Women's Health

Factors associated with mammogram and Papanicolaou testing among Mexican American older women

Background: Mammogram and Papanicolaou (Pap) smear tests are essential screening to detect breast and cancer cervical, respectively. Objective: Identify predisposing, enabling, and need factors associated with mammography and Paptest screenings among older Mexican American women over time. Design: Longitudinal study of 912 Mexican American women aged ⩾ 67 years. Methods: Participants were assessed five times (1995/1996–2007/2008). Independent variables were based on the Andersen’s Behavioral Model of Health Services, including predisposing factors (e.g., age of menopause), enabling factors (e.g., financial strain), and need factors (e.g., medical conditions). Outcomes included having a mammogram in the past 2 years and a Pap test in the past three. Generalized Estimation Equation models estimated the odds ratio (OR) and 95% confidence interval (CI) for receiving a mammogram, Pap test, or both based on these factors. Results: Higher education (OR = 1.04, 95% CI = 1.01–1.07), physician visits (OR = 1.85, 95% CI = 1.33–2.56), hypertension (OR = 1.26, 95% CI = 1.04–1.51), arthritis (OR = 1.31, 95% CI = 1.07–1.60), and greater handgrip strength (OR = 1.02, 95% CI = 1.01–1.04) were associated with greater odds of receiving both a mammogram and Pap. Older age and early menopause (OR = 0.96, 95% CI = 0.94–0.98 and OR = 0.71, 95% CI = 0.58–0.89, respectively) were associated with lower odds of receiving both tests. Spanish interview (OR = 0.71, 95% CI = 0.56–0.91) and financial strain (OR = 0.83, 95% CI = 0.70–0.99) were associated with lower odds of receiving a Pap test and mammogram test, respectively over time. Conclusion: Language barriers and financial constraints reduce cancer screening rates among Mexican American women. Cultural tailored care and improved access, such as bilingual clinics and mobile screening are needed to address these gaps.

On-demand robotic surgery for hysterectomies: A combination of the best of robotic and laparoscopic approach

Background: The advantage of robot-assisted hysterectomy over standard laparoscopy remains controversial. Conventional robots offer limited flexibility to the surgeon. The novel, Dexter robotic system™, allows integration and easy switch between the laparoscopic and robotic interface. Objectives: This study’s objective is to evaluate the feasibility of using Dexter for robot-assisted laparoscopic hysterectomies by analyzing surgical data and intra- and postoperative complication rates. Design: Retrospective study. Methods: Women who underwent surgery using the Dexter robotic system at a University Hospital in Switzerland from March to December 2022 were included in this study. A comprehensive database containing coded demographic and clinical outcome data for these patients was analyzed for surgical data and intra- and postoperative complications. Results: We collected and evaluated data from 24 patients who underwent Dexter robot-assisted hysterectomies for indications like endometrial cancer, endometriosis, and uterine fibroids. For all patients, a hysterectomy was accompanied by other procedures such as radical lymphadenectomy or deep infiltrating endometriosis surgery that was mostly performed by conventional laparoscopy. The mean operating time was 171.9 min, with an average estimated blood loss of 130.8 ml. The patients stayed at the hospital for an average of 4 days. Clavien–Dindo grade III postoperative complications were reported in four patients with three vaginal dome infections and one umbilical (camera arm) trocar hernia. Importantly, there were no intraoperative complications or conversion to laparotomy among the operated patients. Conclusion: We present the first retrospective study reporting the feasibility of Dexter in robot-assisted laparoscopic hysterectomies. All surgeries were performed successfully without technical failure or device-related adverse events. In contrast to the other robotic systems, Dexter offers an on-demand platform, allowing the surgeon to switch between laparoscopic and robotic interfaces as required. Further research is needed to validate its potential advantages and broader applicability.

A rare case of Swyer syndrome from Pakistan in a young girl with primary amenorrhea and 46XY genotype

Swyer syndrome is a condition where individuals with a 46XY karyotype, typically associated with males, display complete gonadal dysgenesis and lack testicular differentiation. This results from a mutation in the SRY gene, which is essential for testis development. As a consequence, affected individuals who appear phenotypically female have male chromosomes but do not develop functional testes. As a result, there is an absence of testosterone that leads to lack of masculinization and the presence of female genitalia. This article describes a 20-year-old female from Pakistan who exhibited primary amenorrhea. On examination, she possessed a typical female physique but lacked breast growth and axillary hair. She had scant pubic hair with female-type external genitalia. The pelvic imaging showed a underdeveloped uterus, along with small ovaries and fallopian tubes. Her karyotype came out to be 46XY. The examination and radiological results indicated Swyer syndrome. During laparoscopy, the patient’s uterus was found to be infantile, while the fallopian tubes were healthy. Streak gonads were also present, and due to the risk of gonadoblastoma, they were surgically removed. Hormone replacement therapy was started to induce pubertal development and optimize bone mineral accumulation.

Predictive models for lymph node metastasis in endometrial cancer: A systematic review and bibliometric analysis

Background: Lymph node metastasis is associated with a poorer prognosis in endometrial cancer. Objective: The objective was to synthesize and critically appraise existing predictive models for lymph node metastasis risk stratification in endometrial cancer. Design: This study is a systematic review. Data Sources and Methods: We searched the Web of Science for articles reporting models predicting lymph node metastasis in endometrial cancer, with a systematic review and bibliometric analysis conducted based upon which. Risk of bias was assessed by the Prediction model Risk Of BiAS assessment Tool (PROBAST). Results: A total of 64 articles were included in the systematic review, published between 2010 and 2023. The most common articles were “development only.” Traditional clinicopathological parameters remained the mainstream in models, for example, serum tumor marker, myometrial invasion and tumor grade. Also, models based upon gene-signatures, radiomics and digital histopathological images exhibited an acceptable self-reported performance. The most frequently validated models were the Mayo criteria, which reached a negative predictive value of 97.1%–98.2%. Substantial variability and inconsistency were observed through PROBAST, indicating significant between-study heterogeneity. A further bibliometric analysis revealed a relatively weak link between authors and organizations on models predicting lymph node metastasis in endometrial cancer. Conclusion: A number of predictive models for lymph node metastasis in endometrial cancer have been developed. Although some exhibited promising performance as they demonstrated adequate to good discrimination, few models can currently be recommended for clinical practice due to lack of independent validation, high risk of bias and low consistency in measured predictors. Collaborations between authors, organizations and countries were weak. Model updating, external validation and collaborative research are urgently needed. Registration: None.

Day case total laparoscopic hysterectomy in a low resource setting: A descriptive analysis

Background: A laparoscopic approach to hysterectomy can significantly reduce patient morbidity and improve the quality of recovery. Subsequent perioperative advances have led to an increasingly shorter hospitalization period following laparoscopic surgery, with the same-day discharge being common. However, due to infrastructural challenges, these shorter times to discharge have mostly been limited to developed countries. Objectives: To provide a descriptive analysis and evaluate the safety and feasibility of day-case laparoscopic hysterectomy in Trinidad and Tobago. Design: A retrospective analysis of all total laparoscopic hysterectomies over a 3-year period at a secondary medical center in Trinidad and Tobago. Methods: The medical records of 154 women who underwent total laparoscopic hysterectomy (TLH) from January 2020 to January 2023 were reviewed. Patient demographics, indications for surgery, perioperative variables, requirements for any additional operative procedures, and perioperative complications were recorded and analyzed. The perioperative management protocol was also outlined. Results: The most common indication for TLH was uterine leiomyoma (45%), followed by endometrial cancer (17.5%). In this study, 96% of patients were discharged satisfactorily within 24 h of surgery, and the mean ± standard deviation (SD) duration of hospitalization was 21 ± 2 h. The mean ± SD surgical time was 91 ± 36 min, and the average estimated blood loss was 93 ± 31 ml. No patients required postoperative blood transfusion. No postoperative opioids were required in 41% of patients, and no perioperative mortality was recorded in this study, with no patients requiring re-operation. Four postoperative complications were noted (2.6%), and this included two patients who developed deep vein thrombosis (DVT) (1.3%), one port-site infection (0.6%), and one case of pulmonary embolism (0.6%). The 30-day readmission rate was 1.9%, and this comprised the patients with DVT and pulmonary embolism. On subgroup analysis, there was no difference in surgical time between patients with body mass index >30 kg/m 2 , uterine size >12 weeks, and previous abdominal surgery ( p  > 0.05). Conclusion: Day-case laparoscopic hysterectomy is feasible in a low-resource setting like Trinidad and Tobago. The procedure is safe and associated with a low postoperative complication rate.

