CT. The chemoradiotherapy (CRT) group patients were treated with intensity modulated radiotherapy (IMRT) to the abdominal and pelvic lymphatic drainage area in our hospital between 2010 and 2020. A propensity score matching analysis was conducted to compare the results between the CRT and CT groups. Kaplan-Meier analysis estimated overall survival (OS), disease-free survival (DFS), and local control (LC) rates. The log-rank test determined the significance of prognostic factors. Results A total of 132 patients with median follow-up of 73.9 months (9.1-137.7 months) were included (44 and 88 for the CRT and RT groups, retrospectively). The baseline characteristics of age, histology, level of CA12-5, surgical staging, residual tumour, courses of adjuvant CT, and courses to reduce CA12-5 to normal were all balanced. The median DFS time, 5-year OS, and local recurrence free survival (LRFS) were 100.0 months vs 25.9 months ( P = .020), 69.2% vs 49.9% ( P = .002), and 85.9% vs 50.5% ( P = .020), respectively. The CRT group mainly presented with acute haematological toxicities, with no statistically significant difference compared with grade III intestinal adverse effects (3/44 vs 6/88, P = .480). Conclusion This report demonstrates that long-term DFS could be achieved in stage III epithelial ovarian cancer patients treated with IMRT preventive radiation to the abdominal and pelvic lymphatic area. Compared with the CT group, DFS and OS were significantly prolonged and adverse effects were acceptable.

Prognostic Value of En-Block Radical Bowel Resection in Advanced Ovarian Cancer Surgery With HIPEC

Purpose To identify prognostic factors of survival and recurrence in advanced ovarian cancer patients undergoing radical surgery and HIPEC. Methods In a single Department of Surgical Oncology, Peritoneal Surface Malignancy Program, and over a 16-year period, from a total of 274 epithelial ovarian cancer patients, retrospectively, we identified 152 patients undergoing complete (CC-0) or near-complete (CC-1) cytoreduction, including at least one colonic resection, and HIPEC. Results Mean age of patients was 58.8 years and CC-0 was possible in 72.4%. Rates of in-hospital mortality and major morbidity were 2.6% and 15.7%. Only 122 (80.3%) patients completed Adjuvant Systemic Chemotherapy (ASCH). Rates of metastatic Total Lymph Nodes (TLN), Para-Aortic and Pelvic Lymph Nodes (PAPLN) and Large Bowel Lymph Nodes (LBLN) were 58.7%, 58.5%, and 51.3%, respectively. Median, 5- and 10-year survival rates were 39 months, 43%, and 36.2%, respectively. The recurrence rate was 35.5%. On univariate analysis, CC-1, high Peritoneal Cancer Index (PCI), in-hospital morbidity, and no adjuvant chemotherapy were adverse factors for survival and recurrence. On multivariate analysis, negative survival indicators were the advanced age of patients, extensive peritoneal dissemination, low total number of TLN and no systemic PAPLN. Metastatic LBLN and segmental resection of the small bowel (SIR) were associated with a high risk for recurrence. Conclusion CC-O is feasible in most advanced ovarian cancer patients and HIPEC may confer a survival benefit. Radical bowel resection, with its entire mesocolon, may be necessary, as its lymph nodes often harbor metastases influencing disease recurrence and survival. The role of metastatic bowel lymph nodes has to be taken into account when assessing the impact of systemic lymphadenectomy in this group of patients.

The Use of Artificial Intelligence for Complete Cytoreduction Prediction in Epithelial Ovarian Cancer: A Narrative Review

Introduction In patients affected by epithelial ovarian cancer (EOC) complete cytoreduction (CC) has been associated with higher survival outcomes. Artificial intelligence (AI) systems have proved clinical benefice in different areas of healthcare. Objective To systematically assemble and analyze the available literature on the use of AI in patients affected by EOC to evaluate its applicability to predict CC compared to traditional statistics. Material and Methods Data search was carried out through PubMed, Scopus, Ovid MEDLINE, Cochrane Library, EMBASE, international congresses and clinical trials. The main search terms were: Artificial Intelligence AND surgery/cytoreduction AND ovarian cancer. Two authors independently performed the search by October 2022 and evaluated the eligibility criteria. Studies were included when data about Artificial Intelligence and methodological data were detailed. Results A total of 1899 cases were analyzed. Survival data were reported in 2 articles: 92% of 5-years overall survival (OS) and 73% of 2-years OS. The median area under the curve (AUC) resulted 0,62. The model accuracy for surgical resection reported in two articles reported was 77,7% and 65,8% respectively while the median AUC was 0,81. On average 8 variables were inserted in the algorithms. The most used parameters were age and Ca125. Discussion AI revealed greater accuracy compared against the logistic regression models data. Survival predictive accuracy and AUC were lower for advanced ovarian cancers. One study analyzed the importance of factors predicting CC in recurrent epithelial ovarian cancer and disease free interval, retroperitoneal recurrence, residual disease at primary surgery and stage represented the main influencing factors. Surgical Complexity Scores resulted to be more useful in the algorithms than pre-operating imaging. Conclusion AI showed better prognostic accuracy if compared to conventional algorithms. However further studies are needed to compare the impact of different AI methods and variables and to provide survival informations.

Blocking CD47-SIRPα Signal Axis as Promising Immunotherapy in Ovarian Cancer

Among the three primary gynecological malignancies, ovarian cancer has the lowest incidence but the worst prognosis. Because of the poor prognosis of ovarian cancer patients treated with existing treatments, immunotherapy is emerging as a potentially ideal alternative to surgery, chemotherapy, and targeted therapy. Among immunotherapies, immune checkpoint inhibitors have been the most thoroughly studied, and many drugs have been successfully used in the clinic. CD47, a novel immune checkpoint, provides insights into ovarian cancer immunotherapy. This review highlights the mechanisms of tumor immune evasion via CD47-mediated inhibition of phagocytosis and provides a comprehensive insight into the progress of the relevant targeted agents in ovarian cancer.

Survival Outcomes of Patients with International Federation of Gynecology and Obstetrics Stage IV Ovarian Cancer: Cytoreduction Still Matters

Purpose There is still no consensus on the therapeutic strategies for patients with International Federation of Gynecology and Obstetrics (FIGO) stage IV ovarian cancer (OC). We aim to outline the clinical characteristics and optimal therapeutic strategies of patients with FIGO stage IV OC. Methods This single center retrospective study analyzed the clinical features and survival of patients with FIGO stage IV OC that underwent cytoreduction or received at least one course of chemotherapy between January 2014 and December 2020. Results One hundred and twenty patients were included. Surgery, especially optimal cytoreduction without residual mass improved the overall survival of patients in surgery group ( P = .047, HR .432, 95% CI .181-.987). Secondly, the completion of chemotherapy improved median overall survival of patients either with (53.0 months vs 25.0 months, P < .001, HR 7.015, 95% CI 1.372-35.881) or without cytoreduction (43.0 months vs 6.0 months, P = .006, HR 5.969, 95% CI 1.115-31.952). In patients with FIGO stage IVB, those with only extra-abdominal lymph node metastases had better survival. Conclusions In patients with FIGO stage IV, complete resection of intra-abdominal tumor foci and completion of chemotherapy provided considerable survival benefits to patients with FIGO stage IV OC. Among patients with FIGO stage IVB, those with only extra-abdominal lymph node metastases had a better prognosis.

Knowledge, Attitudes and Practices of Women in the UAE Towards Breast and Cervical Cancer Prevention: A Cross-Sectional Study

Introduction Breast and cervical cancers represent two important causes of cancer-associated deaths in females. Uptake in prevention towards these cancers remains low in the United Arab Emirates. Objectives This study aimed to understand the knowledge, attitudes and practices of females residing in the Al Ain city, UAE, towards cervical and breast cancer prevention. Methods This cross-sectional survey was conducted with 300 women, aged 30 years and above. The primary outcome measure was cervical and breast cancer prevention knowledge. The knowledge was queried through a number of items, with the resulting aggregate scores categorized into good and low knowledge. Chi-square test was conducted to investigate the association between prevention knowledge and sociodemographic factors. Additional outcomes included attitude towards and uptake of cervical and breast cancer screening. Results Of the participants surveyed, 36.7% had good knowledge on breast cancer prevention, while 5.3% on cervical cancer prevention. Although the majority of the participants believed that prevention methods could save lives, they reported negative attitudes, considering screening unnecessary and painful. The self-reported screening uptake was 23% and 31.3% for mammography and Pap smear, respectively. Conclusions The study reported that the knowledge and uptake of women was low for both breast and cervical cancer prevention. Targeted campaigns not only to increase knowledge but also to resolve misconceptions to change negative attitudes may lead to an increase in uptake.

