European Journal of Public Health

Divergent effects of switching from cytology to HPV-based screening in the Nordic countries

Abstract Background Cervical cytology has been the primary method of cervical cancer screening for decades. Tests that detect viral HPV are shown in several randomized trials to provide better protection against cancer compared with cytology. HPV-based screening has been implemented alongside cytology in the Nordic countries for several years. The aim of this study was to compare cytology and HPV-based screening in the colposcopy referrals and detection rates of cervical lesions. Methods Individual-level screening data from Finland, Iceland, Norway and Sweden were harmonized and aggregated locally. We utilized data for tests taken during years 2015–17 and biopsies taken during years 2015–19 to allow 24 months of follow-up. Age-standardized estimates and age-adjusted risk ratios for six different outcomes of screening management were calculated. Results The age-standardized colposcopy rates were higher in HPV-based testing compared with cytology in Finland (3.5% vs. 0.9%) and Norway (6.0% vs. 4.1%) but lower in Sweden (3.7% vs. 4.9%). The relative detection rate of cervical intraepithelial neoplasia grade 2 and above in HPV-based testing compared with cytology was highest in Finland (RR 2.37, 95% CI 2.13–2.63) and Norway (RR 1.66, 95% CI 1.57–1.72) while in Sweden the difference was not statistically significant (RR 0.98, 95% CI 0.95–1.00). Conclusions The effects of implementing HPV screening varied by country as different screening algorithms were implemented. HPV-based screening increases colposcopy rates mainly through referrals from increased repeat testing and detection rate is therefore significantly higher compared with cytology. Monitoring of these indicators in subsequent rounds of HPV-based screening remains essential.

Targeting under-screened women in cervical cancer: combining self-sampling and human papillomavirus testing with a strategic reminder plan

Abstract Cervical cancer (CC) screening is essential for reducing its incidence, yet engaging under-screened women remains challenging. Self-sampling has emerged as a promising solution to enhance attendance; however, its integration into programmes has proven difficult. This study evaluated a multimodal approach combining self-sampling, human papillomavirus (HPV) testing, and personalized contact to reach women not attending conventional CC screening. To achieve this, 801 women aged 30–59 who had not participated in Portugal’s Central Region CC screening programme for more than 4 years were selected based on specific criteria. Of these, 114 women were excluded for not meeting eligibility criteria, resulting in 687 eligible participants. Using an ‘opt-in’ approach, women who consented to participate received cervicovaginal self-sampling kits at home. Multiple contact strategies, including phone calls and reminder letters, were employed to encourage participation. Women testing positive for high-risk HPV (hr-HPV) were referred for gynaecological follow-up. Of the eligible women, 307 (44.7%) consented to participate and 198 (28.8%) provided valid samples for hr-HPV testing. Approximately 60.0% of participants were enrolled after the first reminder phone call, while additional contact strategies accounted for one-third of submitted samples. Among 12 hr-HPV positive cases, 11 completed gynaecological follow-up, resulting in the identification of six cervical lesions. This study confirms the feasibility and effectiveness of combining self-sampling, HPV testing, and personalized contact strategies to improve CC screening uptake among under-screened women. The findings highlight the potential of such interventions to address participation gaps and enhance early detection of cervical lesions, ultimately reducing CC incidence.

