Cervical Cancer: Prevention and Early Detection

Factors affecting cervical cancer screening and human papilloma virus vaccination among Middle Eastern refugee women in Türkiye: indicators for social workers and nurses

BACKGROUND

This study aimed to generate knowledge regarding factors affecting cervical cancer screening and human papillomavirus vaccination that can be used practically by social workers and nurses while working with Middle Eastern refugee women living in Türkiye.

METHODS AND RESULTS

This study involved the administration of a self-reported questionnaire to 227 female migrants. It identified sociodemographic variables, such as age, marital status, and education level, that influenced the participation of these women in preventive practices against cervical cancer. Despite their cultural beliefs, financial constraints, and language hurdles, the findings indicated that the likelihood of involvement in screening and vaccination for cervical cancer was greater among refugee women if they were well-informed and assisted.

CONCLUSIONS

The results of this study suggest the necessity for specific training programs and improved initiatives for healthcare access to prevent cervical cancer among vulnerable groups. Healthcare providers can support preventive measures more effectively if these concerns are addressed with consideration of the sociocultural elements and language issues among Middle Eastern refugee women. Although some limitations associated with self-reported data collection methods may have introduced response bias, this study showed how social workers and nurses can act as facilitators to prevent cervical cancer.

Long noncoding RNAs and HPV-related cervical cancer: Uncovering molecular mechanisms and clinical applications

Cervical cancer (CC) is the primary cause of cancer-related mortality among women in developing countries and is the most prevalent disease linked to human papillomavirus (HPV). Over 70 % of CC cases result from persistent infections with high-risk HPV types. The virus typically targets the mucocutaneous epithelium, generating viral particles in mature epithelial cells, which leads to disruptions in normal cell-cycle regulation and promotes uncontrolled cellular proliferation. This unchecked cell division results in the accumulation of genetic damage, contributing to the pathogenesis of CC. While HPV infection is a key etiological factor, the disease's progression also necessitates the involvement of genetic and epigenetic influences. One of the epigenetic regulators, long noncoding RNAs (lncRNAs), are characterized by transcripts exceeding 200 nucleotides. These molecules play crucial roles in various cellular processes, including transcription regulation, RNA metaboli35 per 100,000sm, and apoptosis. Investigating the specific roles of lncRNAs in modulating gene expression related to the oncogenic mechanisms of CC, particularly in the context of high-risk HPV infections, may provide valuable insights for diagnostic and therapeutic advancements. Herein, we first review key molecular mechanisms by which lncRNAs interfere with CC-related HPV development. Then, diagnostic, prognostic, and therapeutic potentials of these lncRNA molecules will be highlighted in depth. The focus of this article is on the role of lncRNAs associated with HPV-related CC, emphasizing the investigation of signaling pathways and their underlying molecular mechanisms. Furthermore, we explore the therapeutic potential and diagnostic relevance of the most significant lncRNAs in the context of CC, thereby highlighting their importance in advancing treatment strategies and improving patient outcomes.

Factors that contribute to women's reluctance to undergo cervical cancer screening in clinics of Limpopo Province, South Africa

BACKGROUND

Cervical cancer is a prevalent global health issue, ranking as the fourth most frequently diagnosed cancer, with a high rate of mortality among women as compared to breast cancer. The present study aimed to examine factors contributing to women's reluctance to undergo cervical cancer screening in South African clinics, in Limpopo Province.

METHODS

This study used exploratory and descriptive qualitative design, conducted at five clinics in the Greater Giyani municipality in Limpopo Province among women aged 30 years and older. The clinics were chosen based on their low performance in cervical cancer screening between 2018 and 2020. Data was collected using semi-structured, in-depth face-to-face interviews. Data was analysed using Tesch's open coding method.

RESULTS

The present study revealed factors affecting reluctance to undergo cervical cancer screening. Three themes and their respective subthemes emerged from the analysis. The study noted a lack of knowledge relating to the causes, risk factors, and signs and symptoms of cervical cancer. Experiences that affected participants' reluctance to undergo cervical cancer screening included stereotyping of women regarding male health workers who provide screening services and pain associated with screening procedures. There were also challenges related to the accessibility of results to patients, fear of cancer diagnosis, and long waiting times at clinics.