Cancer Screening Rates Among Asian Americans: A Cross-Sectional Secondary Data Analysis Study

Purpose This study aims 1) to investigate recent cancer screening rates among Asian Americans and 2) to test the relationship between race/ethnicity and cancer screening rates. Methods This is a cross-sectional secondary data analysis study using data from the 2019 National Health Interview Survey. The screening rates of prostate cancer, colorectal cancer, cervical cancer, and breast cancer among non-Hispanic (NH) Asian Americans, Hispanics, NH Whites, NH African Americans, and NH American Indian and Alaska Natives (AIAN) were analyzed in July 2022. The variables were recoded and analyzed using descriptive analysis and chi-square test. The SPSS version 27 software was used. Results Descriptive analysis showed a general low screening rate of cancers among Asian Americans, which ranged from 40.5% to 67.5%. The chi-square test suggested significant associations between race/ethnicity and the screening rates of colorectal cancer ( P = .002), cervical cancer ( P < .01), and breast cancer ( P = .021), but not the prostate cancer ( P = .472). Conclusion Necessary intervention programs should be designed to increase the uptake rates of cancer screening among Asian Americans.

Determinants of Cervical Cancer Screening Among Women Aged 30–49 Years Old in Four African Countries: A Cross-Sectional Secondary Data Analysis

Background Early-stage cervical cancer screening is essential for providing women with a better chance of receiving effective treatment for precancerous and cancer stages. Delay in cervical cancer screening results in late presentation and cancer metastasis. National-level cervical cancer screening in resource-limited countries was scarce and not well studied in Africa based on national data specifically in Kenya, Cameroon, Nambia, and Zimbabwe. Objective To determine the prevalence and determinants of cervical cancer screening among eligible women in Kenya, Cameroon, Nambia, and Zimbabwe. Methods This study analyzed demographic and health survey data from Kenya, Cameroon, Nambia, and Zimbabwe. The data were extracted and analyzed by STATA version 15 and further analysis was done. Intraclass correlation coefficient, median odds ratio, and proportional change in variance were calculated to check the appropriateness of multilevel analysis. Variables with P-value < .25 were selected for multivariable multilevel logistic regression analysis. Finally, statistical significance between dependent and independent variables was assessed by odds ratios and 95% confidence intervals. Results The prevalence of cervical cancer screening in 4 African countries (Nambia, Kenya, Cameroon, and Zimbabwe) was 23.4 [95%CI: 22.8-24.1]. The determinants identified in this study were women of age 41–50 years [AOR = 1.47; 95% CI 1.24, 1.73], rural residence [AOR = .67; 95% CI .55, .81], women who have their own work [AOR = 1.1; 95% CI 1.0, 1.37], smoking status [AOR = 1.89; 95% CI 1.17, 3.0], age at first birth >=35 [AOR = 5.27; 95% CI 1.29-21.52], condom use [AOR = 1.79; 95% CI 1.46,2.19], husbands having worked [AOR = 1.5; 95% CI 1.08,2.11], rich household wealth [AOR = 1.43; 95% CI 1.13,1.8], and having health insurance [AOR = 2.2; 95% CI 1.8,2.7]. Conclusion The prevalence of cervical cancer screening in Kenya, Cameroon, Nambia, and Zimbabwe was low as compared to World Health Organization (WHO) recommendations. Age, residence, work status, smoking status, women’s age at first birth, condom use, husbands having work, wealth status, and health insurance were the identified determinants of cervical cancer screening. Programme and policy interventions could address younger, rural residence women, poor wealth status women, women without work, and those who never use health insurance for the uptake of cervical cancer screening.

Sequential Targeted Therapy for Advanced, Metastatic, and Recurrent Cervical Cancer: A Cost-Effectiveness Analysis of the Patient Journey

Objectives To evaluate outcomes and cost-effectiveness of targeted therapy sequencing for metastatic and recurrent cervical cancer. Method Models were simulated based on phase II and III trials on bevacizumab (bev) from GOG-240, cemiplimab (cemi) from GOG 3016, pembrolizumab (pembro) from KEYNOTE-826, and tisotumab vedotin (tiso) from GOG 3023. Costs were based on IBM Micromedex RED BOOK™ and company listed costs. Results For [chemo + bev → chemo], total cost was $125,918.04, with median overall survival (mOS) of 21.8 months, and cost-effectiveness ratio (CER) of $119,835.79. For [chemo + bev → cemi], total cost was $187,562.99 with mOS of 28.5 months and CER of $162,039.16. For [chemo + bev + pembro → chemo], total cost was $319,963.78 with mOS 32.9 months and CER of $249,930.10. For [chemo + bev + pembro → tiso], total cost was $455,204.45, with mOS 36.5 months and CER of $320,072.99. Conclusion The combination of immunotherapies and biologics have significantly increased overall survival, but with associated higher costs, primarily related to drug costs.

Feasibility of Sentinel Lymph Node Mapping With Carbon Nanoparticles in Cervical Cancer: A Retrospective Study

Introduction This retrospective study aims to investigate the feasibility of using carbon nanoparticles to detect sentinel lymph nodes (SLNs) in cervical cancer. Methods This study involved 174 patients with cervical cancer. Cervix tissues adjacent to the cancer were injected with 1 mL of carbon nanoparticles (CNPs) at the 3 and 9 o’clock positions according to the instructions. The pelvic lymph nodes were then dissected, and the black-stained sentinel lymph nodes were sectioned for pathological examination. Results Of 174 cases, 88.5% of patients (154/174) had at least 1 sentinel lymph node, and 131 patients (75.29%) had bilateral pelvic sentinel lymph nodes. The left pelvic lymph node was the most common sentinel lymph node (34.16%). At least 1 sentinel lymph node was observed in 285 out of 348 hemipelvises, with a detection rate of a side-specific sentinel lymph node of 81.89%. In total, 47 hemipelvises had metastasis of the lymph node, and 33 involved the sentinel lymph node, with a sensitivity of 70.21% and a false-negative rate of 29.79%. There were 238 hemipelvises with no metastasis of the lymph node, as well as negative sentinel lymph nodes, with a specificity of 100% and a negative predictive value of 94.44%. The univariate analysis demonstrated that risk factors included tumor size (OR .598, 95% CI: .369-.970) and deep stromal invasion (OR .381, 95% CI: .187-.779). The deep stromal invasion was the only variable for the false-negative detection of a sentinel lymph node. Conclusion Sentinel lymph node mapping with carbon nanoparticles might be applied to predict the metastasis of pelvic lymph nodes in cervical cancer. However, tumor size and deep stromal invasion might negative influence the detection rate of SLN.

Differences in Cervical Cancer Outcomes by Caribbean Nativity in Black and White Women in Florida

Objective Racial disparities among women with cervical cancer have been reported but are understudied in Caribbean immigrants. The objective of this study is to describe the disparities in clinical presentation and outcomes between Caribbean-born (CB) and US-born (USB) women with cervical cancer by race and nativity. Methods An analysis of the Florida Cancer Data Service (FCDS), the statewide cancer registry, was performed to identify women diagnosed with invasive cervical cancer between 1981 and 2016. Women were classified as USB White or Black and CB White or Black. Clinical data were abstracted. Analyses were done using chi square, ANOVA, Kaplan-Meier and Cox proportional hazards models, with significance set at P < .05. Results 14 932 women were included in the analysis. USB Black women had the lowest mean age at diagnosis, while CB Black women were diagnosed at later stages of disease. USB White women and CB White women had better OS (median OS 70.4 and 71.5 months, respectively) than USB Black and CB Black women (median OS 42.4 and 63.8 months, respectively) ( P < .0001). In multivariable analysis, relative to USB Black women, CB Blacks (HR .67, CI .54–.83), and CB White (HR .66, CI .55–.79) had better odds of OS. White race among USB women was not significantly associated with improved survival ( P = .087). Conclusion Race alone is not a determinant of cancer mortality in women with cervical cancer. Understanding the impact of nativity on cancer outcomes is crucial to improve health outcomes.