Human papillomavirus vaccinations’ impact on preterm birth rates

Abstract Removal of human papillomavirus (HPV) infection associated precancerous cervical lesions by conization is one of the most important causes of preterm birth. Prophylactic HPV-vaccinations can prevent these lesions and reduce the need of their ablative treatment, thereby preventing preterm births. We evaluated whether preterm birth rates vary between HPV-vaccinated and unvaccinated women. Study subjects comprised 6200 cluster-randomized cohorts of HPV-vaccinated and 1667 hepatitis B-virus vaccinated women born in 1992–1993, and age- and community-aligned reference cohort of 19 473 unvaccinated women born in 1990–1991. Age-aligned registry linkage data from the nationwide Finnish Medical Birth Registry were retrieved up to 2018 (older age cohorts) and 2020 (younger age cohorts). Preterm births were categorized as early (gestational age of 22 + 0–33 + 6 weeks) and late preterm births (gestational age 34 + 0–36 + 6 weeks). Logistic regression was used to evaluate the association of HPV-vaccination and preterm births. By the age 28, 23.9% (n = 1484) of HPV-vaccinees and 28.4% (n = 6006) of the unvaccinated women had at least one childbirth recorded. Precisely, 4.1% (n = 61) of HPV-vaccinated and 5.2% (n = 310) of unvaccinated primiparas had a preterm birth. The association of preterm birth with HPV-vaccination was protective with a borderline significant odds ratio of 0.79 (95% CI 0.59–1.04). Most preterm births were at late preterm among both HPV-vaccinees (3.1%) and unvaccinated women (3.4%). Prophylactic HPV-vaccination is likely to reduce the incidence of preterm births. The decrease of preterm births is crucial to reduce the need for extensive and costly postnatal care and life-long morbidity.

Creating a data processing warehouse to support performance monitoring of cancer screening programmes in Europe using a common set of indicators

Abstract The CanScreen-ECIS project implemented by International Agency for Research on Cancer aimed to define indicators to monitor, breast, cervical, colorectal, and lung cancer screening and create a validated mechanism for the European screening programmes to be able to systematically collect and submit performance data for public dissemination through European Cancer Information System (ECIS). Indicators were developed through a stepwise process of literature review, Delphi survey followed by face-to-face interaction. A survey questionnaire to report policies, protocols, and organization of screening programmes and a data collection tool to estimate indicators across the screening continuum were designed. These were integrated into a data warehouse to permit programme managers to access the tools, undergo training, submit data, and estimate the indicators. The same warehouse would allow peer-reviewing of submitted information and data and will ultimately be connected to ECIS for data visualization. Functionalities of the tools and the warehouse were pilot tested through data collection from several European countries. Total 23 indicators were selected based on priority and feasibility. Programme managers from 23 European countries completed the surveys and submitted data from national/regional screening programmes. Data to estimate the indicators were obtained from 17, 13, and 15 breast, cervical, and colorectal cancer screening programmes, respectively. Major challenges identified by the participants included collecting data from opportunistic screening and data disaggregated by socio-economic status and other indicators of inequalities. The data warehouse will facilitate systematic data collection to report the status and performance of cancer screening programmes in the EU.

Which women go for screening?

Abstract Cancer accounts for approximately one-third of deaths in developed countries. Preventing cancer, notably by detecting new cases early, is thus crucial. In the European Union (EU), screening rates have been recommended for several types of cancer; however, most EU countries are still not meeting them. Determining how we can improve people’s adherence to screening is necessary. This study aimed to explore the characteristics of women associated with being up-to-date on mammograms or Pap smears; notably, we wanted to determine the extent to which women’s attitudes towards risk play a role in their adherence to screening. The sample comprised 1411 women who responded to a telephone survey. The survey data, including sociodemographic characteristics, health information, attitudes towards the future, and attitudes towards risk, collected via the Domain-Specific Risk-Taking (DOSPERT) scale, were supplemented by medico-administrative data. The factors associated with undergoing either a mammogram or a Pap smear in a timely manner were similar. Two favourable factors were found: the number of children and a high level of education. In contrast, being older or having a higher DOSPERT score for risk-taking appeared to be negatively associated with timely screening. The fact that women’s attitudes towards risk seem to have a strong impact on their adherence to medical recommendations is a finding that should be considered (e.g. by health professionals or in prevention campaigns) regarding increasing women’s awareness of the importance of regular cancer screening.

High-risk HPV prevalence in the Czech cervical cancer screening population: a comparison of clinician-collected and self-collected sampling

