European Journal of Cancer Prevention

Cancer mortality predictions for 2025 in Latin America with focus on prostate cancer

We provided cancer mortality rate estimates for the year 2025 in six Latin American countries (Argentina, Brazil, Chile, Colombia, Cuba, and Mexico), focusing on prostate cancer. We extracted mortality data for all cancers combined and the most common sites from the WHO and population data since 1970 from the United Nations. Estimates for 2025 were computed applying a linear regression to the most recent segment identified through Poisson join-point regression. Avoided deaths number from 1991 to 2025 was estimated by applying the 1990 peak rate to population data. Mortality from all cancers is predicted to be favorable for both sexes in all countries. The lowest total cancer mortality rates are expected in Mexico (67.7/100 000 males; 61.4/100 000 females), while the highest ones in Cuba (136.6/100 000 males; 91.6/100 000 females). Prostate cancer mortality is declining in all countries, although rates remain high in Cuba (25.2/100 000 in 2025). Downward patterns are observed for all age groups in all countries, except the elderly in Cuba and Mexico. Declines in mortality are predicted for colorectal (except for males in Brazil and Cuba, and females in Chile), stomach (except Cuban males), pancreatic (except Argentinian and Cuban males), lung, bladder (except Argentinian females), breast, and ovarian (except Cuba) cancers. Uterine cancer mortality, particularly from cervical cancer, remains highin Argentina (10.2/100 000) and Cuba (10.4/100 000). Except for uterine, stomach, and prostate cancers, cancer mortality rates are still relatively low in Latin America, except Cuba. Controlling tobacco particularly in Cuba, implementing organized cervical cancer screening, and advancing cancer treatment also for prostate cancer remain crucial in all countries considered.

National organization of uterine cervical cancer screening and social inequality in France

Some of the inequality in uterine cervical cancer (UCC) screening uptake are due to the socioeconomic deprivation of women. A national organized screening programme has proven to be effective in increasing the uptake, but may increase socioeconomic inequality. Therefore, we compared inequality in uptake of UCC screening between two French departments, one of which is experimenting an organized screening programme. We used reimbursement data from the main French health insurance scheme to compare screening rates in the municipalities of the two departments over a three-year period. The experimental department had higher screening rates, but the increase in deprivation in municipalities had a greater effect on the decrease in participation in this department. Moreover, while screening rates were higher in urban areas, the negative effect of deprivation on participation was greater in rural areas. Although these departments were compared at the same time under different conditions, socioeconomic inequality between them may have been greater before the experimentation started. However, screening may have led to an increase in socioeconomic inequality between women screened. Special attention must be paid to changes in socioeconomic and geographic inequality in the uptake of UCC screening when the programme is rolled out nationally.

Human papillomavirus vaccination, cervical cancer screening, and acceptability of self-sampling: a cross-sectional study in vulnerable women

The burden of cervical cancer is heterogeneously distributed across regions and population groups, which is likely to reflect inequalities in the access and use of human papillomavirus (HPV) vaccination and cervical cancer screening (CCS). Groups with worse vulnerability indicators are at higher risk. We aimed to describe the awareness, access, and use of HPV vaccination and CCS, as well as the acceptability of self-sampling, in vulnerable population groups. We evaluated 222 women recruited in institutions that support homeless people, drug users, sex workers, Roma communities, migrants, and older women (>50 years old) from low socioeconomic contexts. For data analysis, women pertaining to more than one group were analyzed in each of them, except for the older women group, that only included women not classified in any of the other groups. Most women never heard about the HPV vaccine (60%) and, among those aware, 80% were not vaccinated. The majority heard about CCS (96%) and had been screened at least once (91%), with Roma women presenting the lowest adherence (84%). Most women were screened opportunistically (68%) and were screened at no fixed intervals (34%) or more often than recommended (46%). Regarding self-sampling, 80% considered they would be able to perform it, and 65% of the unscreened women reported they would be more likely to undergo screening based on self-sampling. Most women were not vaccinated against HPV but underwent CCS. Self-sampling was widely perceived as an acceptable option for CCS that could increase adherence in vulnerable groups.

Association between folate level and cervical intraepithelial neoplasia risk: a systematic review and meta-analysis

There were several studies about the association between folate level and the risk of cervical intraepithelial neoplasia (CIN). This meta-analysis was conducted to evaluate whether folate deficiency is related to a high risk of CIN and cervical cancer. Odds ratios (ORs)/relative risks and 95% confidence intervals (CIs) were summarized regarding the association between folate level and risk of CIN or cervical cancer. The meta-analysis indicated that higher serum folate levels (the second, third, and fourth quartiles of serum folate) were associated with a lower risk of CIN, as demonstrated by a random-effects model (OR = 0.42, 95% CI: 0.28–0.62). Conversely, no significant association was found between erythrocyte folate levels and the risk of CIN, as indicated by a random-effects model (OR = 0.69, 95% CI: 0.43–1.12). In addition, random-effects models demonstrated that higher serum folate levels (the second, third, and fourth quartiles of serum folate) were associated with lower risks of CIN grade 1 and CIN grades 2 or 3, compared with the lowest quartile of serum folate (CIN grade 1: OR = 0.52, 95% CI: 0.29–0.93; CIN grades 2 or 3: OR = 0.33, 95% CI: 0.19–0.58). Higher serum folate levels (the second, third, and fourth quartiles of serum folate) were associated with a lower risk of cervical cancer, compared with the lowest quartile of serum folate (OR = 0.53, 95% CI: 0.36–0.79). Serum low folate levels could increase the risk of CIN and cervical cancer, while erythrocyte folate concentration was not associated with the risk of CIN.

Impact of altering the invitation package on screening participation among never-screeners in the Flemish population-based cancer screening programs

Background The total coverage of both the Flemish breast cancer and cervical screening program remain suboptimal, with approximately 63% for both. Of all the women invited to the breast cancer screening program, 14.1% never underwent any type of breast cancer screening (any type of mammogram, ultrasound, or clinical breast examination). For the cervical cancer screening, this proportion of ‘never-screeners’ is 12.1%. We conducted two randomized controlled trials to assess whether various communication and presentation styles in the invitation package, were effective at motivating women who had never participated to attend. Methods The study population was limited to never-screeners (women who had never participated in the screening program). The RCT embedded in the breast cancer screening consisted of seven intervention arms and one control arm (all of them included a fixed appointment by letter). The RCT embedded in the cervical cancer screening consisted of three intervention arms and two control arms. In both RCTs, several content and style adaptations were made to the invitation letter, information leaflet, and envelope. Results None of the intervention arms in either the breast cancer screening or the cervical cancer screening had a statistically significant impact on the participation rate compared to ‘usual care’ (the regular invitation package used in the screening program). Conclusion Sending adapted invitation packages to never-screeners, from the Flemish breast and cervical cancer screening program, does not seem to be effective in increasing the proportion of women screened. Innovative methods are needed to motivate never-screeners to be screened.

Is phased implementation of HPV testing and triage with dual staining the way to transform organized cytology screening?

Objective The substantial material and legislative investments in establishing and maintaining cytological screening in the Czech Republic represent barriers to a direct transition to primary HPV screening. Therefore, the LIBUSE project was implemented to test the efficacy of phasing in HPV DNA testing as a co-test to cytology in routine screening of women >30 years of age. Methods Women aged 30 to 60 years who underwent regular annual Pap smears were co-tested for HPV DNA with selective 16/18 genotyping at 3-year intervals. All HPV 16/18-positive cases and/or cases with a severe abnormality in cytology were sent for colposcopy; HPV non-16/18-positive cases and LSILs were graded using p16/Ki67 dual-stain cytology, and positive cases were sent for colposcopy. Results Overall, 2409 patients were included. After the first combined screening (year ‘zero’) visit, 7.4% of women were HPV-positive and 2.0% were HPV16/18-positive; only 8 women had severe Pap smear abnormalities. Triage by dual staining was positive in 21.9% of cases (28/128). Biopsy confirmed 34 high-grade precancer lesions. At the second combined visit (year ‘three’), the frequency of HPV infection (5.3% vs. 7.4%) frequency of HPV16/18 (1.1% vs. 2.0%), referrals for colposcopy (35 vs. 83), and biopsy verified high-grade lesions (5 vs. 34) were significantly lower (all P ≤ 0.001). Conclusion The addition of HPV DNA testing with selective genotyping of HPV16/18 to existing cytology screening significantly increased the safety of the program. The gradual introduction of HPV testing was well received by healthcare professionals and patients, and can facilitate transformation of the cytology-based screening. ClinicalTrials.gov Identifier: NCT05578833.