CONCLUSION

While women generally have an awareness of who is at risk for cervical cancer and its signs and symptoms, various experiences and obstacles deter them from undergoing screening. Health information and education that emphasises the significance of preventing cervical cancer with efforts aimed at reaching women who seldom visit healthcare facilities is needed.

Determinants of Cervical Cancer Screening Among Rural Women in Zimbabwe

OBJECTIVE

To identify the determinants of cervical cancer (CC) screening among underserved rural women in Zimbabwe.

DESIGN

Community-based cross-sectional survey.

SAMPLE

840 rural women (25-65 years).

MEASUREMENTS

A structured, pretested questionnaire was used to collect data on sociodemographic characteristics and factors influencing screening. The outcome was defined as self-reported ever screening for CC. Multivariable logistic regression was used to examine the association between CC screening and independent variables.

RESULTS

Of the 840 women included, 33% had a history of screening. Women 25-45 years (adjusted odds ratio (aOR): 0.43; 95% CI: 0.30-0.61) and without medical insurance (aOR: 0.66; 95% CI: 0.45-0.97) had reduced odds of CC screening. Conversely, women who had seen or heard messages on CC screening (aOR: 1.48; 95% CI: 1.03-2.13), were living with HIV (aOR: 1.87; 95% CI: 1.22-2.87) reported recent antibiotic use (aOR: 4.50; 95% CI: 1.47-13.79) and had malaria in the last 6 months (aOR: 2.45; 95% CI: 1.02-5.86) had increased odds of CC screening.

CONCLUSION

There is a need for intensified efforts to improve CC screening uptake, particularly in underserved rural areas with suboptimal screening rates and high CC burden. Strategies should include widespread tailored awareness messaging targeting younger women, women living with HIV, and women without medical insurance.

A novel lightweight multi-scale feature fusion segmentation algorithm for real-time cervical lesion screening

AI-based cervical lesion segmentation in colposcopy images has significant potential in improving screening efficiency and accuracy. However, most current cervical lesion segmentation algorithms are insufficient for rapid image segmentation in mass screening due to heavy parameters and complex framework. Therefore, a lightweight algorithm segmentation for cervical lesion real-time screening system is urgently needed. In this paper, a novel lightweight LSIL + region segmentation framework termed Light-MDDNet is proposed and deployed, which uses the encoder-decoder architecture. In encoder stage, the first layer of MobileNetV2 module outputs shallow features which tend to be lost during multi-layer feature extraction. We also utilize the Denseaspp module to extract deeper semantic information. In the decoder stage, a multi-scale feature fusion (MFF) module is used to fuse multi-scale features. Finally, the algorithm is deployed and tested on the JETSON ORIN NX edge device in cervical lesion segmentation screening system. The experiments on 971 LSIL + colposcopy images of lesions processed with acetic acid show that our proposed model outperforms some state-of-the-art segmentation networks, with a pixel mean pixel accuracy (MPA) of 94.96% and an average speed per image of 19.60ms. After deployment on the mobile terminal, the segmentation accuracy of the model almost unchanged and the interference speed reduces to 31.57ms per image. The Light-MDDNet network achieves the best balance of accuracy and speed in cervical lesion segmentation, showing great potential for the deployment in the mass screening of cervical lesion.

Understanding Cervical Cancer Screening Attendance: Barriers and Facilitators in a Representative Population Survey

Background/Objectives: Cervical cancer causes high mortality rates globally despite the existence of cervical cancer screening. The purpose of this study is to investigate the factors limiting Romanian women's participation in cervical cancer screening, focusing on socio-demographic characteristics, health practices, sexual history, and personal health views. Methods: A cross-sectional study was conducted with a representative sample of 1605 women aged 25 to 64 from all regions of Romania. Computer-Assisted Telephone Interviewing was performed in February and March 2020. Logistic regression models assessed the impact of socio-demographic characteristics, psychosocial factors, sexual health history, and personal beliefs on non-participation, which were quantified using the odds ratio. Results: A percentage of 25.1% of women had never been screened for cervical cancer. Higher education and income levels were linked to higher screening rates. The adjusted odds for a lack of HPV awareness were significantly high (aOR: 2.45, 95% CI: 1.85-3.25), highlighting a gap in health knowledge affecting screening behavior. Not receiving a referral to a specialist from the primary care physician (aOR: 2.96, 95% CI: 2.09-4.19) was strongly associated with increased odds of non-participation. Personal beliefs about cancer prevention, health misconceptions, perceived costs, and stigma emerged as significant contributors to cervical cancer screening participation. Conclusions: Analyzing predictors influencing participation in cervical screening is crucial for public health in Romania, which has high cervical cancer mortality and low participation rates in cervical cancer screening. To improve participation, we recommend enhanced physician referrals, HPV awareness campaigns, addressing social stigma, and widespread communication about screening availability.