Abstract The prevalence of high-risk human papillomavirus (hrHPV) types varies across countries, making it essential to estimate prevalence using nationwide samples. Data on hrHPV prevalence in the Czech Republic are very limited. This study aimed to determine the prevalence of various hrHPV types in an unselected screening population of Czech women aged 30–65 years, using paired clinician-obtained cervical swab (CS) and self-collected cervicovaginal swabs (CVS). A total of 1026 eligible women were recruited into two study arms. In arm A, the digene® HC2 DNA Collection Device was used for both CS and CVS. In arm B, the Evalyn Brush was used for CVS, while the Cervex Brush was used for CS. All samples were tested for hrHPV using the digene® HC2 High-Risk HPV DNA Test and genotyped with the PapilloCheck® HPV-Screening assay. The overall hrHPV prevalence was 14.8%, based on positive results from either CVS or CS samples. hrHPV positivity was detected in 10.8% of clinician-obtained CSs and 11.8% of self-collected CVSs. A combined analysis of CS and CVS samples identified the five most prevalent hrHPV genotypes: HPV16, HPV31, HPV39, HPV56, and HPV68. The comparison of hrHPV detection in paired CS and CVS samples showed an overall concordance of 93%. These findings highlight the importance of detecting hrHPV genotypes alongside conventional Pap testing in national cervical screening programs. Furthermore, the results confirm that self-sampling kits represent a suitable alternative to clinician-collected samples. Clinical trials registration  ClinicalTrials.gov Identifier (NCT04133610)

What factors influence the uptake of bowel, breast and cervical cancer screening? An overview of international research

Abstract Background For cancer screening programmes to be effective in early detection it is important that those invited can access screening services and understand the benefits of participation. A better understanding of the factors that matter to potential participants of cancer screening programmes can assist in developing strategies to increase current uptake. Methods We conducted an overview of systematic reviews to answer the question: What factors influence the uptake of cancer screening services (breast, bowel and cervical) in high-income countries? A thematic approach supported by tabular summaries and qualitative heat maps was used to categorize factors, described as ‘barriers’ or ‘facilitators’. Results A total of 41 systematic reviews met the criteria for inclusion. The barrier with the greatest number of ‘hot spots’ across all three screening programmes was a fear of the unknown regarding a possible diagnosis of cancer or abnormal screening results, followed closely by a general lack of knowledge surrounding cancer screening programmes. The greatest collective facilitator to uptake was recommendation by a healthcare provider to attend screening. Conclusion Across all factors ‘trust’ and ‘building trusted relationships’ can be seen as integral to the success of cancer screening programmes and must be reflective of collaborative efforts to mitigate barriers and enhance facilitators to uptake. There is future scope to consider interventions that (i) increase demand for screening services, (ii) reduce barriers to uptake of services and/or (iii) are relevant to the healthcare system and those providing services.

Cervical cancer mortality trend in Montenegro—1990–2018

Abstract Cervical cancer is the fourth leading cause of cancer-related deaths in women, resulting in an estimated 350 000 deaths worldwide in 2022. Public health preventive strategies can modify the burden of cervical cancer. This study aimed to assess the mortality trends of cervical cancer in Montenegro from 1990 to 2018 and identify the impact of preventive measures on mortality rates associated with cervical cancer. The data concerning cervical cancer mortality from 1990 to 2018 were collected. The joinpoint, linear, and Poisson regressions were applied. The rate was adjusted to the world standard population. Overall and age-specific trends were assessed. Joinpoint regression revealed a statistically significant increase in cervical cancer mortality rates by an average of 2.6% per year [average annual percentage change (AAPC) (95%CI) = 2.6 (1.3–3.8); P < .001] and the number of death cases by 3.5% [AAPC (95%CI) = 3.5 (2.2–4.7); P < .001] for the overall level for the period 1990–2018. Among the women who died from cervical cancer, the majority were aged 55–64 (28.3%), then aged 45–54 (27.6%) and aged 65–74 (17.4%). This analysis highlights a growing trend of mortality from cervical cancer in Montenegro, underscoring the need for additional research into the causes of this serious public health concern.