Structure, utilization, and screening adherence of a student-run women’s health clinic for uninsured Spanish-speaking women: A descriptive analysis

Background: Uninsured, low-income Spanish-speaking women face systemic barriers to accessing gynecologic care, especially within Fort Worth, Texas. Because of this health disparity, we elected to evaluate screening outcomes of patients receiving care at La Clínica de las Mujeres (LCDM), a student-run clinic (SRC) providing free, culturally competent care to this population in Fort Worth, Texas. Objectives: To assess the structure and utilization of an SRC on cancer screening adherence among uninsured, Spanish-speaking women in Fort Worth, Texas. Design: Retrospective descriptive pre-post study. Methods: Chart review of patients seen at LCDM from August 2022 to September 2024 was conducted. Data included 147 clinical encounters with 114 individual patients, assessing demographics, screening history, services, and referrals. McNemar’s test assessed changes in screening adherence. Results: Patients (mean age: 47.5 years; 95.6% Hispanic) primarily resided in underserved zip codes (77.2% in 76110). Pre-intervention, 46% adhered to Pap smear guidelines and 64% to mammography guidelines. Post-intervention adherence approaches complete compliance among those with available post-intervention data (Pap χ²[1] = 66.0, p  < 0.0001; Mammogram χ²[1] = 27.0, p  < 0.0001). Services included pelvic ultrasounds ( n  = 20), specialist referrals ( n  = 11), and contraceptive access ( n  = 12). Conclusions: LCDM was associated with significant improvements in gynecologic preventive care adherence for uninsured Spanish-speaking populations in Fort Worth, Texas. Student-run models may help address critical gaps in accessibility to women’s health services and mitigate systemic barriers to care for underserved populations.

Pretreatment computed tomography L1 attenuation values: Easy reaching predicting factor for radiation-related bone insufficiency fractures in females treated for advanced cervical cancer (prospective study)

Background: Radiotherapy (RT) brings a broad spectrum of side effects that could affect patient well-being. Pelvic insufficiency fractures (PIF) are one of them. Objectives: The aim of our study was to identify easily detectable risk factors for radiation-related PIF. Design: Prospective, single-center study. Methods: We included 104 patients aged 52.9 ± 13.8 years following radical RT for advanced cervical cancer. Patients underwent a pretreatment computed tomography (CT) imaging and a minimally 1-year follow-up by CT or magnetic resonance imaging. We evaluated the association between pretreatment CT attenuation values of L1, their deviation from normative values, age, body mass index, total received radiation dose, smoking habits, and radiation-related bone side effects. Results: In 28 (26.9%) patients PIF were found and first detected at a mean of 16 ± 7 months after RT. Patients with PIF were significantly older; 62.5 ± 10.2 versus 49.4 ± 12.6 years, p  > 0.001; their pretreatment CT L1 attenuation values were significantly lower; 117.5 ± 46.9 HU versus 165.9 ± 44.8 HU, p  < 0.001, as well as more negative deviation from normative values. Age and L1 attenuation values were strongly correlated, p  < 0.001, precluding separation of their independent effects on PIF occurrence. According to logistic regression modeling, a 50-year-old woman had an estimated 16.3% probability of PIF (95% CI [8.6%; 25.9%]); the associated odds ratio increased by approximately 182% [72%; 357%] per 10-year increase in age. Thus, the estimated probability of PIF increased to 34.1% for a 60-year-old and 58.0% for a 70-year-old woman. The pretreatment CT attenuation values of 100 Hounsfield units (HU) were associated with a 51.1% probability of PIF (95% CI [36.2%; 66.5%]), and the probability decreased at higher attenuation values (odds ratio 0.766 [0.663; 0.865] per 10-HU increment). No other variables showed significant associations. Conclusion: Increasing age and lower pretreatment CT L1 attenuation values are strong predictors for radiation-related PIF, reflecting osteoporosis status.

Evaluating the impact of a patient-representative model of support for women affected by cervical cancer

Background: In the aftermath of high-profile healthcare system failures, patient representative groups can emerge as key contributors to support, reform, and accountability. Following the identification of failures in Ireland’s CervicalCheck screening programme in 2018, the 221+ Patient Representative Group (commonly known as 221+) was established to support affected women and families. Objectives: The present research aimed to assess the impact of the 221+ group and associated patient representatives in supporting women and influencing the delivery of healthcare. Design: An independent research team conducted a two-phase qualitative study, gathering perspectives from a range of stakeholders involved in statutory, non-statutory, and voluntary healthcare sectors in Ireland. Method: Interview data collected from key stakeholders (phase 1, N  = 15) and qualitative survey responses from medical and healthcare professionals (phase 2, N  = 86) were analysed separately using reflexive thematic analysis. Results: Findings support the value of a patient-representative model in providing support and advocacy for women affected by cervical cancer and their families, while also highlighting important considerations such as sustainability, integration with healthcare systems, and the need for inclusive representation. Conclusion: This study provides a case example of patient advocacy in action, offering transferable insights and strategies to inform patient-centred care and healthcare reform in other settings.

Analysis of follow-up outcomes in patients with cervical histologic low-grade squamous intraepithelial lesion preceded by serious cytology and repeated diagnosis for at least 2 years

Background: Treatment protocol for patients with cervical histologic low-grade squamous intraepithelial lesion (LSIL) such as that preceded by serious cytology and repeated diagnosis for at least 2 years is unclear. Objective: This study investigates the follow-up results of patients with cervical histologic LSIL and aims to provide evidence support for treatment and follow-up strategy. Design: A retrospective observational study design was used. Methods: The retrospective study included 4263 patients with cervical histologic LSIL diagnosed between August 2014 and February 2021. The follow-up period ended in August 2023. Results: During the followed-up of 6–101 months, 3246 (76.1%), 628 (14.7%), and 389 (9.1%) of the 4263 patients had lesion regression, persistence, and progression. Multiple gravidities, high-risk human papillomavirus (HPV) positive, HPV 16 positive, and cytologic examination (⩾atypical squamous cells cannot exclude high grade squamous intraepithelial lesion (ASC-H)) were independent risk factors for histologic LSIL progression. The annual cumulative cervical intraepithelial neoplasia (CIN)3+ rate of patients with histologic LSIL preceded by cytologic ASC-H and gravidity >2 was 6.3% (1-year), 22.4% (2-year), 28.2% (3-year), 28.2% (4-year), and 28.2% (5-year). The cumulative CIN2+ and CIN3+ rates in patients with histologic LSIL under risk factors and repeated diagnosis for at least 2 years were significantly higher than patients preceded by cytologic negative for intraepithelial lesion or malignancy, atypical squamous cells of undetermined significance, and LSIL. Conclusion: Cervical histologic LSIL had a high natural regression rate and a low progression rate. Multiple gravidities, high-risk HPV positivity, HPV 16 positivity, and cytological examination ⩾ASC-H were risk factors for histologic LSIL progression. For patients with histologic LSIL preceded by cytologic ASC-H, stratified management based on the number of gravidities might be an option.

Risk factors for late presentation of symptomatic uterine fibroid in urban Nigeria: A mixed method study

Background: Uterine fibroids (UFs) are the most common benign tumours of the uterus and are often asymptomatic. However, there is a high incidence of symptomatic fibroids among Black women, with many presenting late for treatment. Objective: We examined the patterns and risk factors associated with the late presentation of UF in Black women. Designs: Mixed methods study design: A quantitative and qualitative approach. Methods: An interviewer-administered questionnaire was used to obtain information about the late presentation of UF from 138 women at the Gynaecology clinic of the University College Hospital, Ibadan, Nigeria. For the qualitative component, in-depth interviews were conducted with eight women experiencing symptomatic fibroids. The odds of late presentation were analysed across socio-demographic, obstetrics and clinical characteristics, along with the type of diagnosis, using logistic regression with a statistical significance level set at p  < 0.05. Qualitative data were examined through an inductive thematic analysis, focusing on emerging themes. Results: The mean age of participants was 36.80± 7.24 years, with a significant proportion (62.3%) presenting late, more than 6 months after the onset of symptoms and 65.1% having multiple UFs. Factors associated with late presentation included age (AOR = 4.000; 95% CI 0.086–0.0730), parity (AOR = 3.299; 95% CI 1.150–9.464) and presenting with subfertility or infertility (AOR = 0.070; 95% CI 0.020–0.249). The qualitative findings highlighted how situational factors such as inadequate knowledge of the condition, aversion to surgery, negligence, cultural misconception and financial constraints contributed to late presentation. Conclusion: A significant number of women, particularly older and nulliparous individuals, sought care late for symptomatic UFs. Increased sensitization and targeted educational interventions are needed to encourage early presentation and timely treatment. Implementing effective health strategies that address the reasons for late presentations will improve health outcomes for women with symptomatic fibroids.