Multiple sexual partnership as an independent predictor of cervical cancer screening among women of reproductive age: an analysis of the 2022 Kenya demographic and health survey

BACKGROUND

Literature shows that women's sexual behavior, specifically, engagement in multiple sexual partnerships (MSP) has some association with the risk of developing cervical cancer. In the context of the Kenyan demographic and health survey, MSP is defined as having more one sexual partner excluding spouse, in last 12 months. Yet, it is unclear how engagement in MSP independently predicts women's uptake of cervical cancer screening (CCS). The study examined the association between recent MSP and CCS uptake among women of reproductive age in Kenya.

METHODS

Data of 16,824 women aged 15-49 who participated in the 2022 Kenya demographic and health survey was used. Recent MSP was defined as having more than one sexual partner, excluding spouse, in last 12 months. The analysis was carried out in STATA version 18. Chi-square tests, bivariable and multivariable logistic regression were performed. The adjusted odds ratio from the multivariable logistic regression were reported along with the 95% confidence interval (CI).

RESULTS

The analysis shows that only 16.68% of the sampled women (i.e., 2,837 out of a total sample of 16,824) had ever been screened for cervical cancer by a healthcare professional. In the bivariable analysis, women who were involved in MSP were more likely [OR = 1.20; 95%CI: 1.07-1.34] to undergo screening for cervical cancer compared to those not involved in MSP. This association remains significant after adjusting for confounders [AOR = 1.34; 95%CI: 1.19-1.52].

CONCLUSION

The low screening rate in Kenya is concerning given the importance of early detection in improving cervical cancer outcomes. The study concludes that recent engagement in MSP is significantly associated with women's uptake of CCS. The study further concludes that there is a need for public health campaigns to raise awareness about the importance of cervical cancer screening among all women, regardless of their sexual behavior. Educational initiatives must emphasize that cervical cancer screening is crucial for all women, not just those with MSP.

Evaluation of pathology resources for cervical cancer detection between 2018 and 2022: a retrospective study at Moi Teaching and Referral Hospital, Western Kenya

BACKGROUND

Cervical cancer cases are increasing in sub-Saharan Africa, particularly in Kenya, exacerbated by inadequate histopathology resources, posing a significant barrier to timely diagnosis and treatment. There has been little research on the availability and evolution of histopathology resources for diagnosing cervical cancer over the years. This retrospective study evaluated this evolution at Moi Teaching and Referral Hospital in Kenya between 2018 and 2022.

METHODS

We used a mixed-methods approach. An in-depth interview was conducted with one of MTRH's pathology laboratory staff to assess the equipment, personnel, and quality control trends between 2018 and 2022. A thematic analysis was conducted in NVivo. We also retrospectively conducted a comprehensive inventory review of laboratory resources from 2018 to 2022 via purposive sampling. Microsoft Excel and Stata version 17 were utilized for descriptive statistical analysis. Turnaround time (TAT) was assessed against the UK's National Health Service Cervical Screening Program guidelines.

RESULTS

The number of histopathology laboratory personnel at MTRH increased from 2018 to 2022, during which the facility included two pathologists, one records person, and one office administrator. Cervical cancer biopsy samples processed by the histopathology lab increased from 225 in 2018 to 674 in 2022. However, the histopathology personnel-to-population ratio decreased from 1.5 pathologists and 2.7 histo-technicians per 100,000 in 2018 to 1.4 pathologists and 1.8 histo-technicians per 100,000 in 2022. Despite this decrease, lab equipment, automatic tissue processors and embedding machines were added, and an average 14-day turnaround time was maintained for cervical cancer pathology reports.