Cervical cancer (over)screening in Belgium and Switzerland: trends and social inequalities

Abstract Background Cervical cancer screening (CCS) by means of Pap smears has led to a decrease in cervical cancer incidence and mortality. In the absence of organized programmes, CCS is opportunistic in Belgium and Switzerland. This might result in a high level of CCS overuse, as screening practices do not conform to the recommended 3-yearly screening interval and the target age-ranges (Belgium: 25–64, Switzerland: 20–70). This study aimed to assess trends in CCS uptake and overuse in Belgium and Switzerland and their social determinants, in the light of reimbursement initiatives, which were implemented in both countries. Methods Data from five waves of the Belgian Health Interview Survey (1997–2013) (N=11 141) and Swiss Health Interview Survey (1992–2012) (N=32 696) were used. We performed Poisson regressions to estimate adjusted prevalence ratios (APR), controlled for socio-economic and socio-demographic characteristics and health status. CCS overuse was operationalized as screening more than once every 3 years and screening above recommended age-range. Results CCS uptake remained relatively stable over time, with a mean coverage of 70.9% in Belgium and 73.1% in Switzerland. Educational and income gradients were found in both countries. Concerning CCS overuse, women above screening-eligible age showed consistently high screening rates, but screening within the past year declined significantly in both countries, matching the temporal implementation of the reimbursement initiatives. Conclusions Although no increase in CCS coverage could be established, CCS has become more efficient in both countries as Pap smear overuse at the population level has declined after the implementation of reimbursement measures tackling CCS overuse.

Cost-effectiveness of a stepwise intervention to promote adherence to cervical cancer screening

Abstract Background Cervical cancer screening is effective in reducing mortality, but adherence is generally low. We aimed to investigate the cost-effectiveness of a stepwise intervention to promote adherence to cervical cancer screening in Portugal. Methods We developed a decision tree model to compare the cost-effectiveness of four competing interventions to increase adherence to cervical cancer screening: (i) a written letter (standard-of-care); (ii) automated short message service text messages (SMS)/phone calls/reminders; (iii) automated SMS/phone calls/reminders + manual phone calls; (iv) automated SMS/phone calls/reminders + manual phone calls + face-to-face interviews. The main outcome measure was cost per quality-adjusted life year (QALY) measured over a 5-year time horizon. Costs were calculated from the societal and provider perspectives. Results From the societal perspective, the optimal strategy was automated SMS/phone calls/reminders, below a threshold of €8171 per QALY; above this and below €180 878 per QALY, the most cost-effective strategy was automated SMS/phone calls/reminders + manual phone calls and above this value automated SMS/phone calls/reminders + manual phone calls + face-to-face interviews. From the provider perspective, the ranking of the three strategies in terms of cost-effectiveness was the same, for thresholds of €2756 and €175 463 per QALY, respectively. Conclusions Assuming a willingness-to-pay threshold of one time the national gross domestic product (€22 398/QALY), automated SMS/phone calls/reminders + manual phone calls is a cost-effective strategy to promote adherence to cervical cancer screening, both from the societal and provider perspectives.

A survey of knowledge, attitudes and awareness of the human papillomavirus among healthcare professionals across the UK

Human papillomavirus (HPV) is a common sexually transmitted infection implicated in 5% of cancers worldwide including most cervical cancer cases. In the UK, the HPV vaccine has been offered routinely to girls aged 11-13 since 2008 while cervical screening is offered to women aged 25-64. HPV testing will soon replace cytology as the primary screening method. This research evaluates what healthcare professionals (HCPs) across the UK know about HPV. A total of 643 UK-based HCPs from primary and secondary care took part in an anonymous cross-sectional survey between March and April 2018. The survey measured general HPV knowledge; HPV triage and test of cure knowledge; HPV vaccine knowledge; attitudes to the HPV vaccine and self-perceived adequacy of knowledge. Participants had a generally good understanding of HPV and the vaccination but there were gaps in detailed knowledge of the National Health Service HPV testing processes. There were some gaps in knowledge about the health sequelae of HPV for males. Years since HPV training was associated with triage and test of cure and vaccine knowledge scores. Furthermore, nurses and doctors in colposcopy clinics had much greater odds of having higher knowledge across all domains than other roles. In total, 76.2% of participants felt adequately informed about HPV and 35.6% made suggestions for improvements in training, many of which requested additional frequency and topics. Our results suggest that additional training is needed to ensure HCPs are equipped to deal with the changing landscape of HPV screening and vaccination in the UK.