Global, regional, and national burden of ovarian cancer among young women during 1990–2019

Background Ovarian cancer, the most devastating tumor in women globally, significantly impacts young women, compromising their daily lives and overall well-being. Ovarian cancer represents a significant public health concern due to its extensive physical and psychological consequences. Material and methods Data from the Global Burden of Disease were used to assess the global, regional, and national burden of ovarian cancer in young women aged 20–39 from 1990 to 2019. This analysis focused on trends measured by the estimated annual percentage change and explored the socioeconomic impacts via the socio-demographic index (SDI). Results During 1990–2019, the incidence and prevalence of ovarian cancer among young women increased globally, with annual rates of 0.74% and 0.89%, respectively. The mortality rate and disability-adjusted life years also rose annually by 0.20% and 0.23%, respectively. A significant burden shift was observed toward regions with lower SDI, with high fasting plasma glucose, BMI, and asbestos exposure identified as prominent risk factors, particularly in lower SDI regions. Conclusion Our findings underscore ovarian cancer in young women as an escalating global health challenge, with the burden increasingly shifting toward lower socioeconomic areas. This underscores the necessity for targeted prevention and control strategies for ovarian cancer, focusing on reducing the identified risk factors and ensuring equitable health resource distribution.

The reduction of CA 125 serum levels in BRCA 1/2 mutation carriers after risk-reducing salpingo-oophorectomy is only partially associated with surgery: a prospective cohort, other biomarker controlled, study

Objectives A significant reduction in CA 125 postoperative serum levels was observed after risk-reducing salpingo-oophorectomy (RRSO) in BRCA mutation carriers. In contrast to previous studies, where control groups were absent, we conducted a prospective study including also a screening only group (RSSO refusal) and a group having previously undergone RRSO. Methods Consecutive BRCA1 and BRCA2 mutation carriers, not hysterectomised, >35 years old and with completed childbearing, were recruited. Some women had previously undergone RRSO (previous RRSO group). The others, who had either chosen RRSO (actual RRSO group) or screening only (screening only group), were enrolled (patient-preference trial). A prospective evaluation (basal and 6-month) of CA 125 and CEA (control biomarker) was performed. Results The study consisted of 116 women, 44.8% BRCA1 and 55.2% BRCA2 mutation carriers (n = 25 in the previous RRSO group, n = 29 in the actual RRSO group, n = 62 in the screening only group). For all subjects, we observed a 6-month decrease in CA 125 (−7.8%, P = 0.003), which was significantly linked only to endometriosis history (odds ratio 1.4; 95% confidence interval 1.1–1.8; P = 0.002). Between different groups, we recorded a non-significantly different decrease in CA 125. CEA showed a 6 months significant increase (+15.4%, P < 0.0001), which was similar between groups. Conclusion The decrease in CA 125 in BRCA mutation carriers after RRSO was only partially associated with surgery, depending also on a physiological decline: this is extremely important in their longitudinal monitoring for the prevention of ovarian cancer.

Temporal trends in incidence and mortality of cervical cancer in China from 1990 to 2019 and predictions for 2034

Objective This study aimed to analyze long-term trends of cervical cancer (CC) burden in China based on the GBD 2019 data and provide information and data support for formulating corresponding policies to control CC. Methods Incidence and mortality rate data of CC in China were described using GBD 2019 data. The Joinpoint regression analysis and age-period-cohort model were implemented to describe temporal trends of CC in China over the past 30 years. ARIMA model was used to predict trends of disease burden of CC in China for the next 15 years. Results From 1990 to 2019, the relative percentage change in age-standardized incidence rate (ASIR) of CC in Chinese women was 30.91 (95% UI: −50.13 to 96.78), and the relative percentage change in age-standardized mortality rate (ASMR) was −12.37 (95% UI: −63.54 to 28.52). The age-period-cohort model had different impacts on incidence and mortality rates. Overall annual percentage change (APC) (net drift) in incidence risk was 1.22 (95% CI: 0.87–1.57), and the overall APC (net drift) in mortality risk was −0.143 (95% CI: −0.38 to 0.09). The ARIMA model predicted ASIR and ASMR trends of CC for the next 15 years. Conclusion From 1990 to 2019, the overall incidence risk of CC in Chinese has shown an upward trend, with an earlier occurrence in the high-incidence age groups, while mortality risk showed a downward trend. It is anticipated that over the next 15 years, the incidence rate will decrease, while the mortality rate will initially rise before decreasing.

Endometriosis and cancer risk

Endometriosis is one of the most common gynecological benign disease. Epidemiological evidence suggests a potential association between endometriosis and cancer risk. Accumulating evidence highlighted the risk of ovarian cancer, particularly endometrioid and clear cell subtypes. Few studies reported a modest correlation between endometriosis and various solid tumors including, endometrial cancer, and melanoma. However, inconsistencies remain across studies. Additionally, some data indicate an increased risk of melanoma, basal cell carcinoma, and non-Hodgkin lymphoma, underscoring the multifaceted nature of cancer risk in women with endometriosis. The underlying mechanisms include chronic inflammation, oxidative stress, hormonal dysregulation, and genetic alterations, such as mutations in ARID1A, PTEN, and KRAS, which contribute to the shared pathology between endometriosis and cancer. This paper explores the complex association between endometriosis and cancer, focusing on specific malignancies. This review emphasizes the importance of understanding the shared mechanisms between endometriosis and cancer. Although most women with endometriosis will not develop cancer, further research is essential to unravel the molecular pathways linking these conditions and enhance long-term outcomes for affected women.

Comparison of psychological distress for breast, ovarian and colorectal cancer predisposition in a Spanish sample at high risk of hereditary cancer

Objectives Although future treatments may speciically target the tumour phenotype, other factors should be included to confirm the efficacy of treatment and prevention strategies. The objective of this study was to compare sociodemographic characteristics and psychological distress for breast, ovarian and colorectal cancer predisposition syndrome in a sample at high risk of hereditary cancer. Methods A cross-sectional study was designed with 799 patients. The nonparametric test, with Kruskal–Wallis test, was used to compare three genetic cancer syndromes, with significant differences in sample size. Results There were no differences in cancer hereditary syndromes related to sociodemographic characteristics except sex, as breast/ovarian cancer mainly affects women. No group differences were observed for cancer worry (P = 0.17). Breast/ovarian cancer syndrome showed significantly higher scores in cognitive distress compared to colorectal cancer (P = 0.01). Conclusion The differences in the distribution of sociodemographic characteristics in these hereditary cancer syndromes can help to better plan resources for patient care in genetic counselling units.

Ovarian cancer risk in relation to blood lipid levels and hyperlipidemia: a systematic review and meta-analysis of observational epidemiologic studies

Epidemiologic evidence regarding association of ovarian cancer risk with blood lipid level and hyperlipidemia is inconsistent. We aimed to synthesize available epidemiologic studies to disentangle associations of cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and hyperlipidemia with ovarian cancer risk. We searched PubMed, EMBASE, and Web of Science for eligible studies. A random-effects model was applied for synthesis. Heterogeneity was evaluated by a Chi-squared test for the Cochran Q statistic and the I-squared value. Subgroup analysis was conducted by design, study locale, and ovarian cancer case number. Sensitivity analysis was conducted for studies adjusting for certain covariates or with superior quality. To explore the potential dose–response relationship, we further synthesized effect measures of moderate levels of cholesterol, triglycerides, HDL-C, and LDL-C. Twelve studies (five cohort and seven case-control studies) were included. In primary meta-analysis, the synthesized risk ratio (RRpool) and 95% confidence interval (CI) suggested that high cholesterol was associated with an increased ovarian cancer risk (RRpool 1.22, 95% CI 1.01–1.48, Cochran P value: 0.40, I2: 0.5%). High HDL-C was associated with a lower ovarian cancer risk (RRpool 0.61, 95% CI 0.40–0.94, Cochran P value: 0.06, I2: 63.7%). We obtained nonsignificant associations for other exposures. Subgroup and sensitivity analyses yielded consistent results as the primary analysis. Only cholesterol showed marginally significant association in synthesis using moderate exposure levels (RRpool 1.18, 95% CI 0.99–1.42, Cochran P value: 0.51, I2: 0.0%). Our study suggests that high blood cholesterol is associated with an increased ovarian cancer risk, whereas the etiological significance of other exposures deserves more investigations.

COVID-19 on cervical cancer screening

Knowledge, awareness, and practices of cervical cancer, its risk factors, screening, and prevention among women in Karachi, Pakistan

Background Cervical cancer has a high mortality rate worldwide; in Pakistan it kills more than 7000 women every year. Prevention is possible through vaccination against human papilloma virus, the causative agent of cervical cancer, or by screening for premalignant lesions through routine Pap smear tests. We have studied the knowledge and practices regarding cervical cancer, its risk factors, screening and prevention and the role of human papilloma virus vaccination and Pap smear testing, among young women of Karachi. Methods Information was gathered using a modified version of Cervical Cancer Awareness Measure Toolkit version 2.1 from 384 women aged 15 to 50 with no medical background attending outpatient clinics of AKUH, Karachi. Data entry was done through EpiData and analysis was done using SPSS version 22.0. Results Our respondents’ mean age was 30 (±7.6) years. Out of the 61.2% of women who had heard about cervical cancer, 47.0% had heard about Pap smear test and among them, 73% had gotten a Pap test. A total of 25.5% of women out of the 61.2%, knew that a vaccine existed for prevention and out of them only 9.8% had vaccinated against human papilloma virus. Conclusion Majority of women in our study belonged to a higher socioeconomic class and were mostly educated but their knowledge and practices regarding prevention and screening of cervical cancer were poor. This reflects that the knowledge levels as a whole would be considerably lower in the city’s general population.