CONCLUSIONS

Our study highlights a growing burden of cervical cancer with biopsy samples processed by the MTRH histopathology laboratory, increasing from 225 in 2018 to 674 in 2022. Despite challenges such as a declining staff-to-patient ratio and limited resources, the lab maintained a commendable 14-day turnaround time, supporting timely cervical cancer diagnoses. These findings emphasize the need for continued investment in pathology resources and personnel to enhance diagnostic capacity and address the rising incidence of cervical cancer in Kenya and similar low-resource settings. The decline in the personnel-to-patient ratio underscores challenges in diagnosis, emphasizing the need to address workforce and infrastructure gaps to improve patient care within similar low-resource settings.

Barriers to early diagnosis and treatment of cervical cancer in Addis Ababa, Ethiopia: qualitative study

OBJECTIVE

Cervical cancer remains the most diagnosed and deadly cancer among women in low and middle income countries, including Ethiopia, although it can be controlled if detected and treated early. However, research on contextual barriers to early diagnosis and treatment of cervical cancer is limited in Ethiopia. This study aimed to describe the lived experience of the patients and to explore the barriers to early diagnosis and treatment of cervical cancer.

DESIGN

We conducted a phenomenological qualitative study, which was part of a larger mixed-methods study.

SETTING

Tikur Anbesa Specialised Comprehensive Hospital, Addis Ababa, Ethiopia.

PARTICIPANTS

24 purposively selected patients with diagnostic delay and 16 patients with treatment delay were interviewed using an in-depth interview guide (IDI).

RESULTS

Two broad themes and seven sub-themes to explain the barriers to early diagnosis and treatment of cervical cancer emerged. These themes and sub-themes include patient related barriers (inadequate knowledge, visits to traditional healers and practice of religious rituals as a solution for illness, poor adherence to the treatments and fear of side effects, and financial hardships) and provider related barriers (limited access to diagnostic and treatment infrastructure, inadequate training of healthcare providers and poor quality of care).

CONCLUSIONS

The findings of the study underscore the need to reinforce awareness among patients and the community, scale up the screening, diagnostic and treatment infrastructure, and advocate for quality of care in the healthcare facilities in Ethiopia to promote early diagnosis and treatment of cervical cancer.

Interpretable artificial intelligence (AI) for cervical cancer risk analysis leveraging stacking ensemble and expert knowledge

Objectives

This study develops a machine learning (ML)-based cervical cancer prediction system emphasizing explainability. A hybrid feature selection method is proposed to enhance predictive accuracy and stability, alongside evaluation of multiple classification algorithms. The integration of explainable artificial intelligence (XAI) techniques ensures transparency and interpretability in model decisions.

Methods

A hybrid feature selection approach combining correlation-based selection and recursive feature elimination is introduced. An ensemble model integrating random forest, extreme gradient boosting, and logistic regression is compared against eight classical ML algorithms. Generative artificial intelligence methods, such as variational autoencoders and generative teaching networks, were evaluated but showed suboptimal performance. The research integrates global and local XAI techniques, including individual feature contributions and tree-based explanations, to interpret model decisions. The effects of feature selection and data balancing on classification performance are examined to stabilize precision, recall, and F1 scores. Classical ML models without preprocessing achieve 95-96% accuracy but exhibit instability.

Results

The proposed feature selection and data balancing strategies significantly enhance classification stability, creating a robust predictive model. The ensemble model achieves 98% accuracy with an area under the curve of 99.50%, outperforming other models. Domain experts validate critical contributing features, confirming practical relevance. Incorporating domain knowledge with XAI techniques significantly increases transparency, making predictions interpretable and trustworthy for clinical use.

Conclusion

Hybrid feature selection combined with ensemble learning substantially improves cervical cancer prediction accuracy and reliability. The integration of XAI techniques ensures transparency, supporting interpretability and trustworthiness, demonstrating significant potential in clinical decision-making.

Interaction of High- and Low-Risk Human Papillomavirus Genotypes is Associated with a Reduced Risk of Developing Cervical Cancer

INTRODUCTION

Cervical cancer is among the most common types of cancer in women and is associated with human papillomavirus (HPV) infection. The association between cervical cancer and high-risk HPV infection has been well documented. However, the effect of simultaneous infection with high- and low-risk HPV or low-risk HPV alone on the risk of developing cervical malignancy remains unanswered in guidelines.