Outcomes in gestational and non-gestational choriocarcinoma: A retrospective cohort study with nomograms and web tools

Background: Choriocarcinoma (CC), a rare and aggressive form of cancer, is composed of cytotrophoblasts and syncytiotrophoblasts. It is present in two subtypes: gestational choriocarcinoma (GCC) and non-gestational choriocarcinoma (NGCC). Recognizing the disparities between GCC and NGCC is essential for the precise staging, prognosis, and determination of the primary treatment strategy. Objective: This study aimed to differentiate clinical outcomes, treatment responses, and prognostic factors between GCC and NGCC and to introduce innovative tools for personalized treatment strategies. Design: A retrospective cohort study with Survival Analysis and Nomogram Development. Methods: We analyzed data from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database and identified female patients diagnosed with GCC and NGCC between 2000 and 2020. The clinicopathological features of each group were compared using the chi-square test. Kaplan-Meier curves, log-rank tests, and Cox proportional hazard regression were used to assess overall survival and cancer-specific survival and to determine risk factors. The 5-year survival predicting nomogram was constructed, evaluated, and validated. Results: The study included 919 patients with 719 CC and 200 patients with NGCC. The NGCC group was characterized by older age, a higher proportion of married individuals, more advanced disease stages, larger tumor sizes, and a higher frequency of surgical interventions than the GCC group. NGCC was associated with worse survival rates than GCC patients. Conclusions: This study highlights the critical role of chemotherapy in improving the survival of patients with NGCC, in contrast to its limited effect on GCC. The negative prognosis associated with radiotherapy underscores the urgent need for further investigation to optimize its use. In addition, the introduction of the first web-based survival prediction tool and predictive nomogram marked a significant advancement in personalized treatment strategies, enabling improved clinical outcomes by tailoring therapy to individual patients.

Determinants of cervical cancer knowledge and barriers to human papillomavirus vaccine uptake among female university students: A cross-sectional study

Background: Cervical cancer is the second most common female cancer in Ghana. Cervical cancer is preventable through knowledge, vaccination against the human papillomavirus (HPV), screening and treatment of precancerous lesions. Objective: This study aimed to assess the determinants of cervical cancer knowledge and barriers to HPV vaccine uptake among female university students in Ghana. Design: An anonymous, online cross-sectional study was conducted from 25 June to 22 September 2024. Methods: The survey contained questions on demographic characteristics, cervical cancer risk factors, symptoms, HPV vaccination and barriers to vaccine uptake. Binomial logistic regression analysis was performed to predict the factors associated with knowledge of cervical cancer. A p -value of less than 0.05 was considered statistically significant. Results: A total of 1662 female university students responded to the online survey. The mean age of the respondents was 21.5 ± 2.03 years. Overall, the prevalence of inadequate knowledge of cervical cancer was 60.2%. The least recognised cervical cancer symptom was blood in the stool or urine (58.4%). Respondents who had a steady partner and living together had 3.59 times higher odds of inadequate knowledge of cervical cancer compared to respondents who were not dating. Muslim respondents had 2.13 times higher odds of inadequate knowledge of cervical cancer compared to Christian. Unvaccinated respondents had 3.85 times higher odds of inadequate knowledge of cervical cancer compared to those who had received the HPV vaccine. More than four-fifths (87.0%) of the respondents indicated that they had not been vaccinated against HPV. The major barriers to HPV vaccine uptake included: inadequate knowledge of the vaccine, fear of side effects, lack of knowledge about the vaccination site, fear of injection and doubts regarding the vaccine’s efficacy. Conclusion: Improving access to cervical cancer awareness and HPV vaccination among university students is a critical public health goal to reduce the incidence of cervical cancer. It is important to promote a free national school-based HPV vaccination programme. Multi-component school-based educational interventions, including traditional methods such as lectures, group discussions and digital tools like web-based educational platforms should be implemented to improve cervical cancer knowledge among university students.

Cervical cancer prevention behaviors in young Black women

Background: In the United States, Black women have the second highest incidence of cervical cancer (CC) due to high incidence of human papillomavirus (HPV), slow HPV clearance rates, and low receipt of preventive pap smears and vaccines. Objective: A Black Feminist Thought framework was used to examine how the media portrayal of Black women, racial identity, and familial factors impact CC prevention behaviors among young Black women. Design: Black women enrolled at a large southeastern university consented and participated in an online mixed-methods survey examining facilitators and barriers to CC prevention behaviors. Quantitative items were analyzed via descriptive statistics, and qualitative items were thematically evaluated using an interpretative phenomenological analysis. Method: Black undergraduate women completed an online survey that collected quantitative data on demographic information, CC knowledge, perceived eHealth literacy, and CC prevention behaviors. Participants also responded to seven qualitative items that explored how the media portrayal of Black women, racial identity, and familial factors impact their CC prevention behaviors. Results: Participants ( N  = 146) were Black college women aged 18–26 who primarily identified as cisgender, non-Hispanic/Latine/x, and heterosexual. Most participants self-reported as having high e-Health literacy (78.1%, n  = 114) but demonstrated inadequate CC knowledge (90.3%, n  = 131). All age-eligible participants received pap smears within their lifetime ( n  = 6), and most received at least one dose of the HPV vaccine (77.5%, n  = 86), with the majority reporting series completion. Qualitative findings highlighted participants experiences of oppression co-existed with self-advocacy, primarily in medical settings. Conclusion: Results provide insight for culturally tailored interventions in care settings serving young Black women that may encourage preventive care to reduce the prevalence of CC in later adulthood.

Improving cervical cancer health literacy in Arabic-speaking immigrant women in the United States through an online patient education tool

Background: Low health literacy rates especially among the medically underserved have called for more understandable and actionable resources to involve patients in their health. The online audio-visual Reproductive Health Network (ReproNet) cervical cancer tool was shown to improve cervical cancer health literacy among marginalized English- and Spanish-speaking populations and Arab and Afghan immigrants in a group setting. Objective: This study aimed to determine whether or not the cervical cancer tool positively impacts health literacy for Arabic-speaking Middle Eastern or North African first- and second-generation immigrant women in the United States when self-administered. Design: In this single-group pre–post interventional study, a convenience sample of 95 Arabic-speaking immigrant women in the United States, ages 18 and over, reviewed an online cervical cancer patient education tool and completed pre- and post-tests. Methods: Participants received links to the tool and to pre- and post-tests, using the cervical cancer literacy assessment tool. We conducted McNemar tests and paired t-tests to compare pre- and post-test results in health literacy per participants. A multivariate regression model was fitted to test the association between demographic variables and the change of cervical cancer literacy content domains, controlling for the baseline scores before administering the tool. Results: Out of 118 participants, 95 participants had complete pre- and post-tests. Health literacy increased overall after self-administration of the tool, specifically in terms of cervical cancer prevention and control ( p < 0.01). There were no significant differences in knowledge in U.S.-born versus foreign-born Arabic-speaking women ( p = 0.6660). Conclusion: The self-administration of the ReproNet cervical cancer tool most significantly increases awareness and knowledge of cervical cancer prevention in Arabic-speaking first- and second-generation immigrant women, thus pointing to increased quality of the provider–patient relationship.

An outreach strategy to increase uptake of vaginal self-sampling for cervical cancer screening in older French women: The RIDECA interventional research protocol

Background: In France, approximately 40% of women, including menopausal women, do not participate in cervical cancer screening. Many studies and meta-analyses have shown that self-sampling devices for high-risk human papillomavirus (HR-HPV) testing are valuable tools to increase participation. The success of self-sampling screening strategies depends on several factors, including the manner and circumstances in which the women are invited to participate. The acceptability and effectiveness of these strategies should be evaluated before further implementation. Objectives: The primary objective is to evaluate the uptake of cervical cancer screening in under-screened women, based on a direct offer of a vaginal self-sampling device by a midwife. Design: RIDECA is an interventional research project located in the South of France. Methods and Analysis: Six hundred women aged 50–65 with no cervical smear or HR-HPV test for 3 years or more will be recruited at two sites. The device will be offered to enrolled women to utilize at home and return to the Montpellier Hospital laboratory for HR-HPV testing. Completion of self-sampling by women who have accepted the device and follow-up of those with positive HR-HPV DNA tests will be monitored. During recruitment, participants will complete questionnaires on their socio-economic environment and motivational factors based on the psychosocial I-Change model. Semi-structured interviews will be conducted with a sub-group to identify barriers and levers to participation. Statistical analyses will be conducted for the full research sample and for each recruitment site. Ethics: The project was approved by the Ethical Research Committee Ile de France VI and by the French Data Protection Authority. Discussion: The results will provide useful information on the effectiveness (acceptability, efficiency) of this outreach strategy and identify barriers and levers that facilitate its implementation. Registration: ClinicalTrials.gov (NCT04716127), January 20, 2021.

Knowledge, attitudes, and barriers to cervical cancer screening utilization among female healthcare professionals in the Tamale Metropolis

Background: Cervical cancer is one of the leading causes of morbidity and mortality among women globally, particularly in regions with limited access to preventive healthcare services. Despite the availability of effective screening methods, uptake remains suboptimal among healthcare professionals. Objectives: This study assessed the knowledge, attitudes, and barriers to cervical cancer screening among female healthcare professionals at Tamale Teaching Hospital. Design: An institution-based cross-sectional study was conducted among 221 female nurses, 27 female midwives, and 30 female medical doctors in the Tamale Metropolis from October to December 2024. Methods: A total of 278 female healthcare professionals were recruited using a simple random sampling method to ensure a representative sample. Data were collected through structured questionnaires and analyzed using SAS JMP Pro Statistical Software version 17.1: JMP Statistical Discovery, LLC (a subsidiary of SAS Institute). Results: Of the 278 respondents, more than half (58.6%) had good knowledge of cervical cancer and its screening methods. Factors associated with knowledge of cervical cancer were education ( p  = 0.002) and professional category ( p  = 0.039). Moreover, attitudes toward cervical cancer screening were generally positive, with 92.8% agreeing on its importance and 91.8% willing to encourage others to participate. However, the utilization of cervical cancer screening was low (33.1%). The most common barriers to screening utilization included having no reason (72.8%), tight schedules (71.1%), financial constraints (69.5%), and fear of screening outcomes (66.3%). Conclusion: Despite positive knowledge and attitudes toward cervical cancer screening, barriers hindered uptake. Workplace-based screening programs are needed to improve screening participation among female healthcare professionals.