Inequalities in adherence to cervical cancer screening in Portugal

Cervical cancer is the second cancer with the highest incidence and mortality in women aged 15–44 living in Europe. Screening is an effective strategy to reduce these rates, although in Portugal, as in other European countries, adherence to screening still presents significant disparities. Thus, this study aimed to assess the prevalence and factors associated with cervical cancer screening (CCS) nonadherence in Portugal. Cross-sectional data from 5929 women aged 25–64 included in the 2014 Portuguese National Health Survey (2014 NHS) were analyzed. The prevalence of CCS nonadherence was estimated. The association between multiple factors and CCS nonadherence was analyzed, using logistic regression, adjusting for age and educational level. The weighted prevalence of nonadherence was 13.2% [95% confidence interval (CI): 12.0–14.0]. Additionally, 10.5% of women had performed the last cervical cytology 3 years ago or more. Higher odds of nonadherence to screening were found for younger women, with low levels of education and income, unemployed, single, born outside Portugal, who never had a medical appointment or had over 12 months ago, who were never pregnant and who had never had a mammography. No association was found with other variables studied, including having public/private health insurance, BMI or smoking status. This study showed that inequalities in CCS adherence in Portugal persist. These findings reinforce the need for developing strategies to reduce inequalities in CCS adherence.

Knowledge, beliefs, and practices related to cancer screening and prevention in Lebanon: community and social media users’ perspectives

Objective Common to many countries in the Middle East, Lebanon has an increasing cancer burden; however, national screening programs are limited to breast cancer. The literature on cancer screening practices and beliefs is scarce. This cross-sectional study investigates the knowledge, beliefs, and practices related to the prevention and screening for breast, cervical, colon, lung, and skin cancers among Lebanese residents, recruited through social media advertisements and community outreach activities. Methods Participants filled an anonymous questionnaire either via a web-based interface or using tablets distributed at primary health clinics. The characteristics of the two cohorts were compared with chi-square and t-tests. We performed descriptive analysis, followed by multivariate logistic regression for predictors of cancer screening. Results A total of 407 participants completed the survey online, and 262 filled the study in tablets available at primary care clinics. The two samples were significantly different in terms of age, education, and perceived socioeconomic status. Online participants demonstrated higher knowledge and higher participation in screening practices than their counterparts recruited through community outreach. Mammography (44.7% online and 39.9% in-person), and cervical cancer screening (44.5% online and 36.7% community) had the highest participation rates. In both samples, participants who were older and more educated were more likely to report engagement with cancer screening practices. Conclusions Our study revealed significant knowledge gaps in cancer prevention and screening. Different sampling techniques accessed diverse populations, highlighting the need for educational messages and targeted screening programs to be inclusive of socio-economically disadvantaged communities with low education and health literacy.

Dose-risk relationships between cigarette smoking and cervical cancer: a systematic review and meta-analysis

Objective Cervical cancer (CC) is the fourth most frequent cancer worldwide. Cigarette smoking has been shown to influence CC risk in conjunction with human papillomavirus (HPV) infection. The aim of this study is to provide the most accurate and updated estimate of this association and its dose-response relationship. Methods Using an innovative approach for the identification of original publications, we conducted a systematic review and meta-analysis of studies published up to January 2021. Random effects models were used to provide pooled relative risks (RRs) of CC for smoking status. Dose-response relationships were evaluated using one-stage random effects models with linear or restricted cubic splines models. Results We included 109 studies providing a pooled RR of invasive CC and preinvasive lesions, respectively, of 1.70 [95% confidence interval (CI), 1.53–1.88] and 2.11 (95% CI, 1.85–2.39) for current versus never smokers, and, respectively, 1.13 (95% CI, 1.02–1.24) and 1.29 (95% CI, 1.15–1.46) for former versus never smokers. Considering HPV does not alter the positive association or its magnitude. Risks of CC sharply increased with few cigarettes (for 10 cigarettes/day, RR = 1.72; 95% CI, 1.34–2.20 for invasive CC and RR = 2.13; 95% CI, 1.86–2.44 for precancerous lesions). The risk of CC increased with pack-years and smoking duration and decreased linearly with time since quitting, reaching that of never smokers about 15 years after quitting. Conclusion This comprehensive review and meta-analysis confirmed the association of smoking with CC, independently from HPV infection. Such association rose sharply with smoking intensity and decreased after smoking cessation.

Cervical cancer screening and outcomes for women under 25 years of age in Belgium: a 10-year nationwide study

Objective The aim of the study was to describe trends in cervical cancer screening and outcomes for women under 25 years of age in Belgium between 2010 and 2019 in response to a changed reimbursement policy. Materials and methods We used the databases of the National Health Insurance Institute (RIZIV/INAMI) and the Belgian Cancer Registry (BCR) for a nationwide description of cervical screening, subsequent diagnostic procedures and outcomes for women younger than 20 years and women aged 20–25 years between 2010 and 2019. Results Over a 10-year period, the number of cytology screening tests and annual screening rates in women younger than 25 years have been reduced by 50%, but no increases in invasive cervical cancer or high-grade intraepithelial lesion diagnoses were observed. The major determinant of this decreased overscreening has been the limitation of reimbursement in 2013 to once every 3 years instead of once every 2 years. In women aged 25–29 years, there is no increase in invasive cervical cancer diagnoses after decreased screening of women younger than 25 years. To detect 29 invasive cervical cancers in women younger than 25 during the 10-year study period, a total of 5606 conizations were performed and 43 million EUR of Belgian health insurance budget was spent. Since the cost of hospitalization, sickness leave and negative psychological impact were not included in our estimation, these costs are underestimated. Conclusion Incidence of cervical cancer in women under 25 years remains low and screening is not effective in preventing cervical cancer, although there is clear evidence of potential reproductive harm and financial cost. We state that restricting reimbursement of cervical cancer screening before the age of 25 will improve guideline adherence and decrease healthcare expenditures without negatively impacting the health of the population.

Evolution of human papilloma virus prevalence in a highly vaccinated region in Belgium: a retrospective cohort study in Flemish women (2010–2019)

Objective In order to lower the incidence of cervical cancer, vaccines against high-risk types of the human papilloma virus (hrHPV) were approved and brought on the market in 2007, with a partial reimbursement for Belgian citizens younger than 18 years old. Since 2010, a school-based vaccination program ensures a high vaccination coverage in young women. In this study, the impact of the Belgian vaccination program on the prevalence of HPV 16/18 is studied, together with the evolution of the prevalence of other hrHPV types and precancerous lesions. Methods Results of HPV typing and cytology in papanicolaou-smears from women aged 20–23 years taken between 2010 and 2019 were used. An older, nonvaccinated group of women of 40–45 years old served as a control group. Results A significant decrease in prevalence of HPV types 16 and 18 was found in the 20–23-years-old women, whereas no decrease was found in the age group 40–45. Alongside this decrease, a significant decrease in prevalence of subtypes 6, 11 and 31 was observed, whereas type 31 is not included in the administered vaccines. Remarkably, there was no decrease in prevalence of cytological abnormalities in the study group during this study. There was even an increase in prevalence of high-risk types 53, 58 and 67. Conclusion These findings emphasise the need to maintain the screening programs, even in areas with high vaccination coverage.

Comment to: Inequalities in adherence to cervical cancer screening in Portugal

Knowledge, attitude, preventive practices and utilization of cervical cancer screening among women in Nepal: a community-based cross-sectional study

Background Cervical cancer continues to be a global public health concern and a leading cause of cancer deaths among Nepalese women. In spite of the availability of screening and treatment services in Nepal, the utilization of screening has been low. This study investigated knowledge, attitude, preventive practices and utilization of cervical cancer screening among women in a semi-urban area of Pokhara Metropolitan City of Nepal. Methods A community-based cross-sectional survey was carried out among 729 women 30–60 years of age, between April and June 2019. Participants were selected by systematic random sampling, and a door-to-door home visit was conducted for data collection. A pretested interviewer-administered Nepali questionnaire was used to collect information on sociodemographic variables, knowledge, attitude and preventive practices regarding cervical cancer screening. Results The mean age of the participants was 45.9 years (SD ±7.7); the majority were married (86.7%). Among the participants, 44.9% were ever screened for cervical cancer. However, only 10.4% of participants received timely repeated screening for cervical cancer. The median knowledge score achieved by participants was 2.0 [interquartile range (IQR) 1–4] on a scale of maximum score 36, the median attitude score was 31.0 (IQR 29–32) on a scale of 40 and the median preventive practice score was 3.0 (IQR 3–4) on a scale of five. Conclusion This study showed low knowledge and low utilization of cervical cancer screening among women in Nepal. We recommend a community-based educational intervention to educate and empower women to increase knowledge and utilization of cervical cancer screening.