Human Papilloma Virus Infection and Gene Subtypes Analysis in Women Undergoing Physical Examinations: A 2015-2020 Study in Wenzhou, China

Background Persistent infection with high-risk human papillomavirus (HPV) is closely related to cervical cancer. The epidemiologic characteristics of cervical HPV have regional differences. Therefore, it is necessary to develop the most favorable policies according to the actual situation of each region to prevent and reduce the prevalence of cervical cancer. This retrospective cross-sectional study investigated the prevalence, gene subtypes, and temporal trends of HPV in women undergoing physical examination in Wenzhou, to provide a decision-making basis for further prevention and control of HPV. Methods A total of 31 131 cervical exfoliated cell specimens obtained from physical examinations in Wenzhou, a coastal city of China, from 2015 to 2020 were collected. The age distribution was analyzed using the chi-squared test, and the time change trend was analyzed using the Mann–Kendall trend test. On this basis, the distribution characteristics of the HPV subtypes were analyzed. Results The total prevalence rate was 9.55%, and the prevalence rate in different age groups ranged from 7.77% to 14.16%. The prevalence rate in different years was 8.84%-11.83%. The prevalence rate was bimodal; it was highest in the group 25 years old, followed by the group >61 years old. The top five high-risk gene subtypes were HPV52, HPV58, HPV53, HPV16, and HPV39, whereas the low-risk subtypes were HPV61, HPV81, HPV44, HPV43, and HPV55. Of all the positive samples, 76.03% were infected with a high-risk subtype. Conclusion Most female HPV patients in Wenzhou are infected with high-risk gene subtypes. Therefore, physical examination and screening for HPV should be further strengthened, and the corresponding vaccination policy should focus on high-risk gene subtypes.

Dietary Inflammatory Index and Epithelial Ovarian Cancer in Southern Chinese Women: A Case-Control Study

The association between inflammatory properties of diet and ovarian cancer risk has been investigated in some Western populations. However, little evidence is available from Asian women whose ovarian cancer incidence rates are low and dietary and lifestyle patterns are very different from their Western counterparts. We aimed to examine whether more pro-inflammatory diets, as indicated by higher dietary inflammatory index (DII®) scores, are associated with increased odds of epithelial ovarian cancer in southern China. A case-control study was conducted during 2006-2008 in Guangzhou, Guangdong Province. Energy-adjusted DII (E-DII) scores were calculated based on dietary intake assessed by a validated food frequency questionnaire administered to 500 incident epithelial ovarian cancer patients and 500 hospital-based controls. Logistic regression models were used to assess the relationship between E-DII scores and odds of ovarian cancer. Positive associations were observed between higher E-DII scores and ovarian cancer odds, using both continuous DII scores (odds ratio (OR) 1.87; 95% confidence interval (CI) 1.65, 2.13) and by DII tertiles (ORtertile3vs1 7.04, 95% CI: 4.70, 10.54, p for trend < 0.001). Likewise, a more pro-inflammatory diet was associated with a higher chance of serous and mucinous ovarian tumors. Our results suggest that a pro-inflammatory diet was associated with increased odds of developing epithelial ovarian cancer in southern Chinese women. The findings add to epidemiological evidence for the role of dietary inflammatory potential in ovarian cancer development.

Feasibility and Acceptability of an App-Based, Multimodal Prehabilitation Program for Women Undergoing Surgery for Gynaecological Cancer

Introduction Prehabilitation aims to optimise functional capacity, nutritional status, and mental wellbeing, to minimise surgical morbidity and enhance recovery. Hospital-based prehabilitation programs may face practical barriers, such as distance, time, and cost of travel. App-based prehabilitation may therefore offer a practical solution. Objective The aim of this study was to assess the feasibility, acceptability, and safety of introducing an app-based prehabilitation program into the standard care for women undergoing gynaecological cancer surgery. Methods This was a feasibility study performed as part of a prehabilitation service development project for women undergoing gynaecological cancer surgery between April 2024 and May 2024. Women were approached to trial the ‘Surgery Hero’ prehabilitation app prior to surgery, which was a multimodal app-based intervention including physical exercise, nutrition, and mental wellbeing through information modules, videos, and real-time access to a health coach. Feasibility was assessed through recruitment, activation, participation, and drop-out rates, and adverse events were monitored. Acceptability was assessed through participant satisfaction scores, and semi-structured interviews with thematic analysis of facilitators and barriers to program participation. Results Fifteen licenses were available and successfully utilised, with a recruitment rate of 58.6% and an activation rate of 88.2%. The participation rate was 93.3% and the mean engagement rate was 76.3%. No adverse events were reported. The mean overall program satisfaction score was 4.5 out of 5. Participants felt motivated to participate and were reassured by the coaching calls and information provision. However, they felt limited by the short preoperative interval and their current state of health. Conclusions App-based prehabilitation appears to be a feasible, acceptable, and safe option for women undergoing surgery for a gynaecological cancer. However, further studies are needed to confirm these findings.

Treatment Outcome and Associated Factors Among Women With Gestational Trophoblastic Neoplasia in Northwest Ethiopia: A Multi-Center Retrospective Cohort Study

Introduction Gestational trophoblastic neoplasia (GTN) is the most curable gynecologic malignancy. However, resistance to first-line chemotherapy remains common, and mortality is high in developing countries. Objective To evaluate remission, relapse, survival, and associated factors among GTN patients in northwest Ethiopia. Methods A hospital-based, multi-center retrospective cohort study was conducted on 205 patients treated between August 1, 2019, and July 31, 2024. Data were collected from medical charts and phone interviews. Logistic regression identified factors affecting remission. Kaplan–Meier analysis was used to estimate the overall survival (OS) probabilities. Prognostic factors were determined using Cox regression. Results were interpreted as adjusted odds (AOR) and adjusted hazard ratios (AHR) with 95% confidence intervals. Statistical significance was declared at P ≤ .05. Results The overall remission rate was 62.4%, with 41.0% of low-risk GTN patients developing resistance to monotherapy. Chemo-resistance was independently associated with FIGO/WHO scores of 5-6 (AOR = 2.4, 95% CI: 1.2-5.6), disease duration ≥4 months (AOR = 1.7, 95% CI: 1.0-3.3), metastases (AOR = 2.2, 95% CI: 1.1-4.6), and choriocarcinoma histology (AOR = 3.0, 95% CI: 1.3-6.7). The 5-year OS was 77%, with metastases independently predicting poor survival (AHR = 4.1, 95% CI: 1.0-15.9). Choriocarcinoma and high-risk GTN were associated with increased relapse. Conclusion Chemoresistance was notably high among low-risk GTN patients. Particularly, patients with metastasis, choriocarcinoma histology, a WHO-FIGO risk score of 5-6, and longer disease duration may benefit from early combination therapy. In addition, GTN patients have shown relatively low survival rates. Metastases significantly affect survival. These findings highlight the importance of early detection, risk-adapted therapy, and therapeutic advancements to improve outcomes in resource-limited settings.

Quality of Life Measurement in PARP Inhibitor Trials of Epithelial Ovarian Cancer – What Do We Know?

Epithelial ovarian cancer (EOC), dominated by high-grade serous carcinoma, continues to impose a heavy global burden, particularly in low- and middle-income countries. Although advances in surgery and chemotherapy have extended survival, relapse within 2 years remains common, underscoring the need for novel strategies. Poly adenosine diphosphate ribose polymerase inhibitors (PARPi) have transformed maintenance therapy by prolonging progression-free survival, yet their influence on health-related quality of life (HRQoL) is less well characterized. Patient-reported outcomes (PROs) serve as key tools for evaluating the impact of treatment on physical, emotional, and social well-being. Trials including SOLO1, NOVA, and ARIEL3 demonstrate the increasing recognition of QoL endpoints, though heterogeneity in tools and endpoints limits cross-trial comparisons. Several gaps persist including limited data collection beyond disease progression. This review integrates evidence from published studies, highlights methodological challenges, and proposes directions for future work, emphasizing the centrality of patient-centered outcomes in advancing precision medicine for ovarian cancer. The evidence underscores the imperative of designing trials that incorporate QoL as a core endpoint, ensuring meaningful benefits for patients in both clinical and real-world settings.