Role of awareness on cervical cancer screening uptake among HIV positive women in Addis Ababa, Ethiopia: A cross-sectional study

Background: Cervical cancer is the second commonest cancer among women living in less developed countries. Although cervical cancer screening for HIV-infected women has been started in different centers in Addis Ababa, there is a paucity of data on the uptake of this service, particularly among HIV-infected women. Objective: This study is aimed to assess the level and determinants of cervical cancer screening uptake among HIV-positive reproductive-age women in Addis Ababa, Ethiopia. Methods: A cross-sectional study was conducted using a structured questionnaire on 411 HIV-infected women aged 15–49 years in St. Paul’s and Zewditu Hospitals. Data were collected using a pre-tested structured questionnaire on randomly selected study participants’ proportional allocation in the two hospitals. Logistic regression analyses were used to assess predictors of cervical cancer screening uptake. Results: Only 25.5% of HIV-positive reproductive-age women have been screened for cervical cancer. Respondents who have not heard about cervical cancer and the screening were 75% and 78% less likely to be screened compared to their counterparts, respectively. Conclusion: The uptake of cervical cancer screening was low in the study area. Awareness about cervical cancer screening was positively associated with cervical cancer screening uptake. Specific awareness programs focusing HIV positive women need to be implemented.

Impact of cervical cancer on the sexual and physical health of women diagnosed with cervical cancer in Ghana: A qualitative phenomenological study

Introduction: Although cervical cancer is preventable, it is a major gynecological disorder among women currently. More than 500,000 new cases of cervical cancer are being diagnosed across the globe, with one woman dying of cervical cancer every 2 minutes. In addition, about half of cervical cancer survivors have challenges with their sexual function. Despite these findings, literature regarding the sexual function of women with cervical cancer is scanty. The study aims to assess cervical cancer’s impact on the sexual and physical health of women diagnosed with cervical cancer in Ghana. Methods: The researchers of this study employed a qualitative approach with phenomenological design. A purposive sampling technique was used to select 30 participants engaged in face-to-face in-depth interviews that were audio-recorded. The content of the transcripts was analyzed using content analysis. Results: This study revealed that cervical cancer patients experienced low libido due to the cervical cancer symptoms and the side effects of chemotherapy. This low libido made them divert their sexual gratification from the vagina to other centers of the body. Findings further revealed that some participants showed apathy toward their partners’ sexual feelings. Some physical problems experienced by the participants were also unraveled. Conclusion: Cervical cancer affects all aspects of a woman’s health, including sexual function and physical well-being. Therefore, there is the need for further studies to help address challenges faced by cervical cancer women about their sexual and physical health.

Cervical screening uptake: A cross-sectional study of self-reported screening attitudes, behaviours and barriers to participation among South Asian immigrant women living in Australia

Introduction: Cervical cancer remains a major cause of morbidity and mortality among women from low and lower middle-income countries, as well as underserved population subgroups in high-income countries. Migration from South Asia to Australia has increased over the last decade, and immigrant women from this region have been reported as a subgroup, with less than optimal cervical screening participation in Australia. This study examined cervical screening uptake and associated behavioural attitudes among South Asian immigrant women living in Queensland Australia. Methods: A cross-sectional, Internet-based survey was used to collect data from a convenience sample of 148 South Asian women living in Queensland. The main outcome measure was receipt of cervical screening test ever (yes/no) and its recency (within 2 years/more than 2 years). The survey also examined participants’ views on barriers towards screening and ways to enhance it. Results: Of 148 women who completed the survey, 55.4% (n = 82) reported ever having a cervical screening test before and 43.9% (n = 65) reported having it in previous two years. Not having a previous cervical screening test was significantly associated with duration of stay in Australia for less than five years, not having access to a regular general practitioner (GP), not being employed, having low cervical cancer knowledge level and not knowing if cervical screening test is painful or not. Most commonly reported barriers to screening uptake included considering oneself not at risk, lack of time and lack of information. The most favoured strategy among participants was encouragement by GP and awareness through social media advertisements. Conclusion: This study provided insights into factors that need consideration when developing future targeted interventions.

High parity is associated with increased risk of cervical cancer: Systematic review and meta-analysis of case–control studies

Background: Cervical cancer is the fourth most common cancer among women. High parity has long been suspected with an increased risk of cervical cancer. Evidence from the existing epidemiological studies regarding the association between parity and cervical cancer is variable and inconsistent. Therefore, the objective of this systematic review and meta-analysis was to synthesize the best available evidence on the epidemiological association between parity and cervical cancer. Methods: Case–control studies reporting the association between parity and cervical cancer were systematically searched in databases like MEDLINE/PubMed, HINARI, Google scholar, Science direct, and Cochrane Libraries. All studies fulfilling the inclusion criteria and published between 2000 and 7 March 2020 were included in this meta-analysis. This study reported according to PRISMA guideline. Cochran’s Q-statistics and I 2 tests were performed to assess heterogeneity among included studies. Egger’s regression analysis was performed to assess publication bias. A random-effect meta-analysis model was used to compute pooled odds ratio of the association between parity and cervical cancer. Results: A total of 6685 participants (3227 patients and 3458 controls) were incorporated in the 12 studies included in this meta-analysis. The meta-analysis revealed that women with high parity had 2.65 times higher odds of developing cervical cancer compared to their counterparts (odds ratio = 2.65, 95% confidence interval = 2.08–3.38). Conclusion: High parity is positively associated with cervical cancer. Strong epidemiological studies are recommended to further explore the mechanisms and role of parity in the causation of cervical cancer.

Implementing self-collection for primary human papillomavirus testing: Perspectives on implications for federally qualified health center patient populations

Background: Primary testing for high-risk human papillomavirus (HPV) via self-collection can increase cervical cancer screening rates. In the United States, federally qualified health center (FQHC) patients often have low incomes, lack health insurance, are medically underserved, and are screened less than the national average. Implementation of HPV self-collection can increase cervical cancer screenings among FQHCs. Objectives: To assess the potential impact of implementing HPV self-collection with FQHC patients by considering perspectives of frontline clinical and administrative staff and leadership to identify patient-focused implementation considerations. Design: This qualitative study utilized focus groups and key informant interviews, and transcripts were analyzed using a coding-based thematic analysis. Emergent themes regarding self-collection implementation perspectives were mapped onto Consolidated Framework for Implementation Research constructs to identify potential facilitators and barriers to implementation for FQHC patient populations. Methods: Participants from six FQHCs in North Carolina were identified. Forty-five clinical and administrative staff participated in focus groups. One chief executive officer, senior level administrator, chief medical officer, and clinical data manager from each FQHC ( N  = 24) were interviewed one-on-one. Coding-based thematic analysis was applied to focus group and interview transcripts to uncover emerging themes. Results: Interviewees indicated that HPV self-collection can be advantageous to patients who do not routinely visit the clinic due to socioeconomic and cultural barriers. Programs must consider these barriers and patient literacy to ensure proper self-collection utilization. For example, FQHC patients may benefit from illustrated instructions for proper self-collection procedures. Conclusion: Tailoring an HPV self-collection implementation to FQHC patient populations may be an important strategy for increasing screening.

Neural plasticity of the uterus: New targets for endometrial cancer?

Endometrial carcinoma is the most common gynecological malignancy in Western countries and is expected to increase in the following years because of the high index of obesity in the population. Recently, neural signaling has been recognized as part of the tumor microenvironment, playing an active role in tumor progression and invasion of different solid tumor types. The uterus stands out for the physiological plasticity of its peripheral nerves due to cyclic remodeling brought on by estrogen and progesterone hormones throughout the reproductive cycle. Therefore, a precise understanding of nerve-cancer crosstalk and the contribution of the organ-intrinsic neuroplasticity, mediated by estrogen and progesterone, of the uterine is urgently needed. The development of new and innovative medicines for patients with endometrial cancer would increase their quality of life and health. This review compiles information on the architecture and function of autonomous uterine neural innervations and the influence of hormone-dependent nerves in normal uterus and tumor progression. It also explores new therapeutic possibilities for endometrial cancer using these endocrine and neural advantages.

The role of aspirin in the prevention of ovarian, endometrial and cervical cancers

Drug repurposing is the application of an existing licenced drug for a new indication and potentially provides a faster and cheaper approach to developing new anti-cancer agents. Gynaecological cancers contribute significantly to the global cancer burden, highlighting the need for low cost, widely accessible therapies. A large body of evidence supports the role of aspirin as an anti-cancer agent, and a number of randomized trials are currently underway aiming to assess the potential benefit of aspirin in the treatment of cancer. This review summarizes the evidence underpinning aspirin use for the prevention of the development and recurrence of gynaecological cancers (ovarian, endometrial and cervical) and potential mechanisms of action.