The uptake rate of risk-reducing salpingo-oophorectomy among Thai women with breast cancer and germline BRCA pathogenic or likely pathogenic variants

Germline BRCA1 and BRCA2 pathogenic and likely pathogenic variants (PVs) significantly increase the risk of breast cancer and ovarian cancer, forming the basis for hereditary breast and ovarian cancer syndrome. Current guidelines recommend risk-reducing salpingo-oophorectomy (RRSO) for women with PVs. This study aimed to evaluate the rate of uptake of RRSO among women with breast cancer who carry germline BRCA PVs. This retrospective study collected data from women with breast cancer who were identified to have germline BRCA PVs between 2020 and 2024 at Siriraj Hospital, Bangkok, Thailand. Baseline characteristics, including age, BMI, underlying diseases, menopausal status, recurrent or metastatic breast cancer, BRCA1 and BRCA2 PVs were recorded. The uptake rate and associated factors of RRSO among these women were analyzed. In addition, the time to surgery and pathological outcomes were evaluated in the RRSO group. One hundred and thirty-eight women were included in the final analysis. Among them, 81 (58.7%) underwent RRSO. Ovarian cancer was detected in six (7.4%) women who underwent RRSO. Factors associated with undergoing RRSO including age greater than or equal to 45 years and the absence of distant metastasis. The median interval between genetic testing and RRSO was 8 months. In the surveillance group, the median follow-up time was 39 months, and no cases of cancer were detected. The RRSO uptake rate among breast cancer patients with germline BRCA PVs was 58.7%. Efforts to improve this rate should focus on understanding reasons for refusal and offering alternative prevention strategies.

The effects of the ketogenic diet on cancer treatment: a narrative review

Despite significant advances in therapy, cancer remains the top cause of death in parts of the globe. For many types of cancer, the typical treatment is a combination of surgery, chemotherapy, and radiotherapy. However, this conventional treatment is not successful on its own. As a consequence, innovative approaches that improve treatment efficacy are urgently needed. The ketogenic diet is a high-fat, moderate protein, and low-carbohydrate diet that appears to sensitize most cancers to conventional therapies by exploiting cancer cells’ altered metabolism, making it an effective adjuvant cancer treatment alternative. This diet could decrease glucose metabolism while enhancing lipid metabolism, interfering with the Warburg effect, and inhibiting tumor cell proliferation. The anticancer impact of ketogenic diet has been established in numerous animal trials and clinical investigations on a wide range of tumor types, including glioblastoma, pancreatic cancer, head and neck cancer, breast cancer, invasive rectal cancer, ovarian cancer, and endometrial cancer. In this review, we discussed the various types of ketogenic diets, the mechanism of action for ketogenic diet as a cancer therapy, and the data gathered from continuing preclinical and clinical studies, intending to establish a solid theoretical foundation for future research.

Duration of human papillomavirus persistence and its relationship with recurrent cervical dysplasia

Objective To evaluate how the duration of human papillomavirus (HPV) persistence influences the risk of developing recurrent high-grade cervical dysplasia (CIN2+). Methods Data of patients with persistent HPV infection (at least at 6 months) after primary conization were extracted from a multi-institutional Italian database, retrospectively. Kaplan–Meier and Cox proportional hazards models were used to evaluate associations between duration of HPV persistence with the 5-year risk of developing recurrent CIN2+. Results Overall, 545 patients met the inclusion criteria. Positive margins were detected in 160 (29.3%) patients. Overall, 247 (45.3%) and 123 (22.6%) patients had a documented infection from HPV16/18, and other high-risk HPV types. 187 (34.3%), 73 (13.4%), and 40 (7.3%) were diagnosed with persistent HPV infection at 12, 18, and 24 months, respectively. Patients with HPV persistence at 6 months experienced a risk of recurrence of 7.46%. Twelve-month HPV persistence strongly correlates with the risk of developing the recurrent disease (risk of recurrence: 13.1%). While, having HPV persistence >12 months did not correlate with an increased risk of recurrence (hazard ratio: 1.34 (95% confidence interval: 0.78–2.32); P = 0.336, log-rank test). Conclusion HPV persistence is one of the most important factors predicting the risk of CIN2+ recurrence. The risk of CIN2+ recurrence increased with the increase of HPV persistence for up to 1 year. The persistence of HPV after the first year does not appear as a risk factor.

Universal testing for MSI/MMR status in colorectal and endometrial cancers to identify Lynch syndrome cases: state of the art in Italy and consensus recommendations from the Italian Association for the Study of Familial Gastrointestinal Tumors (A.I.F.E.G.)

Adjuvant VaccInation After Conization for the Treatment for CervicAL Dysplasia

This study aimed to evaluate the role of adjuvant HPV vaccination in women undergoing conization for cervical intraepithelial neoplasia. This prospective study assessed factors influencing recurrence in patients undergoing conization for high-grade cervical dysplasia. After conization, patients were counseled on the potential benefits of vaccination. We compared outcomes between two groups: women who underwent conization with adjuvant human papillomavirus (HPV) vaccination and observation versus conization with observation only. Data from 281 patients were analyzed, comprising 168 (59.8%) patients in the conization-only group and 113 (40.2%) patients in the conization-plus vaccination group. Vaccinated patients were younger than nonvaccinated patients (38 vs. 45 years, P  < 0.001). Positive surgical margins were more frequently observed in the vaccinated group compared with the nonvaccinated group (9.7 vs. 3.6%; P  = 0.038). Median follow-up was shorter in the vaccinated group, although this difference was not statistically significant (24.9 vs. 27.8 months; P  = 0.395). The risk of developing HPV-related lesions was similar between the vaccinated and nonvaccinated groups ( P  = 0.594, log-rank test). Likewise, the need for reconization did not differ significantly between the groups ( P = 0.593, log-rank test). Multivariate analysis showed no significant impact of HPV vaccination on postoperative outcomes [hazard ratio (HR): 0.50, 95% confidence interval (CI): 0.15–1.68) for any lesion; HR: 0.90, 95% CI: 0.47–1.73 for reconization]. This study indicates that adjuvant HPV vaccination does not significantly affect short-term outcomes in women undergoing conization for cervical dysplasia. Ongoing randomized trials will provide more robust evidence to clarify the role of adjuvant vaccination in this setting.

A roadmap for a comprehensive control of cervical cancer in Poland: integration of available solutions into current practice in primary and secondary prevention

In Poland, cervical cancer incidence and mortality still remain considerably higher than in Western European countries or North America. Recent data indicate decreasing trends in women younger than 60 years and stable trends in older women. In this article, we identified obstacles in primary and secondary prevention of cervical cancer in Poland. We analysed local legislation, management structure and organization of cervical cancer prevention in Poland and reviewed solutions available and implemented in other European countries. The main weaknesses include: (i) very low coverage of organized screening; concurrent unregistered opportunistic screening with unknown coverage and high test consumption (ii) suboptimal quality assurance in organized screening and no external quality assurance in opportunistic screening (iii) very low coverage of human papillomavirus vaccination that is not centrally reimbursed (iv) absence of pilot evaluation of (a) interventions that may improve population coverage and (b) performance of new preventive strategies. The proposed solutions are multifaceted and involve: (i) legislative and organizational regulation of cervical cancer screening aimed at comprehensive registration of procedures, data access and quality assurance (ii) pilot testing and implementation of new ways to increase coverage of cervical cancer screening, in particular among older women (iii) pilot evaluation with possible introduction of human papillomavirus-based screening and (iv) inclusion of human papillomavirus vaccination into the reimbursed national immunization program.

The relationship between atypical glandular cells and malignancy risk: a retrospective single-center study

Objective Atypical glandular cells (AGC) in cervical cytology are often ignored, and the malignancy risk associated with AGC remains uncertain. This study aims to evaluate the histopathology and clinical correlations in patients diagnosed with AGC through cervical cytology. Methods This study was retrospectively analyzed 402 patients who diagnosed with AGC using cervical cytology in our hospital between March 2017 and June 2024. Among these, high-risk human papillomavirus (hrHPV) results and histopathological findings within 1-year follow-up were included. Results The distribution of AGC subcategories were as follows: atypical endocervical cells (AEC), 13.4%; atypical endometrial cells, 10.9%; AGC, not otherwise specified, 49.8%; AEC, favor neoplastic, 6.7%; AGC, favor neoplastic, 19.2%. Precancerous lesions and malignancies were diagnosed in 58.9% of cases, with endometrial carcinoma being the most common (24.4%), followed by adenocarcinoma (10.0%). A total of 358 patients underwent hrHPV testing, with a positive rate of 35.2%, hrHPV positivity significantly increased the risk of cervical lesions, while endometrial lesions and pelvic malignancies were more common in hrHPV-negative patients. Conclusion This study showed that cytological diagnosis of AGC has high predictive value for cervical lesions, endometrial lesions, and pelvic malignancies. A more detailed triage procedure based on the AGC subcategory can reduce the possibility of missed diagnoses of reproductive tract tumors. The combination of hrHPV detection and age can serve as an important basis for the further diagnosis and management of AGC.