Chemotherapy-Induced Neutropenia as a Prognostic Factor in Patients With Advanced Epithelial Ovarian Carcinoma

Background To evaluate the prognostic value of chemotherapy-induced neutropenia (CIN) in epithelial ovarian carcinoma (EOC) treated with primary surgery followed by platinum-based chemotherapy. Methods The records of primary EOC treated between Jan 1st 2002 and Dec 31st 2016 were reviewed according to the including and excluding criteria. CIN was defined as absolute neutrophil count (ANC) after chemotherapy <2.0 × 109/L. Patients with CIN were further divided into mild and severe CIN (ANC <1.0 × 109/L), early-onset and late-onset (>3 cycles) CIN. Clinical characteristic was compared by chi-square test. Overall survival (OS) and progression-free survival (PFS) were compared using Kaplan–Meier analysis, univariate and multivariate Cox regression models. Results Among 735 EOC patients enrolled, no significant differences of the prognosis were found between patients with and without CIN, early and late CIN, mild and severe CIN. However, Kaplan–Meier curve (65 vs 42 months for CIN vs non-CIN, P = .007) and Cox regression analysis (HR 1.499, 95% CI 1.142-1.966; P = .004) both revealed that CIN was significantly related with better OS in advanced EOC patients, but not for PFS. So, subgroup analysis was further conducted and date suggested that CIN was an independent predictor of better survival in advanced EOC with suboptimal surgery (PFS: 18 vs 14 months, P = .013, HR 1.526, 95% CI 1.072-2.171, P = .019; OS: 37 vs 27 months, P = .013, HR 1.455, 95% CI 1.004-2.108; P = .048). Conclusions CIN might be used as an independent prognostic indicator of advanced EOC, especially for those patients with suboptimal surgery.

The Significance of Radiotherapy in Ovarian Clear Cell Carcinoma: A Systematic Review and Meta-Analysis

Objective To assess the response rate and survival effect of adjuvant radiotherapy (RT) or chemoradiotherapy (CRT) during ovarian clear cell carcinoma (OCCC). Methods We searched Web of Science, PubMed, Cochrane library electronic databases, Clinical Trials, WanFang Data and Chinese National Knowledge Infrastructure (CNKI) up to October 2022. We also searched registers of clinical trials, abstracts of scientific meetings and reference lists of included studies. Results We identified a total of 4259 patients from 14 studies met the inclusion criteria. The pooled response rate of residual tumors for RT/CRT was 80.0%, the pooled 5-year progression-free survival (PFS) ratio during RT/CRT group was 61.0%, and the pooled 5-year overall survival (OS) ratio during RT/CRT group was 68.0%; heterogeneity tests demonstrated significant difference between studies (I 2 >50%). Cumulative results suggested adjuvant RT/CRT improved 5-year PFS ratio of OCCC patients (OR: 0.51 (95% CI: 0.42–.88), I 2 = 22%, P = .009), had no impact on 5-year OS ratio (OR: 0.52 (95% CI: 0.19–1.44), I 2 = 87%, P = .21); meta-regression of studies before and after 2000 found consistent results. Sub-analysis observed that adjuvant RT/CRT had no impact on 5-year OS ratio of early-stage (stage I + II) OCCC patients (OR: 0.67 (95% CI: 0.25–1.83), I 2 = 85%, P = .44), but might improve 5-year OS ratio of advanced and recurrent OCCC patients (OR: 0.13(95% CI: 0.04–.44), P = .001). Conclusion This analysis suggested that adjuvant RT/CRT might improve oncologic outcomes of OCCC, especially for advanced and recurrent cases. Due to the inherent selective biases of retrospective studies enrolled in the meta-analysis, more convincing evidences based on prospective randomized controlled trials (RCTs) are urgently needed.

The Infection Status and Distribution of hrHPV in Cervical Lesions Among Overweight Women Referred for Colposcopy: A Cross-Sectional Study

Introduction Among opportunistically screened population with above normal-weight, screening-related information remains limited. This study aimed to evaluate the infection status and distribution of high-risk (hr) human papillomavirus (HPV) on precancerous grades and cancer among overweight women compared with normal-weight women, and further explored the association between clinical characteristics and both HPV infection and cervical lesions. Methods The reporting of this cross-sectional retrospective study conforms to STROBE guidelines. This study was conducted in the Affiliated Cancer Hospital of Xinjiang Medical University. A total of 720 out of 1146 women with complete medical records of demographic and clinical characteristics were enrolled on the colposcopy clinic. HrHPV infection status, cytology abnormality rates, detection rates of cervical intraepithelial neoplasia (CIN) grades and cancer, and clinical performance of triage tests were evaluated by Body Mass Index (BMI) levels, which were classified into two groups as overweight women (BMI ≥24 kg/m 2 ) and normal-weight women (BMI <24 kg/m2). Results The hrHPV infection rate of overweight women (73.0%) was not significantly lower than that of normal-weight women (78.6%) by the GenoArray test ( P = 0.09) and by HC2 test (68.5% vs 71.0%, P = 0.53). The positive rates of most frequent hrHPV subtypes of overweight women vs normal-weight women were HPV16 (31.1% vs 39.1%, P = 0.03). The detection rates of CIN lesions were lower among overweight vs normal-weight (28.3% vs 37.4%, P = 0.01), while the detections rate of cancer was slightly higher but not significant (7.2% vs 4.6%, P = 0.14). The clinical performance of different screening strategies were similar between overweight and normal weight women. Conclusions The HPV16 prevalence and the detection rate of cervical precancerous lesions was lower in overweight women than normal-weight women, indicating that targeted management strategies should be given to overweight women to decrease the underdiagnosis.

Knowledge Toward Cervical Cancer and Its Determinants Among Women Aged 30-49 in Jimma Town, Southwest Ethiopia

Background: Cervical cancer is one of the common causes of premature death and disability in women worldwide. It is preventable through vaccination, and screening for precancerous lesions and early treatment. However, screening service uptake and treatment for cervical cancer face significant challenges in low-income countries due to poor information systems. The aim of this study was to assess knowledge of cervical cancer and its determinants among women aged 30-49 years living in Jimma Town, Southwest Ethiopia. Methods: A community-based cross-sectional study was undertaken from March 20 to April 15, 2017. The data were collected using a structured interviewer-administered questionnaire and analyzed by SPSS version 21. Multivariable logistic regression anaysis was done and variables with a p-value < 0.05 were considered statistically significant. Results: Of the interviewed women, only 321(43.6%) had adequate knowledge about cervical cancer and screening. Attending secondary school or above (AOR = 2.42, 95% CI: 1.24-4.74), using modern contraceptives (AOR = 6.31, 95% CI: 2.86-13.89), knowing somebody with cervical cancer (AOR = 2.24, 95% CI: 1.35-3.71) and knowing someone screened for cervical cancer (AOR = 2.23, 95% CI: 1.30-3.80) were associated with knowledge of cervical cancer. Conclusion: Knowledge of cervical cancer is low in the current study area even if appropriate knowledge regarding the disease is important in decreasing the incidence and prevalence of cervical cancer through screening and human pappiloma virus vaccination. Increasing awereness regarding the disease and prevention strategies are the key issue.

Evaluation of Combined Cancer Markers With Lactate Dehydrogenase and Application of Machine Learning Algorithms for Differentiating Benign Disease From Malignant Ovarian Cancer

Background The differential diagnosis of ovarian cancer is important, and there has been ongoing research to identify biomarkers with higher performance. This study aimed to evaluate the diagnostic utility of combinations of cancer markers classified by machine learning algorithms in patients with early stage ovarian cancer, which has rarely been reported. Methods In total, 730 serum samples were assayed for lactate dehydrogenase (LD), neutrophil-to-lymphocyte ratio (NLR), human epididymis protein 4 (HE4), cancer antigen 125 (CA125), and risk of ovarian malignancy algorithm (ROMA). Among them, 53 were diagnosed with early stage ovarian cancer, and the remaining 677 were diagnosed with benign disease. Results The areas under the receiver operating characteristic curves (ROC-AUCs) of the ROMA, HE4, CA125, LD, and NLR for discriminating ovarian cancer from non-cancerous disease were .707, .680, .643, .657, and .624, respectively. ROC-AUC of the combination of ROMA and LD (.709) was similar to that of single ROMA in the total population. In the postmenopausal group, ROC-AUCs of HE4 and CA125 combined with LD presented the highest value (.718). When machine learning algorithms were applied to ROMA combined with LD, the ROC-AUC of random forest was higher than that of other applied algorithms in the total population (.757), showing acceptable performance. Conclusion Our data suggest that the combinations of ovarian cancer-specific markers with LD classified by random forest may be a useful tool for predicting ovarian cancer, particularly in clinical settings, due to easy accessibility and cost-effectiveness. Application of an optimal combination of cancer markers and algorithms would facilitate appropriate management of ovarian cancer patients.