Knowledge, attitude, and practices regarding human papilloma virus vaccination among physicians in Qatar

Background: The human papilloma virus is a global problem that affects sexually active women and men, with cervical cancer being the most serious associated disease. Most cervical cancer cases can be prevented by vaccination against the human papilloma virus early in life. The objective of this study was to assess the knowledge, attitudes, and practices among physicians working in Qatar, regarding the human papilloma virus, infection, and prevention using vaccines. Study-design: This was a cross-sectional study using quantitative data collection. Methodology: An online survey targeting physicians working in Qatar was conducted, using a web-based pretested questionnaire. The questionnaire comprised four sections capturing a few demographic details, 33 questions in the Knowledge Section, 12 questions eliciting the attitude, and 14 practice-related questions. Mean knowledge score was calculated and those with a score more than the mean score were considered to have sufficient knowledge. Association between knowledge and attitude/practices/independent variables were looked for using bivariate and multivariate analysis. Logistic regression was used to identify the predictors for recommending human papilloma virus vaccines. Results: Of the 557 physicians who participated, 83.7% had sufficient knowledge, but only 69.1% knew that human papilloma virus vaccines were available in Qatar. The majority (89.4%) knew that human papilloma virus infection could be asymptomatic and 96.1% knew at least one symptom; 77% believed the human papilloma virus vaccine would substantially decrease the chances of human papilloma virus infection and related cancers and 46.5% felt physicians were less motivated to promote the human papilloma virus vaccine. The perceived barriers to community acceptance of the human papilloma virus vaccine were lack of awareness regarding the relationship between human papilloma virus and cervical cancer (61.6%), doubts regarding efficacy (32.5%), fear regarding safety (26.9%), concern that the human papilloma virus vaccination may encourage risky sexual behavior (26.8%), and perceived low-risk (23.3%) and cost (24.6%). Only 21.5% commonly discussed sexual health with their clients. More than one-third were not interested in recommending the human papilloma virus vaccine. Bivariate analysis showed nationality, specialization, discussing with patients, and recommending vaccine to be significantly associated with knowledge. Bivariate and regression analysis identified that female gender and physician’s religion were significant predictors to recommend the human papilloma virus vaccine. Conclusion: Most physicians have good knowledge. Less than one-fourth commonly discussed sexual health with their clients. More than one-third were not interested in recommending the human papilloma virus vaccine. This issue might affect the human papilloma virus vaccination program implementation if not well addressed.

Cancer burden in women with HIV on Medicaid: A nationwide analysis

Background: Cancer is the leading cause of death in people living with HIV. In the United States, nearly 1 in 4 people living with HIV are women, more than half of whom rely on Medicaid for healthcare coverage. Objective: The objective of this study is to evaluate the cancer burden of women living with HIV on Medicaid. Design: We conducted a cross-sectional study of women 18–64 years of age enrolled in Medicaid during 2012, using data from Medicaid Analytic eXtract files. Methods: Using International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes, we identified women living with HIV (n = 72,508) and women without HIV (n = 17,353,963), flagging the presence of 15 types of cancer and differentiating between AIDS-defining cancers and non-AIDS-defining cancers. We obtained adjusted prevalence ratios and 95% confidence intervals for each cancer and for all cancers combined, using multivariable log-binomial models, and additionally stratifying by age and race/ethnicity. Results: The highest adjusted prevalence ratios were observed for Kaposi’s sarcoma (81.79 (95% confidence interval: 57.11–117.22)) and non-Hodgkin’s lymphoma (27.69 (21.67–35.39)). The adjusted prevalence ratios for anal and cervical cancer, both of which were human papillomavirus-associated cancers, were 19.31 (17.33–21.51) and 4.20 (3.90–4.52), respectively. Among women living with HIV, the adjusted prevalence ratio for all cancer types combined was about two-fold higher (1.99 (1.86–2.14)) in women 45–64 years of age than in women 18–44 years of age. For non-AIDS-defining cancers but not for AIDS-defining cancers, the adjusted prevalence ratios were higher in older than in younger women. There was no significant difference in the adjusted prevalence ratios for all cancer types combined in the race/ethnicity-stratified analyses of the women living with HIV cohort. However, in cancer type–specific sub-analyses, differences in adjusted prevalence ratios between Hispanic versus non-Hispanic women were observed. For example, the adjusted prevalence ratio for Hispanic women for non-Hodgkin’s lymphoma was 2.00 (1.30–3.07) and 0.73 (0.58–0.92), respectively, for breast cancer. Conclusion: Compared to their counterparts without HIV, women living with HIV on Medicaid have excess prevalence of cervical and anal cancers, both of which are human papillomavirus related, as well as Kaposi’s sarcoma and lymphoma. Older age is also associated with increased burden of non-AIDS-defining cancers in women living with HIV. Our findings emphasize the need for not only cancer screening among women living with HIV but also for efforts to increase human papillomavirus vaccination among all eligible individuals.

Characteristics of women Veterans with incident breast and gynecologic cancers in the Veterans Health Administration

Background: There is an increase in breast and gynecologic cancer cases treated within Veterans Health Administration (VHA). Objectives: To describe the age and race of Veteran women diagnosed with breast and gynecologic cancers in VHA and compare with U.S. women broadly. Design: Retrospective, cross-sectional study. Methods: We obtained data from January 1, 2021 to March 12, 2024 from the Breast and Gynecologic Oncology System of Excellence (BGSoE) dashboard and for women covered in the 2021 Surveillance, Epidemiology, and End Results (SEER) program. Results: In the Veteran cohort ( n  = 6555), the median age is 59 and 58 years for breast and gynecologic cancers, respectively. ~52% ( n  = 2586) of breast cancers are diagnosed among non-Hispanic Whites, ~30% ( n  = 1519) among non-Hispanic Blacks, and 6% ( n  = 301) among Hispanics. For gynecologic cancers, ~58% ( n  = 897) are diagnosed among non-Hispanic Whites, ~23% ( n  = 359) among non-Hispanic Blacks, and ~7% ( n  = 108) among Hispanics. Conclusions: Compared to SEER, women Veterans are diagnosed at younger ages and have similar racial composition.

The effect of Medicaid expansion on female gynecologic cancer-related inpatient admissions

Background: Mortality rate of female gynecologic cancer is higher among individuals without affordable health insurance. Objectives: We determined the impact of Medicaid expansion on the number of female gynecologic-related cancer inpatient admissions in Virginia (VA) relative to North Carolina (NC), the latter of which did not expand Medicaid. Design: This quasi-experimental study was restricted to women between 18 and 64 years old admitted to general, acute, and short-term hospitals with gynecologic cancer. Methods: We used Poisson fixed-effect event study regression to examine differences in the predicted number of female gynecologic-related cancer admissions in the quarters before and after Medicaid expansion (implemented in January 2019) in VA, compared to the same period in NC. Results: Even though not significant, the predicted number of female gynecologic cancer-related inpatient admissions in VA increased by 4.8%, 4.9%, and 5.5% in the second, third, and fourth quarter of 2019, respectively, compared to the first quarter of 2019. Conclusion: Medicaid expansion in VA increased access to health services for Medicaid members, possibly due to initial pent-up demand among uninsured individuals.

Targeting HPV in gynaecological cancers – Current status, ongoing challenges and future directions

Despite the success of preventive vaccination, the Human Papilloma Virus still accounts for 266,000 deaths annually, as the main causative factor of cervical, vaginal, anal, penile and oropharyngeal cancers. Human Papilloma Virus infects epithelial cells, driving tumourigenesis primarily from incorporation of DNA into the host cellular genome. Translation of two particular Human Papilloma Virus–specific oncoproteins, E6 and E7, are the key drivers of malignancy. If diagnosed early cervical, vaginal and vulval cancers have good prognosis and are treated with curative intent. However, metastatic disease carries a poor prognosis, with first-line systemic treatment providing only modest increase in outcome. Having shown promise in other solid malignancies, immune checkpoint inhibition and therapeutic cancer vaccines have been directed towards Human Papilloma Virus–associated gynaecological cancers, mindful that persistent Human Papilloma Virus infection drives malignancy and is associated with immunosuppression and lack of T-cell immunity. In this review, we discuss novel therapeutic approaches for targeting Human Papilloma Virus–driven gynaecological malignancies including vaccination strategies, use of immunomodulation, immune checkpoint inhibitors and agents targeting Human Papilloma Virus–specific oncoproteins. We also highlight the evolving focus on exciting new treatments including adoptive T-cell therapies.