METHOD

We investigated the association of high and low-risk HPVs (HR or LR) genotypes with cervical carcinoma risk and pathological and cytological information in cases recruited from a population- based cohort study of 790 patients. Correlation matrix and t-test were used for analysis.

RESULTS

The percentage of HR+LR and HR-HPV16/18 were 9.30% and 11.20% in class II, 7.15% and 7.10% in class IV, and 7.15% and 5.80% in As-CUS smears. Interestingly, concurrent infection with HR-HPV and LR-HPV types led to a significant reduction in the risk of developing malignancy compared to the high-risk group (OR=0.3 (0.098-0.925), pvalue= 0.04). The percentage of individuals with cervical malignancy was 10.2% and 28.2% within the co-infected and the HR-HPV participants.

CONCLUSION

Our findings suggest that simultaneous infection with high- and low-risk HPV may reduce the risk of cervical malignancy.

Synergistic enhancement: Exploring the potential of piperine in cancer therapeutics through chemosensitization and combination therapies

Despite significant advancements in chemotherapy, effective treatments for advanced cancer stages remain largely elusive due to chemoresistance. Resistance to anticancer agents in cancer cells can arise through various mechanisms, including multi-drug resistance, inhibition of apoptosis, modification of drug targets, and enhancement of DNA repair capabilities. Consequently, there is a critical need for agents that can suppress the molecular signatures responsible for drug resistance. Piperine, an active alkaloid extracted from Piper nigrum L. (black pepper), is one such agent that has been extensively studied for its potential in addressing chronic diseases, including cancer. Piperine's antineoplastic properties are mediated through the regulation of numerous key cellular signaling pathways and the modulation of various biological processes. Its capability to enhance drug bioavailability and counteract mechanisms of drug resistance, such as the inhibition of P-glycoprotein (P-gp) and multidrug resistance-associated protein 1 (MRP-1), emphasizes its potential as an adjunct in cancer therapy. Research across various cancer types has demonstrated piperine's role in chemosensitization by targeting P-gp and MRP-1 and altering drug-metabolizing enzymes. This review provides a comprehensive analysis of piperine's pharmacological characteristics and its capacity to modulate several cellular signaling pathways involved in drug resistance. Furthermore, the review emphasizes how piperine, when used in conjunction with other chemotherapeutic agents or natural compounds, can enhance therapeutic effects, leading to improved outcomes in cancer treatment.

Unrevealing Lithium Repositioning in the Hallmarks of Cancer: Effects of Lithium Salts (LiCl and Li2CO3) in an In Vitro Cervical Cancer Model

Lithium, a natural element, has been employed as a mental stabilizer in psychiatric treatments; however, some reports indicate it has an anticancer effect, prompting the consideration of repurposing lithium for cancer treatment. The potential anticancer use of lithium may depend on its form (salt type) and the type of cancer cells targeted. Little is known about the effects of Li2CO3 or LiCl on cancer cells, so we focused on exploring their effects on proliferation, apoptosis, migration, and cell cycle as part of the hallmarks of cancer. Firstly, we established the IC50 values on HeLa, SiHa, and HaCaT cells with LiCl and Li2CO3 and determined by crystal violet that cell proliferation was time-dependent in the three cell lines (IC50 values for LiCl were 23.43 mM for SiHa, 23.14 mM for HeLa, and 15.10 mM for HaCaT cells, while the IC50 values for Li2CO3 were 20.57 mM for SiHa, 11.52 mM for HeLa, and 10.52 mM for HaCaT cells.) Our findings indicate that Li2CO3 and LiCl induce DNA fragmentation and caspase-independent apoptosis, as shown by TUNEL, Western Blot, and Annexin V/IP assay by flow cytometry. Also, cell cycle analysis showed that LiCl and Li2CO3 arrested the cervical cancer cells at the G1 phase. Moreover, lithium salts displayed an anti-migratory effect on the three cell lines observed by the wound-healing assay. All these findings imply the viable anticancer effect of lithium salts by targeting several of the hallmarks of cancer.

SQLE-a promising prognostic biomarker in cervical cancer: implications for tumor malignant behavior, cholesterol synthesis, epithelial-mesenchymal transition, and immune infiltration

BACKGROUND

Cervical cancer, encompassing squamous cell carcinoma and endocervical adenocarcinoma (CESC), presents a considerable risk to the well-being of women. Recent studies have reported that squalene epoxidase (SQLE) is overexpressed in several cancers, which contributes to cancer development.