Feature Selection is Critical for 2-Year Prognosis in Advanced Stage High Grade Serous Ovarian Cancer by Using Machine Learning

Introduction Accurate prediction of patient prognosis can be especially useful for the selection of best treatment protocols. Machine Learning can serve this purpose by making predictions based upon generalizable clinical patterns embedded within learning datasets. We designed a study to support the feature selection for the 2-year prognostic period and compared the performance of several Machine Learning prediction algorithms for accurate 2-year prognosis estimation in advanced-stage high grade serous ovarian cancer (HGSOC) patients. Methods The prognosis estimation was formulated as a binary classification problem. Dataset was split into training and test cohorts with repeated random sampling until there was no significant difference (p = 0.20) between the two cohorts. A ten-fold cross-validation was applied. Various state-of-the-art supervised classifiers were used. For feature selection, in addition to the exhaustive search for the best combination of features, we used the-chi square test of independence and the MRMR method. Results Two hundred nine patients were identified. The model's mean prediction accuracy reached 73%. We demonstrated that Support-Vector-Machine and Ensemble Subspace Discriminant algorithms outperformed Logistic Regression in accuracy indices. The probability of achieving a cancer-free state was maximised with a combination of primary cytoreduction, good performance status and maximal surgical effort (AUC 0.63). Standard chemotherapy, performance status, tumour load and residual disease were consistently predictive of the mid-term overall survival (AUC 0.63–0.66). The model recall and precision were greater than 80%. Conclusion Machine Learning appears to be promising for accurate prognosis estimation. Appropriate feature selection is required when building an HGSOC model for 2-year prognosis prediction. We provide evidence as to what combination of prognosticators leads to the largest impact on the HGSOC 2-year prognosis.

Multi-Omics Analysis Identifying Key Biomarkers in Ovarian Cancer

Ovarian cancer is one of the most common malignant tumors. Here, we aimed to study the expression and function of the CREB1 gene in ovarian cancer via the bioinformatic analyses of multiple databases. Previously, the prognosis of ovarian cancer was based on single-factor or single-gene studies. In this study, different bioinformatics tools (such as TCGA, GEPIA, UALCAN, MEXPRESS, and Metascape) have been used to assess the expression and prognostic value of the CREB1 gene. We used the Reactome and cBioPortal databases to identify and analyze CREB1 mutations, copy number changes, expression changes, and protein–protein interactions. By analyzing data on the CREB1 differential expression in ovarian cancer tissues and normal tissues from 12 studies collected from the “Human Protein Atlas” database, we found a significantly higher expression of CREB1 in normal ovarian tissues. Using this database, we collected information on the expression of 25 different CREB-related proteins, including TP53, AKT1, and AKT3. The enrichment of these factors depended on tumor metabolism, invasion, proliferation, and survival. Individualized tumors based on gene therapy related to prognosis have become a new possibility. In summary, we established a new type of prognostic gene profile for ovarian cancer using the tools of bioinformatics.

Cervical Cancer Among Older Women: Analyses of Surveillance, Epidemiology and End Results Program Data

Objective: To describe age-specific cervical cancer incidence rates based on demographic and clinical characteristics. Methods: Women with cervical cancer in the SEER program were grouped into 3 age categories. Demographics, clinical characteristics, and incidence rates were obtained for each age group. Results: Older women (≥65 years) had higher incidence rates of cervical cancer than women <65 years with the highest rates in black women ≥75 years. Older black women had more adverse factors at diagnosis than similarly aged white and younger black women. There was a higher incidence rate of cervical cancer in women with lower socioeconomic status (SES), with the highest rates in older black women. However, the incidence rates were similar for older black women regardless of SES. Conclusion: Older black have the highest cervical cancer incidence rates, regardless of SES, suggesting an age and race disparity when compared to younger and white women.

Prevalence and Predictor of Cervical Cancer Screening Service Uptake Among Women Aged 25 Years and Above in Sidama Zone, Southern Ethiopia, Using Health Belief Model

Cervical cancer is the fourth most common cancer affecting women worldwide, and the second leading cancer in Ethiopia. Screening gives protective benefits associated with a reduction in the incidence of invasive cervical cancer and mortality. However, the level of cervical cancer screening uptake is not well document in the country. This study aimed to determine the prevalence and predictors of cervical cancer screening service uptake among women aged 25 years and above in Sidama zone, southern Ethiopia, 2019. A cross-sectional study was conducted among 838 women aged 25 and above years by using an interviewer-administered questionnaire. Multi-stage sampling technique was employed to identify households with women age of 25 and above years who were residing in the selected kebele for more than 6 months. Descriptive and multivariable logistic regression done. P-value <0.05 was considered as significant and presented by adjusted odds ratio (AOR) with 95% C.I. This study showed that among 838 women, only 17.8% (95%CI, 15.2%-20.5%) have undergone for cervical cancer screening. Being age of 35-39 (AOR = 5.2, 95% CI = 2.6-10.6), College and above Educational level (AOR = 3.8, 95% CI = 1.5-9.6), Ever had HIV test (AOR = 2.8, 95% CI = 1.82-4.4) and high perceived self-efficacy (AOR = 4.4, 95% CI = 1.527-12.84) were significant predictors for cervical cancer screening service uptake. The magnitude of cervical cancer screening uptake among women aged 25 years and above was lower than that of the recommended coverage of the target group by the national guideline. Age of women, educational status of women, ever had HIV test, and high perceived self-efficacy were important factors of cervical cancer screening service uptake. So it is very crucial improving cervical cancer screening uptake, through creating awareness and educating women, about the advantage of screening in early detection and management of cervical cancer screening utilization

Dynamic Changes in Bladder Morphology Over Time in Cervical Cancer Patients

Objectives: Continuous surveillance of bladder volume (BV) is beneficial during the treatment of various urogenital diseases because the bladder is always changing its position, size and even shape at different filling phases. For this purpose, we quantified the motion of the urinary bladder. Methods: Daily ultrasound measurements and weekly cone-beam computed tomography scans were obtained from 89 patients in the supine position. BV, bladder centroid positions, and triaxial lengths in the left-right (LR), anterior-posterior (AP), and superior-inferior (SI) directions were compared across different time points. Results: BV linearly increased over time, and the mean urinary filling rate ( vtot) was correlated with the patients’ age and water consumption. The greatest bladder centroid motion occurred longitudinally, with less movement observed laterally. The maximum bladder centroid movement was 18.8 ± 2.2 mm inferiorly and 1.8 ± 0.9 mm posteriorly for every 10% decrease in BV. The rates of changes in triaxial lengths differed across the 4 filling phases. The rate was the largest at a BV range of 10-80 mL, especially in the LR direction, with values of 5.9 ± 1.0, 3.6 ± 1.0, and 3.9 ± 1.0 mm per every 10-mL BV increase for LR, AP, and SI, respectively. With bladder filling (<80 mL), the maximum increase in triaxial length was observed in the SI direction and the rates of all changes considerably decreased, especially at BV > 600 mL. Conclusion: The vtot could be used to evaluate the temporal changes in the bladder. The spatial changes should be assessed according to different filling phases based on the centroid position and triaxial lengths.

Cost-Effectiveness of Primary HPV Screening Strategies and Triage With Cytology or Dual Stain for Cervical Cancer

To identify the optimal cost-effective strategy for cervical cancer screening program in Thailand by comparing the different algorithms which based on the use of primary human papilloma virus (HPV) assay. We use a Microsoft Excel–based spreadsheet to calculate the accumulated cases of preinvasive and invasive cervical cancer and the budget impact of each screening program. The model was developed to determine the cost-effectiveness of 3 screening strategies: pooled HPV test with reflex liquid-based cytology triage, HPV genotyping with reflex p16/ki67 dual stain cytology, and pooled HPV test with dual stain. The main outcomes were the total cost, incremental quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs). Strategy entailing primary HPV genotyping and reflex dual stain cytology is the least costly strategy (total cost US$37 893 407) and provides the similar QALY gained compared to pooled high-risk HPV testing with reflex dual stain (Average QALY 24.03). Pooled HPV test with reflex dual staining is more costly compared to strategy without reflex dual staining. The ICER was US$353.40 per QALY gained. One-way sensitivity analysis showed that the model is sensitive to the cost of dual stain and the cost of cancer treatment. Decreasing the incidence of cervical cancer case and increasing the QALYs can be successful by using dual stain cytology as the triage test for pooled HPV test or HPV genotyping. The result of our analysis favors the use of HPV genotyping with the reflex dual stain as it offers the most QALY at the lowest cost.