Safety and efficacy of vilaprisan in Japanese women with fibroids: The Phase 3 ASTEROID 8 trial

Background: Vilaprisan is a selective progesterone receptor modulator with demonstrated efficacy in the management of uterine fibroids (UFs). Objectives: To evaluate the safety and efficacy of vilaprisan in Japanese women with UFs and heavy menstrual bleeding (HMB). Design: Open-label, parallel-group, Phase 3 randomized clinical trial. Methods: Japanese women with UFs and HMB were randomly assigned 1:1 to receive vilaprisan (2 mg/day) for either four treatment periods (TPs) of 12 weeks each separated by one bleeding period (Arm A1) or two TPs of 24 weeks each separated by two bleeding periods (Arm A2). The primary endpoint was the incidence of treatment-emergent adverse events (TEAEs). Results: Of 179 women enrolled, 151 were included in the full analysis set and 148 in the safety analysis set. TEAEs occurred in 79.1% of women, with the majority being mild; events were evenly distributed across both treatment arms. Study drug-related TEAEs were observed in 44.6% of women, and serious TEAEs were reported in 3.4% of women. During the treatment phase, the mean (standard deviation) number of bleeding days per 28 days decreased to 1.40 (1.34) days in Arm A1 and 1.42 (0.82) days in Arm A2 from respective baseline values of 5.1 (2.3) and 5.2 (2.0) days. Median time to onset of amenorrhea was 4 days in TP1 in both arms, and 4 days in TP2 in Arm A1. Absence of bleeding for the last 28 days was more common in TP1 (Arm A1: 91.89%, Arm A2: 89.19%) than TP2 (Arm A1: 80.85%, Arm A2: 85.71%). Conclusion: In this study, vilaprisan 2 mg/day was found to be well tolerated and efficacious in Japanese women with UFs and HMB. However, the study sponsor later terminated the overall clinical development of vilaprisan due to potential safety concerns from long-term rodent studies. Registration: The ASTEROID 8 study was registered at https://clinicaltrials.gov/ (registration number: NCT03476928).

“Give me the sense that I matter:” Queer women’s recommendations for an ideal cervical cancer screening exam and pathways to screening equity

Background: Cervical cancer screening is a powerful tool in the prevention, early detection, and diagnosis of precancers and cancer. There is mounting evidence, however, demonstrating that Queer cisgender women experience disparities in cervical cancer screening access and uptake compared to their heterosexual counterparts. To close gaps in screening, Queer women’s voices and visions must foreground recommendations aimed at remedying screening inequities. Objectives: This study aims to explore perceptions on an ideal cervical cancer screening exam among a racially and ethnically diverse group of Queer women. Design: This qualitative interview study is led in partnership with a multidisciplinary community steering committee. Our work is grounded in the Reproductive Justice Framework. Methods: We held in-depth interviews with 19 Queer women to understand their recommendations for improving cervical cancer screening experiences for their community. Data from these interviews were analyzed through thematic analysis. Results: We identified five themes around creating an ideal cervical cancer screening experience among Queer women: (1) community outreach and education, (2) cues of affirmation and safety, (3) Queer patient navigation and advocacy, (4) Queer-affirming and knowledgeable providers, and (5) trauma-informed care. Conclusion: Engaging Queer women in developing solutions to address screening disparities is a missing link in cervical cancer prevention and the advancement of reproductive health equity. We share actionable strategies at the healthcare professional, community, and organizational levels to support healthcare systems in translating Queer women’s visions into practice. Our findings also inform medical organizations, expert panels, and health authorities on patient-defined strategies and pathways to remedying screening inequity.

A case of giant labia majora lipoma in an adult

Lipomas are common benign adipose tissue tumors but are infrequently found in the labia majora, especially at a large size. We report a case of a giant lipoma of the labia majora in a 37-year-old woman diagnosed by imaging methods and successfully treated by surgery. This case highlights the importance of considering lipoma in the differential diagnosis of labial masses and underscores the role of imaging in diagnosis. They need to be differentiated from liposarcoma or omental herniation into Nuck’s canal. It also demonstrates the effectiveness of surgical management for large lipomas in sensitive areas, with attention to both medical and aesthetic outcomes.

Identifying the key barriers, facilitators and factors associated with cervical cancer screening attendance in young women: A systematic review

Background: Cervical cancer (CC) results in around 604,00 new cancer cases yearly and is caused by the human papillomavirus (HPV). Uptake rates for both the HPV vaccination and screening have been decreasing over recent years, particularly in young women, whilst CC remains a concern for both low- and high-income countries. Objectives: To highlight the key barriers and facilitators of CC screening attendance in young women and to identify the factors associated with their CC screening behaviour, to inform interventions to increase screening rates. Design: Systematic review. Data sources and methods: A systematic review was conducted using Scopus, Web of Science, MEDLINE, PsycINFO/PyscARTICLES and CINAHL. The review included primary qualitative, quantitative and mixed-method studies that reported barriers, facilitators and factors associated with current CC screening behaviours in women aged 30 or below. Outcomes were summarised narratively. Risk of bias was conducted for individual studies using the Mixed-Method Appraisal Tool. Results: Among the 106 studies included in the review, the most frequently reported barriers were financial constraints ( n  = 36), embarrassment ( n  = 35) and low accessibility to obtaining screening ( n  = 34). The most frequently reported facilitators were knowledge of CC ( n  = 12), healthcare provider recommendations ( n  = 11) and communication with friends ( n  = 11). Age (older), marital status (in a relationship) and sexual activity (active) were key factors associated with attendance at screening. Studies also highlighted that those vaccinated were more likely to have screened than those not vaccinated against HPV. Conclusion: These unique factors represent potential targets for interventions to increase CC screening attendance in young women. Future research could benefit from employing strong theoretical frameworks, such as the COM-B model of behavioural change, to categorise and gain further insight into the contributing factors affecting CC screening attendance. Registration: PROSPERO CRD42022324948.

Ovarian cancer surgery in Germany: An analysis of the nationwide hospital file 2005–2015

Objectives: Nationwide hospitalization data on the surgical management of ovarian cancer are scant. We assessed type of surgery, surgical approach, length of stay, surgery-related complications and in-hospital mortality among women with ovarian cancer in Germany. We analyzed nationwide hospitalization file of 2005 through 2015 including 77,589 ovarian cancer-related hospitalizations associated with ovarian surgery. Methods: We calculated the relative frequency of the surgical approaches by type of surgery and calendar time. We used log-binomial regression models to estimate relative risk of in-hospital mortality (including 95% confidence intervals) according to complications. About 63% of the hospitalizations included an additional hysterectomy besides ovariectomy. Results: About 85% of the surgeries were performed by laparotomy. However, from 2005–2006 through 2013–2015, the proportion of laparoscopic ovariectomies (±salpingectomy) increased from 14% to 35%. The in-hospital mortality risks for laparotomic and laparoscopic surgery were 2.9% and 0.4%, respectively. Adjusted mortality risk ratios varied from 1.35 (95% confidence interval = 0.94–1.94) for bleedings requiring blood transfusion to 3.65 (95% confidence interval = 3.31–4.03) for postoperative infections. Conclusion: We observed a tendency away from laparotomy toward laparoscopy for ovariectomies (±salpingectomy) over time. Compared with laparotomy, laparoscopy was associated with lower risk of complications and death. All complications studied were associated with higher in-hospital mortality risk.

Cervical pap smears and pandemics: The effect of COVID-19 on screening uptake & opportunities to improve

Background: The Coronavirus disease 2019 (COVID-19) pandemic has led to an unprecedented upheaval within global healthcare systems and resulted in the temporary pausing of the National Health Service (NHS) Scotland Cervical Screening Programme. With several months of backlogs in appointments, there has not only been a reduction in primary samples being taken for human papilloma virus (HPV) testing but there have also been fewer women referred to colposcopy for investigation and treatment of precancerous or cancerous changes as a result. Encouraging uptake for cervical screening was always a priority before the pandemic, but it is even more important now, considering that the fears and barriers to screening that women may have are now exacerbated by COVID-19. Objectives: This article explores the impact of the pandemic on the uptake of cervical screening within NHS Ayrshire & Arran and evaluates potential strategies to improve uptake now and in future such as self-sampling and telemedicine. Methods: This article presents evidence-based literature and local health board data relating to cervical screening during the pandemic. Results: Human papilloma virus self-sampling carried out by the woman in her home has been shown to improve uptake, especially in non-attenders, whilst maintaining a high sensitivity and, crucially, reducing the need for face-to-face contact. Increased education is key to overcoming barriers women have to screening and telemedicine can strengthen engagement with women during this time. Conclusion: There are lessons to be learned from the pandemic, and we must use this opportunity to improve cervical screening uptake for the future.