Joint effects of HPV-related knowledge and socio-demographic factors on HPV testing behaviour among females in Shenzhen

Abstract Background Limited population-based studies explore the utilization and associated barriers or facilitators to cervical cancer screening in China. We attempted to investigate the associations of socio-demographic factors, HPV specific knowledge with HPV testing behaviour in Shenzhen, China. Methods A citywide cross-sectional survey was conducted from January to June 2015 in Shenzhen city by using a multistage stratified cluster sampling method. Socio-demographic information, awareness and specific knowledge of HPV, practice of HPV testing, and HPV vaccination-related attitude were collected. Multivariate logistic regression model was used to analyse possible associations. Results Approximately one third of total 8639 women aged from 30 to 60 years old had ever received HPV testing. Overall, 67.6% of all participants demonstrated low knowledge level of HPV. High HPV knowledge level was significantly associated with HPV testing behaviour (odds ratio: 3.792, 95% confidence interval: 3.400–4.230). The impact of residence and education on testing behaviour only turned to be significant if women had low level of HPV knowledge (P for multiplicative interactions: 0.001 and <0.001, respectively), whereas monthly income exerted promotion effects apparently among those with high knowledge level (P for multiplicative interaction: 0.037). Conclusions Our study revealed gaps in HPV knowledge and screening participation among Chinese women, and provided novel clues that women with high HPV knowledge level would be more appeal to involve in HPV testing behaviour. The influence of HPV-related knowledge on HPV testing also lies in the joint effects with socio-demographic factors, including residence, education and monthly income.

Social inequalities in participation in cancer screening: does the mode of data collection matter? The CONSTANCES cohort

Abstract Background Self-reported data are prone to item non-response and misreporting. We investigated to what extent the use of self-reported data for participation in breast (BCS) and cervical cancer screening (CCS) impacted socioeconomic inequalities in cancer screening participation. Methods We used data from a large population-based survey including information on cancer screening from self-reported questionnaire and administrative records (n = 14 122 for BCS, n = 27 120 CCS). For educational level, occupation class and household income per capita, we assessed the accuracy of self-reporting using sensitivity, specificity and both positive and negative predictive value. In addition, we estimated to what extent the use of self-reported data modified the magnitude of socioeconomic differences in BCS and CCS participation with age-adjusted non-screening rate difference, odds ratios and relative indices of inequality. Results Although women with a high socioeconomic position were more prone to report a date for BCS and CCS in questionnaires, they were also more prone to over-declare their participation in CCS if they had not undergone a screening test within the recommended time frame. The use of self-reported cancer screening data, when compared with administrative records, did not impact the magnitude of social differences in BCS participation but led to an overestimation of the social differences in CCS participation. This was due to misreporting rather than to item non-response. Conclusions Women’s socioeconomic position is associated with missingness and the accuracy of self-reported BCS and CCS participation. Social inequalities in cancer screening participation based on self-reports are likely to be overestimated for CCS.

A method of estimating cervical cancers prevented by the introduction of national screening in Ireland

Abstract Cervical cancer screening is a life-saving endeavour. The introduction of an organized population-based national screening programmes has potential to both reduce incidence of cervical cancer in an asymptomatic population and detect early-stage cancers for accelerated treatment. A methodology for estimating cancers prevented by such programmes has immediate utility. This work derives a model for estimating cancer prevented by screening, applied to data from Ireland’s organized national cervical screening programme since its introduction in August 2008 to August 2022. A novel Markov-chain model for human papilloma virus (HPV) induced cervical cancer was derived with realistic transition probabilities validated against literature estimates. Data from the Irish National Screening Programme (CervicalCheck) and from the National Cancer Registry of Ireland (NCRI) was applied to estimate the number of cancers prevented by screening, changes in Irish cancer detection since the implementation of screening, and treatment costs saved by screening. Since its inception in 2008, the modelling in this work suggests that CervicalCheck has prevented an estimated 5557 cancers (95% confidence interval: 5114–6000 cancers) and saved €102 million in future treatment costs (95% confidence interval: €94–110 million) not including inflation costs. Additionally, 48.8% (95% confidence interval: 41.4%–56.2%) of all cervical cancers in Ireland have been detected through screening between 2008 and 2022. National screening in Ireland has been highly effective at reducing future cervical cancers, and detecting asymptomatic cancers. The model outlined here has direct future applicability for the assessment of national and regional cervical cancer screening programmes.