A Nomogram for Predicting Cancer-Specific Survival in Patients With Stage I Vulvar Squamous Cell Carcinoma: A Study Based on the SEER Database and External Validation

Introduction Vulvar squamous cell carcinoma (VSCC) is a rare but increasingly prevalent gynecological malignancy. This study aimed to identify risk factors for stage I VSCC, which accounts for approximately 70% of VSCC patients, and to develop a nomogram to predict cancer-specific survival (CSS) for this large subgroup. Methods This study analyzed the datasets consisting of public training and independent external validation sets of patients diagnosed with stage I VSCC between 2010 and 2019. Prognostic factors were discerned through Cox regression analyses and the least absolute shrinkage and selection operator (LASSO) method. A nomogram for CSS was developed and evaluated using the C-index, Kaplan-Meier curves, and decision curve analysis (DCA) plots. Results Our analysis revealed variations in predictors of CSS and overall survival (OS) in stage I VSCC cases from the Surveillance, Epidemiology, and End Results (SEER) database. The multivariate Cox model suggested associations between CSS and age, grade, and number of tumors (NMT), while the LASSO model indicated potential roles for age, stage, invasion depth, NMT, and surgical method. The nomogram showed reasonable discriminative ability in the training (C-index: 0.785) and validation cohorts (C-index: 0.729), with supporting Kaplan-Meier and DCA analyses. Conclusion This study proposes a prognostic model for CSS in stage I VSCC, identifying exploratory associations with multifocal tumors and surgical extent. Further prospective studies are needed to validate these findings and clarify their clinical implications.

The Prevalence and Associated Factors of Cancer Screening Uptake Among a National Population-Based Sample of Adults in Marshall Islands

Background: The study aimed to estimate the prevalence and associated factors of cancer screening among men and women in the general population in Marshall Islands. Methods: The national cross-sectional sub-study population consisted of 2,813 persons aged 21-75 years (Median = 37.4 years) from the “2017/2018 Marshall Islands STEPS survey”. Information about cancer screening uptake included Pap smear or Vaginal Inspection with Acetic Acid (=VIA), clinical breast examination, mammography, faecal occult blood test (FOBT), and colonoscopy. Results: The prevalence of past 2 years mammography screening was 21.7% among women aged 50-74 years, past year CBE 15.9% among women aged 40 years and older, past 3 years Pap smear or VIA 32.6% among women 21-65 years, past year FOBT 21.8% among women and 22.3% among men aged 50-75 years, and past 10 years colonoscopy 9.1% among women and 7.3% among men aged 50-75 years. In adjusted logistic regression, cholesterol screening (AOR: 1.91, 95% CI: 1.07-3.41) was associated with past 2 years mammography screening among women aged 50-74 years. Blood pressure screening (AOR: 2.39, 95% CI: 1.71-3.35), glucose screening (AOR: 1.59, 95% CI: 1.13-2.23), dental visit in the past year (AOR: 1.51, 95% CI: 1.17, 1.96), binge drinking (AOR: 1.88, 95% CI: 1.07-3.30), and 2-3 servings of fruit and vegetable consumption a day (AOR: 1.42, 95% CI: 1.03-1.95) were positively and high physical activity (30 days a month) (AOR: 0.56, 95% CI: 0.41-0.76) was negatively associated with Pap smear or VIA screening among women aged 21-65 years. Higher education (AOR: 2.58, 95% CI: 1.02-6.58), and cholesterol screening (AOR: 2.87, 95% CI: 1.48-5.59), were positively and current smoking (AOR: 0.09, 95% CI: 0.01-0.65) was negatively associated with past 10 years colonoscopy uptake among 50-75 year-olds. Conclusion: The study showed a low cancer screening uptake, and several factors were identified that can assist in promoting cancer screening in Marshall Islands.

Disparities in the Diagnosis, Treatment, and Survival Rate of Cervical Cancer among Women with and without Disabilities

Introduction Not much is known regarding the disparities in cancer care between women with and without disabilities. Objectives The aim of this study was to investigate the potential disparities in the diagnosis, treatment, and survival of women with cervical cancer with and without disabilities. Methods We performed a retrospective cohort study and linked the National Disability Database, Korean Central Cancer Registry, and Korean National Health Insurance claims database. Charlson comorbidity index was used for adjusting the comorbidity. The study population comprised 3 185 women with disabilities (physical/brain, communication, mental, cardiopulmonary, and other impairment) who were diagnosed with cervical cancer and 13 582 age- and sex-matched women without disability who were diagnosed with cervical cancer for comparison. Results Distant metastatic stage (7.7% vs 3.7%) and unknown stage (16.1% vs 7.0%) were more common in cervical cancer women with grade 1 disabilities, compared with women without disabilities. Women with cervical cancer with disabilities were less likely to undergo surgery (adjusted odds ratio (aOR) 0.81, 95% confidence interval (CI) 0.73–0.90) or chemotherapy (aOR 0.86, 95% CI 0.77–0.97). Lower rate of surgery was more evident in patients with physical/brain impairment (aOR 0.46, 95% CI 0.37–0.58) and severe mental impairment (aOR 0.57, 95% CI 0.41–0.81). The overall mortality risk was also higher in patients with disabilities (adjusted hazard ratio (aHR) 1.36, 95% CI 1.25–1.48). Conclusion Women with cervical cancer with disabilities, especially with severe disabilities, were diagnosed at later stages, received less treatment, and had higher mortality rates, compared with patients who lacked disabilities. Social support and policies, along with education for women with disabilities, their families, and healthcare professionals, are needed to improve these disparities.

Prognostic Role of Matrix Metalloproteinases in Cervical Cancer: A Meta-Analysis

Objective Studies have published the association between the expression of matrix metalloproteinases (MMPs) and the outcome of cervical cancer. However, the prognostic value in cervical cancer remains controversial. This meta-analysis was conducted to evaluate the prognostic functions of MMP expression in cervical cancer. Methods A comprehensive search of PubMed, Embase, and Web of Science databases was conducted to identify the eligible studies according to defined selection and excluding criteria and analyzed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Fixed and random effects models were evaluated through the hazard ratios (HRs) and 95% confidence intervals (CIs) to estimate the overall survival (OS), recurrence-free survival (RFS), and progress-free survival (PFS). Results A total of 18 eligible studies including 1967 patients were analyzed for prognostic value. Totally 16 selected studies including 21 tests were relevant to the cervical cancer OS, 4 studies focused on RFS, and 1 study on PFS. The combined pooled HRs and 95% CIs of OS were calculated with random-effects models (HR = 1.64, 95% CI = 1.01–2.65, P = .000). In the subgroup analysis for OS, there was no heterogeneity in MMP-2 (I2 = .0%, P = .880), MMP-1 (I2 = .0%, P = .587), and MMP-14 (I2 = 28.3%, P = .248). In MMP-7 and MMP-9, the heterogeneities were obvious (I2 = 99.2% ( P = .000) and I2 = 77.9% ( P = .000), respectively). The pooled HRs and 95% CIs of RFS were calculated with fixed-effects models (HR = 2.22, 95% CI = 1.38–3.58, P = .001) and PFS (HR = 2.29, 95% CI = 1.14–4.58, P = .035). Conclusions The results indicated that MMP overexpression was associated with shorter OS and RFS in cervical cancer patients. It suggested that MMP overexpression might be a poor prognostic marker in cervical cancer. Research Registry Registration Number: reviewregistry 1159.