Clinical significance of atypical glandular cells on cytology: 10 years’ experience of a colposcopic referral center

Introduction ‘Atypical glandular cells’ (AGC) is an uncommon cytological result of cervical Pap smears which includes a wide of histopathological diagnoses, from benign to premalignant and malignant cervical disorders, endometrial cancer and, occasionally, other genital malignancies. This study aims to provide a comprehensive overview of AGC, assessing risk factors and clinical and histological features in affected patients. Materials and methods A retrospective analysis was conducted on a cohort of 239 women diagnosed with AGC between 2012 and 2022 at the ‘Regional Referral Center for Prevention, Diagnosis and Treatment of HPV-related Genital Disorders’, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy. Following AGC detection, patients underwent colposcopy with endocervical sampling and endometrial assessment via pelvic ultrasound. Selective cases also received endometrial biopsies. Results Among a total of 190 women who underwent both colposcopy and endometrial assessment, 116 (61%) had negative clinical and histopathological findings. The remainder displayed various abnormalities: 36 women (18.9%) were found to have endometrial or cervical polyps, 23 (12.1%) were diagnosed with preinvasive cervical neoplasia, and 21 (10.9%) with invasive cervical or endometrial disease. Menopause, multiparity, and older age were all significantly associated with endometrial cancer, but none of the abovementioned variables were significantly associated with cervical neoplasia. Conclusion Our data confirm that AGC may reveal the presence of a wide range of histopathological conditions. Patients diagnosed with AGC should undergo a careful evaluation including both colposcopy with endocervical sampling and an endometrial assessment.

Prevalence of BRCA1 and BRCA2 mutations in ovarian cancer patients from Yunnan Province in southwest China

Carriers with germline breast cancer 1/2 gene mutations (BRCAm) are likely to develop ovarian cancer (OC). Therefore, identifying these mutations may enable individualized therapy for OC and preventive measures to reduce OC risk in BRCAm carrier families. Thus, we investigated the prevalence of BRCAm in OC patients from Yunnan Province in Southwest China. In total, 674 unselected OC patients were enrolled and tested for BRCAm via next-generation sequencing. Data on clinicopathological characteristics and personal/family history of cancer were collected. The prevalence rates of pathogenic/likely pathogenic BRCAm were 26.6% overall, 20.8% among BRCA1m carriers, 5.5% among BRCA2m carriers, and 0.3% among carriers of both BRCA1m and BRCA2m. The most common pathogenic mutation in the BRCA1 gene was c.5114T>C (n = 9). The number of BRCAm carriers was significantly greater among patients with serous cancer, a personal tumor history, a family history of hereditary breast and ovarian cancer (HBOC)-related tumors, and bilateral tumors. The most common pathogenic mutation in this cohort was c.5114T>C (n = 9) in BRCA1. The prevalence and spectrum of BRCAm in OC patients from Yunnan Province are different from those in other groups. BRCA status testing is advised for all OC patients, particularly those with a family history of HBOC.

A meta-analysis of albumin, globulin, and albumin globulin ratios for predicting prognosis of cervical cancer

This study intends to investigate the performance of albumin, globulin, and albumin-globulin ratio (AGR) in predicting the prognosis of patients with cervical cancer. PubMed, Web of Science, Embase, and Cochrane Library databases were searched for relevant articles up to 1 March 2024. To elucidate the prognostic power of albumin, globulin, and AGR in cervical cancer patients, hazard ratios and 95% confidence intervals (CI) were computed. Subgroup analyses were performed to assess the association between albumin and the prognosis of cervical cancer patients. Ten studies involving 2394 cervical cancer patients were enrolled. Our results manifested that low albumin level was linked to poorer overall survival (OS) (hazard ratio = 2.01, 95% CI = 1.45–2.80, p < 0.001), independent of progression-free survival (PFS), whereas high globulin and low AGR were not notably correlated with both OS and PFS. Subgroup analyses by tumor stages, and treatment measures noted that low albumin levels were linked to poorer OS in tumor stages I–II (hazard ratio = 1.96, 95% CI = 1.12–3.43, p = 0.018), I–IV (hazard ratio = 1.96, 95% CI = 1.24–3.10, p = 0.004), and IV (hazard ratio = 3.4, 95% CI = 1.39–8.29, p = 0.007). Low albumin levels were associated with poorer OS in multifactorial analysis (hazard ratio = 1.94, 95% CI = 1.52–2.48, p < 0.001) and survival curves (hazard ratio = 3.38, 95% CI = 1.94–5.88, p < 0.001). In patients undergoing surgery only (hazard ratio = 2.32, 95% CI = 1.70–3.17, p < 0.001) and those with radiotherapy (hazard ratio = 2.12, 95% CI = 1.41–3.2, p < 0.001), low albumin levels were linked to poorer OS, but neither associated with PFS. Low albumin levels in cervical cancer patients are associated with poorer prognoses, and therefore can be viewed as a simple and economical prognostic index for cervical cancer.

HPV infection patterns and viral load distribution: implication on cervical cancer prevention in Western Kenya

Human papillomavirus (HPV) coinfection remains common globally. However, its clinical significance compared to mono-infection remains controversial. Further, the epidemiology of HPV genotype combination in coinfection is not well studied in Kenya. . Between June and August 2023, a cross-sectional facility-based survey enrolled 434 women aged 16–68 years using purposive sampling strategy. Structured questionnaire was obtained from each woman regarding demographic and sexual behavior characteristics. Cervical specimen was collected from each participant and analyzed using RIATOL assay to determine HPV genotypes and viral load. Overall, HPV 52 was the most frequently detected HPV strain. The mean HPV viral load was elevated among coinfected women than those with mono-infection but there was no evidence to support differences in viral load in the two groups (P = 0.113). Mono-infection was common (58.52%). HPV 16 was noted to have a near equal presence both in mono-infection and coinfection (52.17% and 47. 83%), respectively. HPV 33 (alpha 9) and 45 (alpha 7) had the greatest preference for each other compared to all other HPV interactions. HPV 52 is the most prevalent HPV in the population supporting the need for the nonavalent HPV vaccine. Mono-infection with HPV 16 remains common corroborating the relevance of bivalent vaccine in resource limited setting where nonavalent vaccines may be unavailable. The frequent coinfection preference of HPV 33 and 45 (alpha 9 and alpha 7, respectively) pauses the need for further concurrent characterization. HPV vaccination and education on safe sexual behaviors is key in reducing HPV coinfection.

Primary prevention of HPV-related diseases from the patients’ perspective in Poland

Objectives This study aimed to assess the knowledge of human papillomavirus (HPV) and attitudes toward HPV vaccination (HPVv) among female patients in Poland, investigating the impact of sociodemographic factors on these aspects. The study also explored awareness of state-funded bivalent vaccination and gauged willingness to vaccinate children, especially in the aspect of the newly introduced nonavalent vaccine. Material and methods An 11-question questionnaire was administered to newly referred patients at a dysplasia consultation center in Kraków University Hospital between February and December 2022. Statistical analysis using IBM SPSS Statistics 25 evaluated sociodemographic characteristics, HPV knowledge, attitudes toward HPVv and correlations among responses. Results By December 2022, 187 completed forms were received, primarily from women aged 30-40 years, residing in large cities, and with higher education qualifications. While most were aware of HPV’s association with cancer and abnormal cytology, over 40% were unaware of its asymptomatic nature. Higher education is correlated with better HPV awareness. Participants generally showed positive attitudes toward HPVv for themselves and their children, yet only a small fraction had received the vaccine. Education significantly influenced HPV knowledge, with higher education levels linked to better awareness and willingness to vaccinate children. Awareness of HPV is positively correlated with knowledge test performance and vaccination attitudes. Conclusion The study revealed a lack of awareness regarding government co-financing for the bivalent vaccine. Campaigns endorsing reimbursed vaccination were found to be inadequate, highlighting the need for corrective measures to enhance awareness and improve vaccination rates, particularly for individuals outside the age range between 12 and 13 years relying on self-financing or sporadic government initiatives.

Quantitative analysis of trends and inequalities in disease burden and care quality of gynecological cancers, 1990–2021

Background Cervical (CC), ovarian (OC), and uterine (UC) cancers are major contributors to global gynecological cancer (GC) burden. This research intended to update trends in disease burden and care quality for these cancers and quantify cross-country inequalities between 1990 and 2021. Methods We performed a secondary analysis utilizing the Global Burden of Disease 2021 database. Disease burden and care quality were evaluated through age-standardized incidence rates (ASIR), age-standardized years lived with disability rates (ASYR), and quality-of-care index (QCI). Trends were analyzed using estimated annual percentage changes, while absolute and relative cross-country inequalities were quantified using the slope index of inequality and concentration index. Results From 1990 to 2021, global ASIR and ASYR for CC and OC declined, whereas UC showed an increase in both rates. Concurrently, a general uptrend in QCI was observed for all three GCs. Across the WHO regions, the European region reported the highest ASIR and ASYR for OC and UC in 2021, and the African region recorded the highest for CC. In both 1990 and 2021, countries/territories with higher socio-demographic index (SDI) experienced a higher ASYR for OC and UC, while CC primarily concentrated in lower SDI countries/territories. Significant healthcare inequalities in age-standardized QCI were observed, with higher SDI countries/territories generally exhibiting better QCI. Conclusion Trends in the burden and QCI for gynecological cancers demonstrated significant disparities among WHO regions and 204 countries/territories, with global inequalities persisting. Urgent action is needed to develop geographically tailored strategies for equitable access to high-quality healthcare.