Direct mailing of HPV self-sampling kits to women aged 50–65 non-participating in cervical screening in the Czech Republic

Abstract Background A population-based cervical cancer screening programme is implemented in the Czech Republic. However, participation is insufficient among women over 50 years. This study aimed to estimate the potential improvement in participation through directly mailed HPV self-sampling kits (HPVssk) compared with standard invitation letters in women aged 50–65 non-participating in screening. Methods The study recruited 1564 eligible women (no cervical cancer screening in the last 3 years or more, no previous treatment associated with cervical lesions or cervical cancer). Eight hundred women were mailed with an HPVssk (HPVssk group), and 764 women were sent a standard invitation letter (control group) inviting them to a routine screening (Pap test). The primary outcome was a comparison of the overall participation rate between study groups using a binominal regression model. Results The participation rate in the HPVssk group was 13.4% [95% confidence interval (CI) 11.2–15.9%; 7.4% of women returned the HPVssk and 6.0% attended gynaecological examination] and 5.0% (95% CI 3.6–6.8%) in the control group. Using the binominal regression model, the difference between the groups was estimated as 7.6% (95% CI 5.0–10.2%; P < 0.001). In the HPVssk group, 22% of women who returned HPVssk had a positive result and 70% of them underwent a follow-up examination. Conclusions Compared with traditional invitation letters, the direct mailing of the HPVssk achieved a significantly higher participation rate, along with a notable HPV positivity rate among HPVssk responders. This approach offers a potentially viable method for engaging women who have not yet attended a cervical screening programme.

Socioeconomic, lifestyle and biological determinants of cervical screening coverage: Lolland–Falster Health Study, Denmark

Abstract Background Cervical cancer is preventable. Screening is important for early detection. However, even in high-income countries, coverage is sub-optimal. We identified socioeconomic, lifestyle and biological determinants of cervical screening coverage. Methods In Denmark, women aged 23–64 are free of charge personally invited to screening. All cervical cell samples are registered centrally in the Patobank. We linked data from the Lolland–Falster Health Study (LOFUS) with Patobank data. LOFUS was a population-based health survey undertaken in 2016–2020. With logistic regression, coverage defined as ≥1 cervical sample registered within a 6-year period from 2015 to 2020 was compared across levels of risk factors expressed as adjusted odds ratios (aOR) with 95% confidence intervals (CI). Results Among 13 406 women of screening aged 23–64 and invited to LOFUS, 72% had ≥1 cervical sample registered. Non-participation in LOFUS was a strong predictor of low coverage; aOR 0.32; 95% CI 0.31–0.36. Among LOFUS participants, education was a strong predictor of coverage in univariate analysis, OR 0.58; 95% CI 0.48–0.71, but this association disappeared in multi-variate analysis, aOR 0.86; 95% CI 0.66–1.10. In multi-variate analysis, predictors of low coverage were high age, living without a partner, retired, current smoker, poor self-rated health, elevated blood pressure and elevated glycated haemoglobin. Conclusions Women with low cervical screening coverage had limited contact to healthcare, exemplified by non-participation in LOFUS, and pertinent health and social problems, exemplified by elevated blood pressure and glycated haemoglobin, poor self-rated health, and retirement already in screening age. Structural changes in screening are needed to reach non-screened women.

Perspective of pregnant women on feasibility of integrating cervical cancer screening into antenatal care in the Netherlands: a questionnaire study