Therapeutic Potential of Selenium and Selenium Compounds in Cervical Cancer

Cervical cancer is a common female cancer. It is strongly associated with human papillomavirus (HPV) infection. However, HPV infection alone is not sufficient to induce cervical cancer because its development is dependent on the coexistence of several factors that enable the virus to overcome the host immune system. These include individual genetic background, environmental factors, or diet, including dietary selenium intake. Selenium is an essential trace element with antiviral properties and has been shown to exert antitumor effects. Surprisingly, the role of selenium in cervical cancer has not been studied as intensively as in other cancers. Here, we have summarized the existing experimental data on selenium and cervical cancer. It may be helpful in evaluating the role of this nutrient in treatment of the mentioned malignancy as well as in planning further studies in this area.

Cervical Cancer and Human Papillomavirus Vaccine Knowledge, Utilisation, Prevention Educational Interventions and Policy Response in Nigeria: A Scoping Review

Purpose This review evaluated the knowledge, utilisation, prevention education, and policy response across the six geopolitical regions of Nigeria to inform national efforts for the prevention and control of cervical cancer. Methods A keyword-based systematic search was conducted in PubMed/MEDLINE (NCBI), Google Scholar, and AJOL electronic databases, including a manual scan of papers, journals and websites to identify relevant peer-reviewed studies. Articles were screened and assessed for eligibility. Results Many (158) articles were downloaded and after duplicates were removed, 110 articles were included in the final analysis. These were made up of qualitative, quantitative (cross-sectional), intervention and policy studies. Studies have generally reported poor knowledge and awareness of cervical cancer screening but those carried out in urban areas demonstrated a slightly higher level of awareness of Human Papilloma Virus (HPV) vaccine, HPV vaccination uptake and utilization of cervical cancer preventive services than the rural studies. The studies did not show strong government support or policies in relation to cervical cancer control. Conclusion Knowledge and uptake of cervical cancer preventive services across diverse groups in Nigeria remain poor. These could be linked to socio-cultural factors, the lack of an organised cervical cancer screening programme and low financial resource pool for cervical cancer prevention. Therefore, it is necessary to increase government, donor prioritisation and political support in order to ensure increased investment and commitment to cervical cancer elimination in Nigeria.

The Recurrence of Cervical Precancerous Lesion Among HIV Positive and Negative Ethiopian Women After Cryotherapy: A Retrospective Cohort Study

Background Early testing and treatment is among the successful strategies for the prevention and control of cervical precancerous and invasive cancer, and a paramount for women with HIV. In Ethiopia, visual inspection with acetic acid for screening and cryotherapy treatment is commonly practiced, though the recurrence of the precancerous lesion after treatment has not been well documented. Objective This study was aimed to estimate the association of HIV status and the recurrence of cervical precancerous lesion after cryotherapy among Ethiopian women. Methods We conducted a retrospective cohort study from January to April 2021. The time to the incidence of recurrence was compared between HIV positive and HIV negative women. Cox regression models were used to adjust the analyses for potential confounders, and only women treated with cryotherapy after a positive Visual Inspection with Acetic acid (VIA) screening test were included. Results A total of 140 eligible patient cards were included in the analysis with the median follow-up of 15.5 months. The overall recurrence rate was 15.7% (22/140), with a greater proportion among HIV negative women, 19.0% (4/21) than HIV positive 15.1% (18/119). Prolonged use of corticosteroid and higher age were the major significant predictors of a higher likelihood of recurrence. The recurrence of screening positive lesion was higher among women aged above 39 years (hazard ratio (HR) of 11.94 (95% CI, 1.07-133.04; P = .04), and women with prolonged use of corticosteroid (HR = 7.82, 95% CI = 1.04-58.75; P = .046) than their counterparts. Conclusion The recurrence of cervical precancerous lesion after cryotherapy was higher than the expert panel report by WHO with a higher proportion among women of old age and prolonged corticosteroid use. Cryotherapy showed a satisfying performance against the recurrence of cervical disease diagnosed through VIA. To substantiate, our findings, further prospective cohort study is also recommended.

Performance of visual Inspection With Acetic Acid for Cervical Cancer Screening as Compared to Human papillomavirus Deoxyribonucleic acid Testing Among Women With HIV in Ethiopia: A Comparative Cross-sectional Study

Objectives The aim of this study was to evaluate the performance of visual inspection with acetic acid compared with Human papillomavirus Deoxyribonucleic acid (HPV DNA) testing among women with HIV in Ethiopia. Methods A comparative cross-sectional study was conducted to address the aforementioned objective. Data were collected from January to October 2021, to compare the performance of these two screening modalities. Trained clinicians collected cervical specimens and immediately applied acetic acid for visual inspection. The HPV DNA testing was done using Abbott m2000rt/SP by trained laboratory professionals in accredited laboratories. A total of 578 women with HIV aged 25-49 years were included. Results Test positivity was 8.9% using visual inspection with acetic acid (VIA) and 23.3% using HPV DNA test. The sensitivity and specificity of the VIA test were 19.2% and 95.1%, respectively. The strength of agreement between the two screening methods was poor (k = .184). The burden of genetic distribution of high risk HPV16 was 6.1%, and HPV18 was 1.1%. Other high risk HPV types (ie non-HPV 16/18 high risk HPV genotypes) were predominant in this study (18.6%). Conclusion The higher positivity result using HPV DNA testing compared with VIA, and low sensitivity of VIA are indicating that the implementation of HPV DNA testing as the primary screening strategy is likely to reduce cervical cancer cases and deaths of women in the country.

The Effect of Peer-Led Navigation Approach as a Form of Task Shifting in Promoting Cervical Cancer Screening Knowledge, Intention, and Practices Among Urban Women in Tanzania: A Randomized Controlled Trial

Background Even though the government’s priorities in preventing cervical cancer are implemented in urban areas, the screening rate remains unsatisfactory at 6%, compared to 70% recommended by the world health organization. The ongoing public health education has not resulted in sufficient screening rates. The study aims to assess peer-led navigation (PLNav) in promoting cervical cancer screening knowledge, intention, and practices among urban women in Tanzania. Since PLNav is the form of task shifting, it involves delegating cervical-cancer-related tasks from healthcare professionals to community health workers (CHWs). Methods It is a community-based randomized controlled trial conducted in Dar es Salaam in Tanzania March-Sept 2020. The PLNav involved the CHWs delivering health education, counselling and navigation assistance to community women (COMW). The CHWs help women who have never undergone cervical cancer screening (CCS) and those who have undergone CCS but with a precancerous cervical lesion to overcome screening barriers. The data related to PLNav were analyzed by descriptive statistics, an independent-samples t-test, repeated measures ANOVA and linear regression. Results The repeated measures ANOVA across time showed that PLNav intervention on mean knowledge score changes was statistically significant in the intervention group compared with the control group’s usual care, [F (1, 43) = 56.9, P < .001]. At the six-month follow-up, 32 (72.7%) out of 44 participants from the intervention group had screened for cervical cancer, and only one participant (2.3%) from the control group screened. The PLNav intervention on CCS uptake changes was statistically significant in the intervention group compared with usual care in the control group [F (1, 43) = 100.4, P < .001]. The effect of time on CCS uptake in the intervention and control groups was statistically significant [F (1.64, 70.62) = 73.4, P < .001]. Conclusion Peer-led navigation (PLNav) was effective in promoting cervical cancer screening knowledge, intention, and uptake.

Prevalence and Distribution of Vaccine-Preventable Genital Human Papillomavirus(HPV) Genotypes in Ghanaian Women Presenting for Screening

Background Cervical cancer is the most common gynaecologic cancer in Ghana where it is also the second most common cause of all female cancers. A number of vaccines are available to provide both individual and population-level protection against persistent infection with high-risk human papillomaviruses (HR-HPV) and reduce the burden of cervical cancer. Data on the epidemiology of vaccine-preventable papillomaviruses in Ghana is scant. Methods A cross-sectional observational study was implemented from May 2011 to November 2014 to understand the epidemiology of genital human papillomavirus (HPV) genotypes and cervical dysplasia in the Greater Kumasi area of Ghana. A nested multiplex polymerase chain reaction (NMPCR) assay incorporating degenerate E6/E7 consensus primers and type-specific primers was used for the detection and typing of eighteen (18) HPV genotypes among women who had never attended cervical screening prior to this study. Results The general prevalence of HPV infection in Kumasi was 37.2%. The age-standardized prevalence was 40.9% overall. The frequency of HR-HPV genotypes present in decreasing order were HPV-52, -56, -35, -18, -58, -68, -51, -39, -45, -16, -59, -33 and -31. Low-risk HPVs were also detected in the following order: HPV-42, -43, -66, -6/11 and -44. Conclusions The study shows that currently available prophylactic vaccines have the potential to be useful in the primary prevention of HPV infections in the country. This study strengthens the belief that prophylactic HPV vaccination could be a long-term strategy to reduce the burden of HPV infections and potentially reduce the burden of HPV-associated cancers and epithelial cell abnormalities among health-seeking women in Kumasi. Efforts to make vaccines available to young girls should be prioritized.