Cervical cancer screening – The challenges of complete pathways of care in low-income countries: Focus on Malawi

Cervical cancer is the fourth most common cancer among women globally, with approximately 580,000 new diagnoses in 2018. Approximately, 90% of deaths from this disease occur in low- and middle-income countries, especially in areas of high HIV prevalence, and largely due to limited prevention and screening opportunities and scarce treatment options. In this overview, we describe the opportunities and challenges faced in many low- and middle-income countries in delivery of cervical cancer detection, treatment and complete pathways of care. In particular, drawing on our experience and that of colleagues, we describe cervical screening and pathways of care provision in Malawi, as a case study of a low-resource country with high incidence and mortality rates of cervical cancer. Screening methods such as cytology – although widely used in high-income countries – have limited relevance in many low-resource settings. The World Health Organization recommends screening using human papillomavirus testing wherever possible; however, although human papillomavirus primary testing is more sensitive and detects precancers and cancers earlier than cytology, there are currently costs, infrastructure considerations and specificity issues that limit its use in low- and middle-income countries. The World Health Organization accepts the alternative screening approach of visual inspection with acetic acid as part of ‘screen and treat’ programmes as a simple and inexpensive test that can be undertaken by trained health workers and hence give wider screening coverage; however, subjectivity and variability in interpretation of findings between providers raise issues of false positives and overtreatment. Cryotherapy using either nitrous oxide or carbon dioxide is an established treatment for precancerous lesions within ‘screen and treat’ programmes; more recently, thermal ablation has been recognized as suitable to low-resource settings due to lightweight equipment, short treatment times, and hand-held battery-operated and solar-powered models. For larger lesions and cancers, complete clinical pathways (including loop excision, surgery, radiotherapy, chemotherapy and palliative care) are required for optimal care of women. However, provision of each of these components of cancer control is often limited due to limited infrastructure and lack of trained personnel. Hence, global initiatives to reduce cervical mortality need to adopt a holistic approach to health systems strengthening.

Lymph node ratio as an indicator of nodal status in the assessment of survival and recurrence in vulvar cancer: A cohort study

Background: Inguinal lymph node (LN) metastasis and particularly the number of metastatic lymph nodes (NMLN) represent a determinant prognostic factor in vulvar squamous cell carcinoma (VSCC). However, the NMLN may be related to the number of removed LNs. Therefore, the lymph node ratio (LNR) reflects not only the burden of LN involvement but also the quality and extent of lymphadenectomy. Objectives: To investigate the value of the LNR and the count of LN on overall survival (OS) and recurrence-free survival (RFS). Design: This study is a retrospective, longitudinal, institution-based study. Methods: This study included 192 patients treated for VSCC at the Salah Azaiez Institute between 1994 and 2022. Clinical, pathological, and evolutionary data were reported. Survival curves were generated by the Kaplan–Meier method, and predictive factors of outcome were analyzed using Cox proportional hazards models. Results: Surgery consisted of a radical vulvectomy, hemivulvectomy, and pelvic exenteration in, respectively, 96.4%, 2.1%, and 1.6% of cases followed by adjuvant radiotherapy in 38.5% of cases. LN dissection was bilateral in 88.5% of cases. LNR = 0, LNR = 0–0.2, and LNR ⩾0.2 were recorded in, respectively, 64.7%, 22.1%, and 13.2% of cases. With a mean follow-up time of 35 ± 42.06 months, the 5-year OS was 52.5% and the 5-year RFS was 55.8%. On multivariate analysis, the independent prognostic factors of OS were the LNR (hazard ratio (HR) = 5.702; 95% confidence interval (CI) = 2.282–14.245; p < 0.0001), Federation of Gynecology and Obstetrics (FIGO) stage (HR = 2.089; 95% CI = 1.028–4.277; p = 0.042), and free margins (HR = 2.247; 95% CI = 1.215–4.155; p = 0.01). Recurrences were recorded in 37.5% of cases. Independent prognostic factors of RFS were the LNR (HR = 2.911; 95% CI = 1.468–5.779; p = 0.002), FIGO stage (HR = 1.835; 95% CI = 1.071–3.141; p = 0.027), and free margins (HR = 2.091; 95% CI = 1.286–3.999; p = 0.003). Conclusion: Surgical margin, FIGO stage, and LNR represent the independent prognostic factors of survival and LNR showed superior prognostic predictive accuracy compared with the revised 2021 FIGO staging system for predicting OS and RFS in VSCC.

Turkish and Moroccan Dutch women’s views of using a self-sampling kit for human papillomavirus testing as a tool for cervical cancer screening: What are the barriers and the motivators?

Objective: This study explores barriers and motivators to use self-sampling kits for human papillomavirus testing for cervical cancer screening as perceived by Dutch women of Turkish and Moroccan origin living in the Netherlands. Methods: A total of 11 in-depth semi-structured interviews were conducted and structured according to the theory of planned behavior. Results: Findings suggest that self-sampling may lift important barriers hampering traditional cervical cancer screening, such as those related to shame and chastity. However, self-sampling raises its own barriers too. Most importantly, some women fear that self-sampling may harm virginity. Some women also do not feel confident about their ability to properly use the self-sampling kit, but fears about the inability to properly use it often fade away upon having seen the self-sampling kit. Moreover, results show that knowledge about cervical cancer and its origin is limited, which may undermine women’s willingness to participate in a screening program. Conclusions: These results suggest that communication strategies to encourage using self-sampling kits among women of Turkish and Moroccan origin could benefit from culturally sensitive approaches, for example, by placing emphasis on issues such as virginity and chastity. Consistent with a recent advice of the Health Council of the Netherlands, the kit could furthermore be sent to eligible women as a standard procedure, rather than upon request. This could reduce hassle and doubts about women’s ability to use the self-sampling kit. Finally, educating women about the importance of screening to prevent cervical cancer is needed to foster informed decision-making.

Human Papilloma Virus infection and cervical cancer among women who sell sex in Eastern and Southern Africa: A scoping review

Objectives: Women who sell sex have a high prevalence of human papilloma virus, which may cause cervical cancer. The objective of this review was to collate findings on prevalence, associated factors, screening, service provision and utilization of services in relation to human papilloma virus and cervical cancer among women who sell sex in Eastern and Southern Africa. Methods: A scoping review methodology was employed. Inclusion criteria were as follows: (1) empirical papers, (2) of studies conducted in Eastern and Southern Africa, (3) published in the last 10 years, and (4) addressing women who sell sex in relation to (5) human papilloma virus and cervical cancer. A thorough search of a range of databases surfaced 66 papers. Both authors applied inclusion and exclusion criteria, resulting in 14 papers being reviewed. Results: The reported prevalence of high-risk human papillomavirus virus varied between 23.6% and 70.5%. HIV sero-positivity, other sexually transmitted infections and Epstein-Barr virus were associated with human papilloma virus and high-grade cervical lesions. High-risk human papilloma virus was associated with women who reported younger age at first intercourse, non-barrier contraceptive use, and no history of condom use. For screening, there was overall agreement between physician- and self-collected samples. Contradictory results were found for visual inspection with acetic acid. Screening services utilization was associated with provider’s recommendation, history of sexually transmitted infections, frequency of facility visit and history of vaginal examination. A diagonal programme led to an increase in screening, attributed to the targeted services. Conclusions: Context is important in planning cervical cancer services. There is a need for enhanced sexually transmitted infections and viral management within cervical cancer prevention. Women who sell sex should be empowered in self-collection of stored-dry specimens, especially in resource-constrained regions. Cervical cancer screening services should be honed to the needs of women who sell sex.

An exploratory study of undergraduate healthcare student perspectives regarding human papillomavirus and vaccine intent in India

Objective: Safe and effective human papillomavirus vaccines are available against cervical cancer and other human papillomavirus–associated diseases. Vaccine uptake is low in India given lack of universal vaccination programme. This exploratory study describes the medical, dental and nursing undergraduate student perspectives about human papillomavirus and intentions to receive the vaccine. Methods: Using a cross-sectional, explorative study design, we conducted two focus group discussions among a convenience sample of male (n = 11) and female (n = 9) student group aged ⩾18 years, respectively, at a medical college in South India. The focus group discussion sessions were recorded, transcribed and analysed using thematic content analysis. Results: Over half of the students showed adequate knowledge of cervical cancer and human papillomavirus. Medical students had much in-depth knowledge of cervical cancer, vaccine cost and its side effects compared to dental and nursing students. Human papillomavirus vaccine knowledge was relatively less among males compared to females; most male participants were unaware of the availability of the human papillomavirus vaccine. Intention to receive the vaccine was higher among females than males. All the participants had positive attitude in creating awareness in the community and making the vaccine cost-effective. Cultural concerns and high vaccine cost were cited major barriers for vaccine uptake. Suggestion of physician recommendation in promotion of human papillomavirus vaccine uptake was an emerging theme. Conclusion: Educating male students and those enrolled in dental and nursing courses about human papillomavirus vaccine, addressing cultural concerns and advocating provider recommendation for promoting vaccine uptake are potential strategies to improve future human papillomavirus vaccine intent among students and recommendations to patients in their role as future healthcare provider.

Factors associated with cervical cancer screening behaviour of women attending gynaecological clinics in Kazakhstan: A cross-sectional study

Objective: Although cervical cancer could be prevented through medical screening, it remains one of the top causes of cancer-related morbidity and mortality all over the world. A number of factors may contribute to cervical cancer screening behaviour of women. The aim of this study was to investigate factors related to cervical cancer screening behaviour of women in Kazakhstan. Methods: This was a cross-sectional survey-based study with a total of 1189 participants. Women attending gynaecological clinics aged between 18 and 70 years were administered paper-based questionnaires about their awareness of cervical cancer, the associated risk factors, and cervical cancer screening. Student t test or Wilcoxon rank-sum test and chi-square test or Fisher’s exact test, where appropriate, were used to determine associations with categorical independent variables. Results: The mean age of participants was 36.5 ± 10.1 years. Less than half (45.7%) of the participants had been screened for cervical cancer. The key factors related to the cervical cancer screening behaviour of women in this study included age, having a larger number of children, regular menstrual function, awareness of Pap smear test, and free screening programme for cervical cancer, and the causal association of human papillomavirus with cervical cancer. Conclusion: This study revealed several significant factors predicting screening behaviour in Kazakhstani women. To improve the rate of screening, there is a need to increase public knowledge and awareness of cervical cancer and opportunities for the free screening programme in the female population of Kazakhstan.