Marital status as an independent prognostic factor for survival in women with vaginal cancer: evidence from the SEER database analysis

This study aimed to evaluate the influence of marital status on the survival outcomes of women diagnosed with vaginal cancer, considering the potential role of sociodemographic factors in patient prognosis. Utilizing data from the Surveillance, Epidemiology, and End Results database, the study included 6046 women with primary vaginal cancer diagnosed between 2000 and 2020. The propensity score matching (PSM) method was employed to balance comparison groups and account for confounding factors. The primary outcomes were overall survival (OS) and cancer-specific survival (CSS), with Cox proportional-hazards regression models used for statistical analysis. Married patients exhibited better survival outcomes than their unmarried counterparts [OS: hazard ratio = 1.520, 95% confidence interval (CI) = 1.430–1.630, P < 0.001; CSS: hazard ratio = 1.380, 95% CI = 1.270–1.490, P < 0.001]. Subgroup analyses stratified by age and race highlighted a significant survival benefit for married individuals, particularly those aged 50–69 years and white patients. After PSM, the widowed subgroup within the unmarried category showed worse survival outcomes (OS: hazard ratio = 1.580, 95% CI = 1.430–1.750, P < 0.001; CSS: hazard ratio = 1.360, 95% CI = 1.200–1.530, P < 0.001). This study demonstrates that marital status serves as an independent prognostic factor for OS and CSS among patients with primary vaginal cancer, which supports that unmarried people need more individualized care strategies.

A combined clinical and genetic model for predicting risk of ovarian cancer

Objective Women with a family history of ovarian cancer or a pathogenic or likely pathogenic gene variant are at high risk of the disease, but very few women have these risk factors. We assessed whether a combined polygenic and clinical risk score could predict risk of ovarian cancer in population-based women who would otherwise be considered as being at average risk. Methods We used the UK Biobank to conduct a prospective cohort study assessing the performance of 10-year ovarian cancer risks based on a polygenic risk score, a clinical risk score and a combined risk score. We used Cox regression to assess association, Harrell’s C-index to assess discrimination and Poisson regression to assess calibration. Results The combined risk model performed best and problems with calibration were overcome by recalibrating the model, which then had a hazard ratio per quintile of risk of 1.338 [95% confidence interval (CI), 1.152–1.553], a Harrell’s C-index of 0.663 (95% CI, 0.629–0.698) and overall calibration of 1.000 (95% CI, 0.874–1.145). In the refined model with estimates based on the entire dataset, women in the top quintile of 10-year risk were at 1.387 (95% CI, 1.086–1.688) times increased risk, while women in the top quintile of full-lifetime risk were at 1.527 (95% CI, 1.187–1.866) times increased risk compared with the population. Conclusion Identification of women who are at high risk of ovarian cancer can allow healthcare providers and patients to engage in joint decision-making discussions around the risks and benefits of screening options or risk-reducing surgery.

Updated evidence-based recommendations for cervical cancer screening in France

Introduction A national organized cytology-based cervical cancer screening program was launched in 2018 and rollout is ongoing. Concomitantly, the High Authority for Health (HAS) recently assessed new evidence on primary HPV testing to update screening recommendations. Methods The HAS commissioned systematic reviews and meta-analyses to evaluate the effectiveness of primary HPV screening; accuracy of HPV testing on self-samples; effectiveness of self-sampling to reach underscreened women; and triage strategies to manage HPV-positive women. Recommendations developed by the HAS were reviewed by a multidisciplinary group. Results Compared with cytology screening, HPV screening is more sensitive to detect precancers but less specific. In women aged ≥30, if the test is negative, HPV screening greatly reduces the risk of developing precancer and cancer for at least 5 years. HPV testing, using validated PCR-based assays, is as sensitive and slightly less specific on self-samples than on clinician-taken samples. Self-sampling is more effective to reach underscreened women than sending invitations to have a specimen taken by a clinician. Two-time triage strategies ensure a sufficiently high risk if triage-positive to justify referral and low risk if triage-negative allowing release to routine screening. Conclusions The HAS recommends three-yearly cytology screening for women aged 25–29 and HPV screening for those aged 30–65 with an extension of the screening interval to 5 years if the HPV test is negative. Self-sampling should be offered to underscreened women aged ≥30. HPV-positive women should be triaged with cytology. Those with abnormal cytology should be referred for colposcopy and those with normal cytology re-tested for HPV 12 months later. Recommendations for implementation of HPV-based screening in the organized program are provided.

Risk factors of cervical cancer among ethnic minorities in Yunnan Province, China: a case–control study

Background Cervical cancer is a common malignant tumor of the female reproductive system in the world, which is a serious threat to women’s life and health. According to the latest report, the incidence of cervical cancer is 11.42 per 100 000, and the mortality rate is 3.77 per 100 000 in Yunnan Province, which is still higher than the national average. Although there have been some relevant studies on the risk factors of cervical cancer in recent years, research on ethnic minorities is lacking in Yunnan Province. Objective To analyze and explore the related risk factors of cervical cancer in women of ethnic minorities in Yunnan Province, to provide the scientific basis for the development of cervical cancer prevention and control strategies and measures in this region. Methods In total 1119 cervical cancer patients diagnosed by histopathology at the Yunnan Cancer Center (Yunnan Cancer Hospital) from January 2010 to December 2019 were selected as the case group. According to the 1:1 matching principle of the case–control study, 1119 patients with nonmalignant tumors of the same nationality, the same hospital, age difference less than 3 years old, were selected as the control group. Univariate and multivariate conditional logistic regression were used for statistical analysis. Results Basic medical insurance for rural residents (OR = 3.659; P = 0.003), human papilloma virus (HPV) infection (OR = 90.030; P < 0.001) and concurrent reproductive tract infections (OR = 1.992; P = 0.047) were risk factors for cervical cancer. Late first marriage(OR = 0.881; P = 0.032), the number of normal childbirths ≤2 (OR = 0.480, P = 0.033) and contraception (OR = 0.291; P = 0.002) were positive factors for cervical cancer. Conclusion The high incidence of cervical cancer in Yunnan minority women is the result of many factors: HPV infection is the highest risk factor for cervical cancer, women with reproductive tract infections and basic medical insurance for rural residents have a higher risk for cervical cancer; Late first marriage, the number of deliveries ≤2 and contraception are positive factors for cervical cancer.

An economic evaluation of two cervical screening algorithms in Belgium: HR-HPV primary compared to HR-HPV and liquid-based cytology co-testing

Objective To assess the costs and benefits of two algorithms for cervical cancer screening in Belgium (1) high-risk human papillomavirus (HR-HPV) primary screening and (2) HR-HPV and liquid-based cytology (LBC) co-testing. Methods A decision tree was adapted from published work and parameterised using HORIZON study data and Belgian cost and population data. The theoretical model represents two different screening algorithms for a cohort of 577 846 women aged 25–64 attending routine cervical screening. Scenario analyses were used to explore the impact of including vaccinated women and alternative pricing approaches. Uncertainty analyses were conducted. Results The cost per woman screened was €113.50 for HR-HPV primary screening and €101.70 for co-testing, representing a total cost of €65 588 573 and €58 775 083, respectively, for the cohort; a 10% difference. For one screening cycle, compared to HR-HPV primary, co-testing resulted in 13 173 more colposcopies, 67 731 more HR-HPV tests and 477 020 more LBC tests. Co-testing identified 2351 more CIN2+ cases per year (27% more than HR-HPV primary) and 1602 more CIN3+ cases (24% more than HR-HPV primary) than HR-HPV primary. Conclusion In Belgium, a co-testing algorithm could increase cervical pre-cancer detection rates compared to HR-HPV primary. Co-testing would cost less than HR-HPV primary if the cost of the HPV test and LBC were cost-neutral compared to the current cost of LBC screening but would cost more if the cost per HPV test and LBC were the same in both co-testing and HR-HPV primary strategies.

Universal screening for Lynch syndrome in operated colorectal cancer by immunohistochemistry: a cohort of patients in Liaoning province, China

Objective Lynch syndrome (LS) is the most common hereditary colorectal cancer syndrome worldwide. Due to the decreasing family size in Liaoning province. The Bethesda and Amsterdam II criteria have lower sensitivity and specificity and are not suitable for the local population. Immunohistochemistry screening for mutations in DNA mismatch repair (MMR) in newly diagnosed colorectal cancer can improve the detection rate of LS. Methods All newly diagnosed colorectal cancer patients who underwent surgery between January 2018 and June 2020 at Cancer Hospital of China Medical University and Shengjing Hospital of China Medical University from Liaoning China were included retrospectively, and the ratio of universal LS screening by immunohistochemistry, MMR protein deficiency (dMMR) ratio, MLH1 loss, MSH2 loss, MSH6 loss, and PMS2 loss was analyzed. The clinicopathological characteristics of patients with pMMR and dMMR were analyzed. Results A total of 7019 colorectal cancer patients underwent surgery and 4802 (68.41%) patients were screened by immunohistochemistry for MMR, 258 (5.37%) cases were reported to have a loss of MMR expression. In the dMMR group, a higher number of patients were under 50 years old, more tumors were located at the right colon, less patients have lymph node metastasis, more tumors were stage II, and histological types of mucinous carcinoma or signet ring carcinoma were more common, compared with the pMMR group. Only 2.71% dMMR patients meet Amsterdam criteria II, 2.71% of patients meet Revised Bethesda guidelines, and 17.83% meet Chinese LS criteria. Twenty-five dMMR patients were confirmed by next-generation sequencing and five families were confirmed as Lynch family. Conclusion These data imply that universal screening for LS by immunohistochemistry may be effective in Liaoning province.