METHODS

RNA sequencing data for SQLE were obtained from The Cancer Genome Atlas. In vitro experiments, including colorimetry, colony formation, Transwell, RT-qPCR, and Western blotting were performed. Furthermore, a transplanted CESC nude mouse model was constructed to validate the tumorigenic activity of SQLE in vivo. Associations among the SQLE expression profiles, differentially expressed genes (DEGs), immune infiltration, and chemosensitivity were examined. The prognostic value of genetic changes and DNA methylation in SQLE were also assessed.

RESULTS

SQLE mRNA expression was significantly increased in CESC. ROC analysis revealed the strong diagnostic ability of SQLE toward CESC. Patients with high SQLE expression experienced shorter overall survival. The promotional effects of SQLE on cancer cell proliferation, metastasis, cholesterol synthesis, and EMT were emphasized. DEGs functional enrichment analysis revealed the signaling pathways and biological processes. Notably, a connection existed between the SQLE expression and the presence of immune cells as well as the activation of immune checkpoints. Increased SQLE expressions exhibited increased chemotherapeutic responses. SQLE methylation status was significantly associated with CESC prognosis.

CONCLUSION

SQLE significantly affects CESC prognosis, malignant behavior, cholesterol synthesis, EMT, and immune infiltration; thereby offering diagnostic and indicator roles in CESC. Thus, SQLE can be a novel therapeutic target in CESC treatment.

In-host density-dependent model of high-risk HPV virions, basal cells, lymphocytes t-cells incorporating functional responses

Cervical cancer is one of the most common types of cancer and it is caused mostly by high-risk Human Papillomavirus (HPV) and continues to spread at an alarming rate. While HPV impacts have been investigated before, there are currently only a scanty number of mathematical models that account for HPV's dynamic role in cervical cancer. The objectives were to develop an in-host density-dependent deterministic model for the dynamics implications of basal cells, virions, and lymphocytes incorporating immunity and functional responses. Analyze the model using techniques of epidemiological models such as basic reproduction number and simulate the model using Matlab ODE solver. Six compartments are considered in the model that is; Susceptible cells (S), Infected cells (I), Precancerous cells (P), Cancerous cells (C), Virions (V), and Lymphocytes (L). Next generation matrix (NGM), survival function, and characteristic polynomial method were used to determine the basic reproduction number denoted asR 0 . R 0 was obtained using three methods because NGM has some weaknesses hence the need for the other two methods. The findings from this research indicated that Disease-Free Equilibrium point is locally asymptotically stable wheneverR 0 * < 1 and globally asymptotically stable ifR 0 * ≤ 1 and the Endemic Equilibrium is globally asymptotically stable ifR 0 * > 1 . The results obtained shows that the progression rate of precancerous cells to cancerous cells ( θ ) has the most direct impact on the model. The model was able to estimate the longevity of a patient as 10 days when ( θ ) increases by 0.08 . The findings of this research will help healthcare providers, public health authorities, and non-governmental health groups in creating effective prevention strategies to slow the development of cervical cancer. More research should be done to determine the exact number of cancerous cells that can lead to the death of a cervical cancer patient since this paper estimated a proportion of 75 % .

Socioeconomic Inequities in Pap Test Use Among Black Women in the United States: An Intersectional Approach

INTRODUCTION

Research investigating racialized inequities in cervical cancer screening has rarely considered the influence of socioeconomic position (SEP), a key social determinant of health that intersects with race/ethnicity and racism. Thus, data on socioeconomic inequities in Pap test use within racialized groups-including Black women, who are at elevated risk of cervical cancer morbidity and mortality-are limited.

METHODS

Using 2011-2019 data from the National Survey of Family Growth and guided by an intersectional framework, we used multivariable logistic regression to examine the association between educational attainment, employment status, and income and the adjusted odds of Pap test use in the last 3 years among Black U.S. women.