Cervical cancer knowledge and screening uptake by marginalized population of women in inner-city Durban, South Africa: Insights into the need for increased health literacy

Background: Cervical cancer in South Africa accounts for 15.85% of all female cancers and 30.29% of African female cancers, resulting in over 5000 deaths annually. South Africa’s proposed move towards universal healthcare places emphasis on health promotion through education and screening, but there is little data on the baseline levels of knowledge and screening uptake regarding cervical cancer. This study explored the levels of knowledge and screening rates of cervical cancer among vulnerable women living in the inner-city of Durban, South Africa. Methods: A mixed-method study was conducted within the context of a Women’s Health outreach initiative. Data were collected from women attending the outreach ( n = 109), many of whom were from marginalized communities. A pre-intervention survey was used to collect the data. This was followed by cervical cancer education sessions and the opportunity for a free Pap smear. Results: Knowledge of cervical cancer was low (<25%) and only a third of the women had previously been screened. After the educational sessions, 64% of women ( n = 70) took advantage of the opportunity for Pap smears, with many expressing the need for wider cervical cancer education, screening centres and support groups. Only 20% of the Pap smears were normal ( n = 14). Half of the women tested positive for infections ( n = 36; 51.4%), and a small proportion ( n = 8; 11.4%) tested positive for human papilloma virus. Abnormal cervical intra-epithelial neoplasia (CIN1 and CIN 2) were also detected in this population ( n = 12; 17.1%). Conclusion: Cervical cancer knowledge and screening among vulnerable women in Durban, South Africa, is inadequate, especially considering the high levels of abnormality found in the Pap smears. Education drives, accompanied with the provision of free testing, are required. Community health outreach initiatives in collaboration with non-government organizations set in accessible locations could be a possible course of action.

Effect of educative reminder telephone calls on human papillomavirus immunization rate: A randomized controlled trial

Context: Human papillomavirus coverage varies widely among women depending on their race, incomes, geographical location and education level. Objective: To evaluate whether reminder educative phone calls increase human papillomavirus vaccination rates in adult women aged 18–45 with high-risk factors of cervical cancer. Design: We conducted a single-blind randomized controlled trial in patients who consulted at a Canadian tertiary center in October 2019 during National Cervical Cancer Awareness Week. Interventions: We randomized women to receive three standardized educative phone calls or standard care. Main outcome measure: We assessed the immunization rate at 6 months. Results: A total of 130 patients were randomized of which 62 patients were randomized to the intervention. Eight patients (15.4%) got immunized at 6 months in the intervention group as compared to seven (11.7%) in the control group (p = 0.5645). The main barrier to vaccination reported by non-immunized patients at 6 months was the cost of vaccination (42.3%). Conclusion: Reminder educative phone calls did not increase human papillomavirus vaccination rates in adult women with risk factors of cervical cancer. ISRCTN registration number: ISRCTN58518971

Trauma and cervical cancer screening among women experiencing homelessness: A call for trauma-informed care

Objective: Women experiencing homelessness are at increased risk of cervical cancer and have disproportionately low Pap screening behaviors compared to the general population. Prevalence of Pap refusals and multiple kinds of trauma, specifically sexual trauma, are high among homeless women. This qualitative study explored how trauma affects Pap screening experiences, behaviors, and provider practices in the context of homelessness. Methods: We conducted 29 in-depth interviews with patients and providers from multiple sites of a Federally Qualified Health Center as part of a study on barriers and facilitators to cervical cancer screening among urban women experiencing homelessness. The Health Belief Model and trauma-informed frameworks guided the analysis. Results: Trauma histories were common among the 18 patients we interviewed. Many women also had strong physical and psychological reactions to screening, which influenced current behaviors and future intentions. Although most women had screened at least once in their lifetime, many patients experienced anticipated anxiety and retraumatization which pushed them to delay or refuse Paps. We recruited 11 providers who identified strategies they used to encourage screening, including emphasizing safety and shared decision-making before and during the exam, building strong patient–provider trust and communication, and individually tailoring education and counseling to patients’ needs. We outlined suggestions and implications from these findings as trauma-informed cervical cancer screening. Conclusion: Discomfort with Pap screening was common among women experiencing homelessness, especially those with histories of sexual trauma. Applying a trauma-informed approach to cervical cancer screening may help address complex barriers among women experiencing homelessness, with histories of sexual trauma, or others who avoid, delay, or refuse the exam.

Evaluation of mental disorder related to colposcopy procedure during the COVID period: A cross-sectional study

Background: The Coronavirus Disease (COVID-19) has had a significant impact on healthcare organizations, leading to a reduction in screening. The pandemic period has caused important psychological repercussions in the most fragile patients. Objectives: This study aimed to assess the levels of depression, anxiety, peri-traumatic stress, and physical symptoms in patients undergoing colposcopy during the COVID-19 pandemic and to compare these data with the post-pandemic period. Design: This longitudinal study included 96 individuals undergoing colposcopy, aged between 22 and 64, who were examined between March 2020 and December 2023. Methods: Participants were assessed at four distinct time points, referred to as T0, T1, T2, and T3. T0 encompassed the pandemic period, ranging from March 2020 to August 2020, while T1 occurred 1 year later, T2 and T3 correspond to data collected in 2022 and 2023. Statistical analysis was conducted to assess the impact of the COVID-19 pandemic on various psychological variables. Descriptive statistics, including means, standard deviations, and frequency distributions, were calculated for each psychological variable within each time period. Results: Our findings revealed a significant reduction in peri-traumatic stress and pain levels in the post-pandemic (from 2021 to 2023) period compared to the pandemic period. Conversely, anxiety and depression levels exhibited a statistically significant increase in the post-pandemic period and then gradually decrease in the subsequent follow-up. Conclusion: This study provides valuable insights into the profound impact of the COVID-19 pandemic on psychological distress experienced during the pandemic period itself, as well as its enduring effects on anxiety and depression in the subsequent period.

Non-attendance in cervical cancer screening among migrant women in Portugal: A cross-sectional study

Objectives: Cervical cancer has a high mortality rate among women worldwide. Although cervical cancer screening (CCS) is an effective strategy in reducing mortality of the disease, inequalities in accessing screening exist, particularly among migrant women. This study aims to characterize migrant women’s participation in CCS and determine factors associated with non-attendance to CCS. Methods: A cross-sectional study based on a web-based survey targeting adult migrant women living in Portugal was conducted. Prevalence of non-attendance to CCS was examined, and its associations with socioeconomic, migration-related, and health-related factors were determined using adjusted logistic regression models. Results: A total of 1100 migrant women were included in the study. Prevalence of CCS non-attendance was 24.5%. CCS non-attendance was associated with younger age, being born in Africa or Asia, being single/divorced/widowed, never having had a GP appointment in Portugal and not having regular gynecology appointments. Being born in South and Central America, shorter length of stay in Portugal, having had HPV vaccination, and not having children are associated with CCS attendance. Conclusion: These findings point out that an important percentage of migrant women do not attend CCS. Strategies to increase participation should be developed, considering the inequalities identified and designed to target the specific needs of migrant women to improve their CCS attendance and increase cervical cancer prevention.

The experience of under-screened and never-screened participants using clinician-supported self-collection cervical screening within the Australian National Cervical Screening Program

Background: Australia has had significant successes in the prevention of cervical cancer. However, there is considerable scope for improving screening participation. In December 2017, Australia shifted from cytology to a human papillomavirus–based screening program as part of the renewed National Cervical Screening Program. This provided the opportunity to introduce a clinician-supported self-collection cervical screening pathway, which allows screening participants aged 30 years or more and who are under-screened or never-screened to screen via a self-collected human papillomavirus test. Objective: This study aimed to explore screening participant experiences of a clinician-supported self-collection cervical screening pathway. Methods: Interviews (n = 45) were conducted with participants who had used the clinician-supported self-collection cervical screening pathway in the Australian National Cervical Screening Program between December 2017 and April 2019. Interviews were analyzed using template analysis. Results: Under-screened and never-screened participants reported a variety of interrelated barriers to cervical screening due to the nature of the test. For these participants, self-collection was a preferable way to perform screening as it overcame various barriers, was easy to use and promoted a sense of empowerment. Participants reported that the role of their practitioner was influential in their decision to undertake cervical screening, and that the support and information provided was a key factor in their experiences of the self-collection pathway. Conclusion: Findings support the use of a clinician-supported model of care, as an alternative screening modality in Australia’s National Cervical Screening Program. As more countries consider the move from a cytology to human papillomavirus–based cervical screening program, this model may assist in greater engagement of under-screened participants.