‘Exploring the Influence of Social Media Influencers on Intention to Attend Cervical Screening in the UK: Utilising the Theory of Planned Behaviour’

Objectives Cervical cancer is 99.8% preventable when detected early; however, uptake of screening in the United Kingdom is at a 20-year low. Recently, a number of social media influencers have video logged about their experiences of cervical screening through narrative communication with their audience. Here we aimed to explore if accessing cervical screening information from a social media influencer can impact the theory of planned behaviour variables and predict intention to attend cervical screening appointments. Design Utilising a cross-sectional design a volunteer sample of 102 UK women (mean age = 28; SD = 3.10; range = 25–35) took part in an online questionnaire study. Results Hierarchical regression modelling revealed attitude as a significant predictor of intention to attend a cervical screening appointment and that social media influencers affect attitudes of their audience, indirectly influencing intention to attend. Conclusion Health messages communicated by social media influencers are effective in promoting positive attitudes but not directly influence intention to attend towards cervical screening. Further research should explore influencer impact on attitudes towards this health behaviour with the ultimate aim of increasing attendance and consequently saving lives.

Knowledge, Attitude, and Practice Toward Cervical Cancer Screening Among Women Attending Health Facilities in Central Ethiopia

Background In Ethiopia, cervical cancer ranked as the second leading cause of female cancer and also stands as the most common cancer among women aged from 15 to 44 years old. Hence, this study aimed to assess knowledge, attitude, and practice toward cervical cancer screening among women attending health facilities in central Ethiopia. Methods Institutional-based cross-sectional study was conducted among 420 study participants. Data were collected using an interviewer-administered questionnaire. The collected data were entered into EPI data 3.1 and exported to SPSS version 23 for analysis. Binary and multivariate logistic regressions were used to identify factors associated with knowledge, attitude, and practice of cervical cancer screening. Odds ratio (OR) with 95% CI and a P-value < .05 were used to declare statistical significance. Results Half, 50.7% of study participants had good knowledge. Less than half, 46.1% had a positive attitude toward cervical cancer screening. Only 6.3% of women have been screened for cervical cancer. Diploma and above education (AOR: 2.22, 95% CI: 1.32, 6.157), no idea about cervical cancer curable at an early stage (AOR: 6.23, 95% CI: 6.23 (2.77, 15.13) were significantly associated with knowledge of cervical cancer screening. Diploma and above education (AOR: 0.37, 95% CI: 0.19, 0.74) and multiple sexual partners (AOR: 0.18, 95% CI: 0.05, 0.62) were factors associated with a negative attitude toward cervical cancer screening. Positive attitude about cervical cancer screening (AOR: 2.37, 95% CI: 1.91, 6.20) was significantly associated with the practice of being screened. Conclusions Cervical cancer screening knowledge and attitudes were moderate, but practice was low. Educational status, considering cervical cancer is not curable at an early stage and not having an idea about its curability at an early stage, was significantly associated with knowledge of cervical cancer screening. Sexual partner status and educational status showed significant association with an attitude toward cervical cancer screening and having a positive attitude toward cervical cancer screening were significantly associated with the practice of cervical cancer screening. Health professionals need to disseminate cervical cancer screening information and offer cervical cancer treatment during health-care appointments.

Cervix Uteri Cancer in Lebanon: Incidence, Temporal Trends, and Comparison to Countries From Different Regions in the World

Background Invasive cervix uteri cancer is the fourth most common malignancy in women globally. This study investigates the incidence and trends of cervix uteri cancer in Lebanon, a country in the Middle East, and compares these rates to regional and global ones. Methods Data on cervix uteri were obtained from the Lebanese national cancer registry for the currently available years 2005 to 2016. The calculated age-standardized incidence and age-specific rates were expressed as per 100,000 population. Results From 2005 to 2016, cervix uteri cancer was the tenth most common cancer among women. Its age-standardized incidence rate fluctuated narrowly between 3.5 and 5.7 per 100,000, with the lowest rate in 2013 and the highest rate in 2012. The age-specific incidence rate had 2 peaks, the highest peak at age group 70–74 years and the second at age group 50–59 years. The annual percent change (+.05%) showed a non-statistically significant trend of increase. The age-standardized incidence rate of cervix uteri cancer in Lebanon was comparable to that of the Western Asia region that has the lowest incidence rate worldwide. The rate was intermediate as compared to other countries in the Middle East and North Africa Region and relatively similar to the ones in Australia, North America, and some Western European countries. Conclusion The incidence rates of invasive cervix uteri are low in Lebanon. This could be attributed to the low prevalence of human papilloma virus infection and other sexually transmitted infections among Lebanese women, and the opportunistic screening practices. It is important to adopt a comprehensive approach to decrease the potential burden of cervix uteri, especially with the rising patterns of risky sexual behaviors. This includes improving awareness, enhancing access to preventive services, developing clinical guidelines, and training health care providers on these guidelines.

Perspectives on Self-Sampling for Cancer Screening From Staff at Federally Qualified Health Centers in Rural and Segregated Counties: A Preliminary Qualitative Study

Background Self-sampling for colorectal and cervical cancer screening can address the observed geographic disparities in cancer burden by alleviating barriers to screening participation, such as access to primary care. This preliminary study examines qualitative themes regarding cervical and colorectal cancer self-sampling screening tools among federally qualified health center clinical and administrative staff in underserved communities. Methods In-depth interviews were conducted with clinical or administrative employees (≥18 years of age) from FQHCs in rural and racially segregated counties in Pennsylvania. Data were managed and analyzed using QSR NVivo 12. Content analysis was used to identify themes about attitudes towards self-sampling for cancer screening. Results Eight interviews were conducted. Average participant age was 42 years old and 88% of participants were female. Participants indicated that a shared advantage for both colorectal and cervical cancer self-sampling tests was their potential to increase screening rates by simplifying the screening process and offering an alternative to those who decline traditional screening. A shared disadvantage to self-sampling was the potential for inaccurate sample collection, either through the test itself or the sample collection by the patient. Conclusions Self-sampling offers a promising solution to increase cervical and colorectal cancer screening in rural and racially segregated communities. This study’s findings can guide future research and interventions which integrate self-sampling screening into routine primary care practice.

Clinician Nudge to Gynecologic Oncology Referral at Suspected Ovarian Cancer Diagnosis: A Pilot Study

Introduction Only two-thirds of patients with ovarian cancer ever see a gynecologic oncologist. Our objective was to examine the feasibility of an electronic health record-based nudge to clinicians for referral to gynecologic oncology at suspected ovarian cancer by imaging. Methods We developed a nudge, a short behavioral economics informed best practice advisory with a pended referral order for gynecologic oncology, for primary care, emergency medicine, and obstetrician/gynecology clinicians for when a patient had a O-RADS 4 or 5 lesion on imaging and had not already seen gynecologic oncology. In 2024, clinicians were sent the nudge within 2 business days of a patient’s abnormal imaging through the electronic health record. Our primary outcome was referral rate to gynecologic oncology compared to a historic cohort of patients with O-RADS 4 or 5 lesions from 2020-2023. Results In this prospective cohort study, we sent 20 clinician nudges for gynecologic oncology referral; six clinicians (30%) responded that the nudge changed their referral behavior. The 90-day referral rate was 75% compared to historic baseline of 61%. In the pilot, 92% patients undergoing surgery for complex adnexal mases had surgery with gynecologic oncology compared to historic baseline of 82%. One in four patients in the pilot were diagnosed with cancer, all early-stage disease. Conclusions A clinician nudge for gynecologic oncology referral at suspected ovarian cancer diagnosis was acceptable and associated with 75% referral rate. A clinician nudge standardizes gynecologic oncology referral and may improve early detection of ovarian cancer. A randomized controlled trial of the clinician nudge is warranted.