Effectiveness of the cervical cancer prevention programme: a case-control mortality audit in Lithuania

The cervical cancer burden in Lithuania has remained high, and there are no previous effectiveness studies of cervical cancer prevention programme in the country. We investigated the effect of a prevention programme on the risk of mortality from cervical cancer in Lithuania by conducting a mortality audit study. The register-based case-control study included 715 cervical cancer deaths that occurred during 2010–2015 in Lithuania and their 2145 matched controls. Screening histories for cases and controls were obtained from the National Health Insurance Fund database. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using conditional logistic regression and corrected for self-selection bias. Index screening was associated with a 56% reduction in the cervical cancer death risk, OR: 0.44; 95% CI 0.26–0.74. The ORs for stage I and stage II+ cancers were 0.80; 95% CI 0.32–2.00 and 0.36; 95% CI 0.21–0.62, respectively. The preventive effect was statistically significant for women aged ≥40 years, while nonsignificant for younger. In women who died of cervical cancer, 71% were not invited and 88% were not screened within the recommended 36 months prior to index date. Among cases with index invitation, 32% had index screening compared to 70% in controls. In conclusion, participation in screening has been effective in reducing cervical cancer mortality in Lithuania. The study shows poor screening attendance, emphasizing the importance of greater efforts at the national level to improve the effectiveness of the screening.

Trends in prevalence in human papillomavirus types and their association with cervical dysplasia: an analysis on 15 138 women over 20 years

To investigate trends in prevalence of various human papillomavirus types in order to assess the unmet clinical needs for women affected by human papillomavirus-related disease. Data of consecutive 15 138 patients undergoing human papillomavirus DNA testing from 1998 to 2018 were retrospectively identified. Human papillomavirus types were classified at high-risk according to the classification of the International Agency for Research on Cancer. The International Agency for Research on Cancer included seven human papillomavirus types covered by nine-valent vaccine and five not yet covered by any available vaccines. Overall, 4159 (65.3%), 1500 (23.5%) and 714 (11.2%) women had human papillomavirus types covered by nine-valent vaccination, not covered by nine-valent vaccination and co-infections of human papillomavirus types of both groups. At least one high-risk human papillomavirus type(s) was detected in 1241 patients with genital dysplasia: 832 (67.1%), 291 (23.4%) and 118 (9.5%) women had human papillomavirus types covered by nine-valent vaccination, not covered by nine-valent vaccination and co-infections of human papillomavirus types of both groups. Over the twenty-year study period, the number of human papillomavirus types not covered by nine-valent vaccine increased dramatically (from 4 to 16%; P < 0.001, P for trend). Similarly, looking at patients with genital dysplasia, high-risk human papillomavirus types not covered by nine-valent vaccine increased from 3 to 13% (P < 0.001, P for trend). Our data highlight that human papillomavirus types covered by nine-valent vaccine represent are the main types associated with genital dysplasia. However, over the study period, we observed an increasing prevalence of confections and high-risk human papillomavirus types not covered by the nine-valent vaccine, thus suggesting the need of developing more complete vaccines against human papillomavirus.

Equal prevalence of severe cervical dysplasia by HPV self-sampling and by midwife-collected samples for primary HPV screening: a randomised controlled trial

Objectives HPV self-sampling is an option for cervical screening. The aim of this randomised study was to investigate the compliance, prevalence of HPV, and prevalence of severe dysplasia in a vaginal self-sampling group in comparison to cervical samples collected by midwives (control arm). The hypothesis was that there would be no difference between vaginal self-sampling and cervical sampling to find high-grade cervical dysplasia or cancer. Methods Vaginal HPV self-sampling kits were sent by regular mail to 14 765 randomly selected women aged 30–64 years old in the screening programme. HPV-positive women were invited for a follow-up examination by their midwife in which they provided a cervical sample for cytological and HPV co-testing. The control arm consisted of 14 839 women who met the same inclusion criteria and were invited to have cervical sampling by midwives for primary HPV screening. All HPV samples were analysed by the Aptima HPV assay (Hologic Inc.). Main results The participation rate was 33.5% in the self-sampling arm and 47.5% in the cervical sampling arm, (P < 0.0001). HPV was detected in 17.1% (95% confidence interval (CI), 16.1–18.23%) in the self-sampling arm and 4.5% (95% CI, 4.0–5.0%) in the cervical sampling arm. Histological, severe dysplasia was observed among 0.48% (95% CI, 0.3–0.72%) and 0.47% (95% CI, 0.3–0.66%) of the self-sampling and the cervical sampling groups, respectively. Conclusion The self-sampling approach detects a similar proportion of severe dysplasia as regular screening. Thus, our study indicates that self-sampling could replace primary HPV screening of cervical samples.

HPV vaccine acceptance and hesitancy – lessons learned during 8 years of regional HPV prophylaxis program in Wroclaw, Poland

In 2019, the WHO has announced that it will intensify efforts to eliminate cervical cancer worldwide by increasing coverage of the HPV (Human Papillomavirus) vaccine. Finding reasons for low HPV vaccine coverage and looking for solutions to address the problem should be the priorities for public health. The municipality of Wroclaw (Poland) attempted to meet the challenge earlier by introducing a Prophylaxis Program against HPV in 2010. The core of the program are educational meetings at schools and free vaccinations offered at GP offices. After five successful years (vaccination coverage >80% fully vaccinated), vaccination uptake declined to 61.8%. A survey was carried out in 2015 to verify the experience concerning the Program among 1360 volunteers. Three groups were surveyed: parents (n = 509), teenage girls (n = 748) and nurses who performed the vaccinations (n = 103). What is noteworthy in the results there are factors that positively influenced vaccine acceptance: education offered within the program; the fact that the vaccinations are offered free of charge and the experience of earlier vaccination. It turned out that fear of side effects and the lack of trust in vaccination effectiveness were the most common reasons for vaccination refusal. Most nurses underestimated their role in building vaccination acceptance and 7.1% of them felt uncertain administrating the vaccination. Conslusions: the vaccination delivery strategy should be reconsidered; interventions to raise the nurses’ awareness of their role in building vaccine acceptance should be improved; the 13th year of life is the best moment to offer a vaccination.

Cesarean delivery may be protective against neoplasms of the uterine cervix in women of childbearing age

Parity has been reported as a risk factor for cervical cancer. However, no study has investigated the risk of neoplasms of the uterine cervix according to the delivery type. We carried out a retrospective cohort study using nationwide data from the Korean Health Insurance Review and Assessment Database to investigate whether cesarean delivery might be associated with less development of neoplasms of the uterine cervix than a vaginal delivery in women of childbearing age. Women aged 20–44 years, who had undergone vaginal or cesarean deliveries in 2009 were included as subjects. Two individual datasets for carcinoma in situ (CIS) and cancer of the cervix were followed for 8 years until either disease outcomes or 31 December 2016. In total, 260 438 and 132 232 women had undergone vaginal only and cesarean only deliveries, respectively. There were 1505 and 423 new cases of CIS and cervical cancer, respectively, with median follow-up durations of 89.9 and 90.0 months for vaginal delivery and cesarean delivery, respectively. The unadjusted CIS risk ratio for cesarean delivery compared with vaginal delivery was 0.90 [95% confidence interval, (CI), 0.80–1.00]. After adjusting for categorical age, residential area, facility types, and number of visits to obstetrics and gynecology clinics, it was 0.83 (95% CI, 0.75–0.93). The unadjusted and adjusted risk ratios for cervical cancer for cesarean delivery were 0.98 (95% CI, 0.80–1.20) and 0.87 (95% CI, 0.71–1.08), respectively. Cesarean delivery may be more protective against CIS than vaginal delivery in women of childbearing age.