Abstract Background Dutch programmed cervical cancer screening starts at the age of 30, but efficacy is hampered due to low uptake, especially among youngest invitees aged 30-40 (< 50%). Currently, pregnant women are excluded from screening, but we hypothesize that participation could be increased if screening would be discussed routinely during obstetric care, motivating unscreened women to attend. Via this questionnaire study, we aimed to assess whether pregnant women in the Netherlands considered such “antenatal screening” acceptable. Methods In 2021 and 2022, a single written questionnaire was provided to pregnant women aged 30 years or older, undergoing obstetric care in the Rotterdam region, the Netherlands. Women were asked about previous screening attendance and perceived feasibility of antenatal screening, including benefits and harms. Primary outcome was the percentage of women considering antenatal screening feasible. Secondary outcomes included considered benefits and harms of antenatal screening and differences between adequately screened and un-/under screened women. Results In total, 372 out of 1511 (24.6%) returned the questionnaire. Among respondents 106 of 372 (28.5%) were un-/under screened. Of all responders, 78% considered introduction of antenatal screening a good idea, without difference among adequately screened (78.9%) vs un-/under screened women (75%; P = .25). Benefits of antenatal screening considered most by respondents were a feeling of reassurance (58.5%) and easier scheduling (37.0%). Conclusions Introduction of cervical cancer screening via obstetric care is considered acceptable by a majority of pregnant women in the Netherlands. Benefits considered most were a feeling of reassurance and easier scheduling of attendance.

Analysis of the global burden of cervical cancer in young women aged 15–44 years old

Abstract Background Understanding the burden of cervical cancer (CC) in young women aged 15–44 years old are essential for formulating effective preventive strategies. Methods Utilizing the Global Burden of Disease 2019 Study, we estimated incidence, disability-adjusted life-years (DALYs), years of life lost (YLLs) and years lived with disability (YLDs) due to CC among young women from 1990 to 2019. Additionally, we evaluated the temporal trends using estimated annual percentage changes (EAPCs) during this period. We conducted a decomposition analysis to assess the absolute contributions of three components: population growth, population age structure and epidemiologic changes. Results Globally, there were 187 609.22 incident cases of CC worldwide, resulting in 2621 917.39 DALYs in 2019. From1990 to 2019, the age-standardized rates were decline, only the age-standardized YLDs rate (EAPC = 0.02; 95% CI: −0.02 to 0.05) showed a stable trend. The largest increase in age-standardized incidence rate (ASIR) and age-standardized YLDs rate observed in the high-middle social demographic index (SDI) quintiles. Population growth and age structure changes were associated with substantial changes in cases of CC, especially in South Asia and East Asia. Conclusions Globally, the burden of CC in young women continues to increase, as measured by the absolute number. As populations are growing and age structure changes were associated with substantial changes in cases of CC, governments will face increasing demand for treatment, and support services for CC, especially in South Asia and East Asia.

Understanding the high-risk human papillomavirus prevalence and associated factors in the European country with a high incidence of cervical cancer

Abstract Background High-risk human papillomavirus (HR-HPV) is a known cause of cervical cancer (CC). Latvia has a high incidence of CC compared with the average incidence in the European Union. This study aims to fill the data gap on the HR-HPV burden in Latvia, providing information on its prevalence and associated factors. Methods The cross-sectional study was conducted from February 2021 to April 2022. Participants 25–70 years old visiting a general practitioner (general population) or those referred to a colposcopy clinic with changes in their cervical cytology (colposcopy population) collected vaginal self-sample and completed a paper-based questionnaire. Samples were analyzed with Cobas 6800 System (Roche) for HPV16, HPV18 and other HR-HPV (HPV31/33/35/39/45/51/52/56/58/59/66/68). Descriptive statistics for categorical variables were performed. The Chi-square test was used to determine for the statistical significance of differences in the proportions of the dependent variable between subgroups of the independent variable. Univariate and multivariate binary logistic regression were used to identify factors associated with positive HR-HPV status. Results were considered statistically significant at P < 0.05. Results A total of 1274 participants provided a valid sample. The prevalence of any HR-HPV infection was 66.8% in the colposcopy group and 11.0% in the general population. Factors associated with positive HR-HPV status were marital status single/divorced/widowed (vs. married/cohabiting) [adjusted OR (aOR) 2.6; P = 0.003], higher number of lifetime sex partners [aOR 5.1 (P < 0.001) and 4.0 (P = 0.001)] for six or more and three to five partners in the general population; in the colposcopy group, the statistical significance remained only for Latvian ethnicity (vs. other) (aOR 1.8; P = 0.008) and current smoking (vs. never) (aOR 1.9; P = 0.01). Conclusion We documented a comparison to European Union HR-HPV infection burden in Latvia. Any HR-HPV positivity was significantly associated with sexual and other health behavior.