Factors associated with cervical intraepithelial neoplasia (CIN2/CIN3), early stage and advanced stage of cervical cancer diagnosis in the Brazilian Amazonian region

To understand the impact of demographic, behavioral and contextual factors on cervical cancer, we examined the profile of women classified according to cervical cancer staging [precursor lesions cervical intraephitelial neoplasia (CIN2/CIN3), early- and advanced-stage cancer]. Patients were identified in the main oncological reference hospital in Pará State, Brazil, from 2013 through 2015. Adjusted prevalence ratios and their respective 95% confidence intervals were estimated using Poisson regression with robust variance. The study included 172 cases of CIN2/CIN3 lesions, 158 of early stage and 552 of advanced stage of cervical cancer. The proportion of gynecological complaints as a reason for clinic visit was 2.3 times higher among patients at an early stage compared with patients with CIN2/CIN3 lesions. Compared with early-stage cancer groups, the prevalence of advanced-stage cancer was higher among older patients, those without paid activity (adjusted prevalence ratio = 1.15; confidence interval 95%: 1.03–1.29), those who never had a Pap test (adjusted prevalence ratio = 1.23; confidence interval 95%: 1.08–1.40), those who were seen at the hospital clinic due to gynecological complaints (adjusted prevalence ratio = 1.48; confidence interval 95%: 1.19–1.85) and those who underwent biopsy in the private care system (adjusted prevalence ratio = 1.12; confidence interval 95%: 1.02–1.22). These differences seem to reflect problems in the health system, low socioeconomic level and poor awareness of the importance of Pap tests among those with a diagnosis of advanced-stage cervical cancer.

Cervical cancer screening and Pap test non-adherence risk factors in systemic sclerosis patients

Systemic sclerosis is a rare autoimmune disorder that potentially affects nearly every organ of the body. Malignancies are one of the most common non-systemic sclerosis related cause of mortality. There are controversial findings regarding the cervical cancer rate among these patients, but prolonged immunosuppressive medication makes them more susceptible to cervical cancer. In the present study, we have aimed to investigate the cervical cancer screening result and the Pap test non-adherence risk factors among systemic sclerosis patients. This cross-sectional study was conducted on 100 systemic sclerosis patients. The clinicodemographic variables in addition to cervical cancer risk factors were obtained from the patients. Pap test performed using the liquid-based method. The non-adherence risk factors were determined by univariate and multivariate logistic regression analysis. Benign inflammatory and atrophic changes were reported in 26 and 5%, respectively. None of the cases had abnormal cytological finding. Twenty-two percent of the participants were a routine Pap test performer. According to the multivariate model, higher age was associated with Pap test non-adherence [odds ratio (95% confidence interval): 1.058 (1.010–1.108) and P-value: 0.018]. In the present study, we have shown that compliance with Pap test performing is extremely low among Iranian systemic sclerosis patients. In addition, we have demonstrated that older age is a risk factor for non-adherence. These findings highlighted the crucial role of the physicians in motivating the patients toward cancer screening.

Human papillomavirus vaccination in immigrants and descendants of immigrants in Denmark

Objective In Denmark, human papillomavirus (HPV) vaccination has been offered at age of 12 to girls born in 1996 and later. In this cohort study, we examined routine HPV vaccination uptake in immigrants and descendants from different countries and regions compared with native Danes, including the influence of socioeconomic characteristics and potential changes in uptake by birth cohort. Methods In nationwide registers, we identified all girls born in 1996–2003 (n = 260 251) and obtained information on country of origin, HPV vaccinations and parents’ income and employment. Vaccination was defined as receiving ≥1 dose within 2 years after eligibility for routine vaccination. Odds ratios (ORs) were estimated by logistic regression separately for birth cohorts 1996–2000 and 2001–2003. Results Uptake in immigrants and descendants varied by country and region of origin. Overall, immigrants had lower uptake than native Danes, in birth cohorts 1996–2000 [79% vs. 93%, OR = 0.31; 95% confidence interval (CI), 0.29–0.34] and 2001–2003 (63% vs. 73%, OR = 0.60; 95% CI, 0.54–0.66). Descendants had lower uptake than native Danes in cohorts 1996–2000 (89% vs. 93%, OR = 0.65; 95% CI, 0.60–0.68), but higher uptake in cohorts 2001–2003 (76% vs. 73%, OR = 1.15; 95% CI, 1.08–1.21). Most associations were attenuated, but not entirely explained, when adjusting for socioeconomic characteristics. Conclusion HPV vaccination uptake varied by country and region. Most immigrants had lower uptake than native Danes, and in most groups, this was not fully explained by socioeconomic differences. Patterns in descendants were mixed. Interventions to increase uptake should be tailored to specific groups of immigrants/descendants.

Prevalence of positive screening test results and agreement between cytology and human papillomavirus testing in primary cervical cancer screening in North-Western Romania

Using data from a pilot study conducted in North-Western Romania, we aimed to estimate the prevalence of abnormal cytology and positive high-risk human papillomavirus (hr-HPV) test results in an ethnically diverse screening population and to assess the agreement between cytology and hr-HPV testing to evaluate the feasibility of integrating the latter as a primary test in the national cervical cancer screening program. The cross-sectional pilot study included Roma women, other ethnic minorities, and women in rural remote areas. Samples were taken for liquid-based cytology and hr-HPV testing (Hybrid Capture 2 DNA test) by a mobile health unit. The prevalence of positive screening results and the agreement between cytology and hr-HPV testing were estimated by κ coefficient. A total of 1019 women were included in the study. The population prevalence of positive screening results was similar for both tests (12%). The prevalence of abnormal cytology increased with increasing age, whereas the prevalence of positive hr-HPV test showed a bimodal age pattern. Substantial differences in the prevalence of abnormal cytology were found by ethnicity, with highest prevalence in Romanian women (14%), followed by Roma women (6%) and women of other ethnicities (5%) (P = 0.002). Similar ethnic differences in the prevalence of positive hr-HPV test were not observed. The overall agreement of positive screening results between the two methods was fair (κ = 0.25; 95% confidence interval = 0.18–0.30, P < 0.001) and ranged from poor to substantial depending on the age group. The prevalence of abnormal cytology result was high and similar to the prevalence of positive hr-HPV test result, which could allow for the implementation of hr-HPV testing as a primary test in the cervical cancer screening program in Romania.

Enhancing prognostic insights: myometrial invasion patterns in endometrial carcinoma, with emphasis on MELF pattern–a comprehensive review and meta-analysis

Purpose The microcystic, elongated, and fragmented (MELF) pattern, characterized by myxoid and inflamed stroma, is readily identifiable as a form of myometrial infiltration. This meta-analysis endeavors to assess the prognostic significance of MELF infiltration patterns in patients diagnosed with endometrial cancer. Methods A comprehensive literature search, spanning until 11 October 2023, across PubMed, Embase, Cochrane, and Web of Science databases, identified 23 relevant studies involving 5199 patients. Data analysis was performed using Stata 16.0. Results Analysis indicates that MELF infiltration predicts a higher risk of lymph node metastasis in endometrial cancer patients [hazard ratios (HR) = 5.05; 95% confidence interval (CI), 3.62–7.05; P < 0.05]. Notably, this association remains consistent across various patient demographics, analytical approaches, study designs, and treatment modalities. However, MELF infiltration does not significantly correlate with recurrence (HR = 1.05; 95% CI, 0.73–1.52; P > 0.05), overall survival (HR = 1.24; 95% CI, 0.91–1.68; P > 0.05), or disease-free survival (HR = 1.40; 95% CI, 0.85–2.28; P > 0.05). Conclusion While MELF infiltration heightens the risk of lymph node metastasis in endometrial cancer, its impact on recurrence, overall survival, and disease-free survival remains statistically insignificant.

Strategies for Lynch syndrome identification in selected and unselected gynecological cancers

Background Endometrial carcinoma represents a sentinel cancer for Lynch syndrome (LS) identification. It is crucial to highlight how other types of tumors can arise in the gynecological tract acting as sentinel tumors in LS patients. Up to now, no established LS patient management strategy has incorporated the presence of these additional candidate sentinel tumors to improve the prevention and management of LS tumors. Methods In order to investigate the involvement of the most frequent gynecological cancers in gynecological cancers, we studied different subsets of gynecological cancers using both somatic approaches, including mismatch repair (MMR) gene immunohistochemical expression, microsatellite instability, and germline analyses ofMSH2, MSH6, MLH1, PMS2 and EPCAM genes. A total of 261 patients referring to the Cancer Genetic Counselling Service of our institution were included in the study. In detail, our series was composed of 131 patients affected by uterus cancers including endometrial, isthmus and non-HPV endocervical carcinomas, 113 patients affected by ovarian cancers and 17 patients affected by synchronous endometrial/ovarian carcinomas (SEOC). In addition, we studied 115 cases of endometrial cancers identified by 2 years of universal testing (endometrial cancers/UTs) using IHC analysis of four MMR proteins. Results and conclusions The incidence of MMR defective gynecological cancers ranged from 7.1 to 47.1% depending on cancer site and selection. LS patients carriers of pathogenetic MMR variants were identified in 19.8% of uterus cancers, 35.3% of SEOC, 4.4% of ovarian cancers. In addition, pathogenetic MMR variants were identified in 4.3% of endometrial cancers/universal testing investigated with universal screening. In conclusion, gynecological cancers are heavily involved in LS and our study shows that MMR screening using immunohistochemical pattern and MSI analysis of endometrial and ovarian cancers as well as of rare entities such as non-HPV related endocervical cancers and synchronous endometrial and ovarian cancers are sentinels for LS. Tumor testing approach improves early identification of MMR defective gynecological cancers and this is an effective strategy to detect high-risk patients and to offer them and their relatives personalized cancer prevention.