RESULTS

Compared to Black women with a bachelor's degree or greater, those with less than a high school diploma ([odds ratio] = 0.45; [95% confidence interval] 0.31-0.67) and a high school diploma/GED (0.57; 0.40-0.81) had significantly lower odds of Pap test use, adjusting for sociodemographic factors. Unemployed women had significantly lower adjusted odds of Pap test use compared to employed women (0.67; 0.50-0.89), and women living below 100% of the federal poverty level (FPL) had significantly lower adjusted odds of Pap test use relative to those living at or above 300% FPL (0.63; 0.45-0.88).

CONCLUSION

Low-SEP Black women had significantly lower adjusted odds of Pap test use relative to their higher SEP counterparts. Interventions that address both racism and economic barriers to care are needed to facilitate access to regular cervical cancer screening among low-SEP Black women.

Evaluation of Pathology Resources for Cervical Cancer Detection Between 2018 & 2022: a Retrospective Study at Moi Teaching and Referral Hospital, Western Kenya

Background

Cervical cancer cases are increasing in sub-Saharan Africa, particularly in Kenya, exacerbated by inadequate histopathology resources, posing a significant barrier to timely diagnosis and treatment. There has been little research on the availability and evolution of histopathology resources for diagnosing cervical cancer over the years. This retrospective study evaluated this evolution at Moi Teaching and Referral Hospital in Kenya between 2018 and 2022.

Methods

We used a mixed-methods approach. An in-depth interview was conducted with one of MTRH's pathology laboratory staff to assess the equipment, personnel, and quality control trends between 2018 and 2022. A thematic analysis was conducted in NVivo. We also retrospectively conducted a comprehensive inventory review of laboratory resources from 2018-2022 via purposive sampling. Microsoft Excel and Stata version 17 were utilized for descriptive statistical analysis. Turnaround time (TAT) was assessed against the UK's National Health Service Cervical Screening Program guidelines.

Results

The number of histopathology laboratory personnel at MTRH increased from 2018 to 2022, during which the facility included two pathologists, one records person, and one office administrator. Patient annual visits increased from approximately 350,000 in 2018 to approximately 500,000 in 2022. However, the histopathology personnel-to-population ratio decreased from 1.5 pathologists and 2.7 histo-technicians per 100,000 in 2018 to 1.4 pathologists and 1.8 histo-technicians per 100,000 in 2022. Despite this decrease, lab equipment, automatic tissue processors and embedding machines were added, and an average 14-day turnaround time was maintained for pathology reports.

Conclusions

Despite a decreased personnel-to-patient ratio, the addition of crucial histopathology equipment mirrors the operational commitment of the Moi Teaching and Referral Hospital. The 14-day TAT is commendable, contributes to operational effectiveness and significantly contributes to timely detection. The hospital's dedication to upgrading its infrastructure underscores a proactive approach to addressing growing healthcare demands and improving patient outcomes, even with limited human resources. The decline in the personnel-to-patient ratio underscores challenges in diagnosis, emphasizing the need to address workforce and infrastructure gaps to improve patient care within similar low-resource settings.

Cervical cancer screening practice and associated factors among female health care professionals in Ethiopia 2024: a systematic review and meta-analysis

BACKGROUND

Cervical cancer, ranking as the fourth most common gynecological cancer worldwide, claimed an estimated 570,000 lives and resulted in 311,000 new cases in 2018. This disease disproportionately affects those living in poverty and is more prevalent in countries with weak healthcare systems. Low and middle-income nations, particularly in Sub-Saharan Africa, face higher incidence and mortality rates due to limited access to vaccines, screening, and treatment. The world health organization recommends regular screening for women from age 25, setting a 90-70-90 target for low- and middle-income countries by 2030. Despite limited previous knowledge, the study aims to assess the pooled prevalence of cervical cancer screening practices and associated factors among female healthcare professionals in Ethiopia in 2024.

OBJECTIVE

The study aimed to synthesize the existing literature on cervical cancer screening practice and associated factors among female health workers in Ethiopia.

METHODS

Studies were searched through the search engine of Google Scholar, PubMed, and Cochrane Library. Searching was made using Keywords/ MeSH terms Cervical cancer; utilization; Preventive practice. Heterogeneity was assessed using the Cochran Q test and I2 statistics. A random-effects model with a 95% confidence interval was used for the pooled prevalence and odds ratio estimations.

RESULT

Seven studies were included in this systematic review and meta-analysis. The overall pooled prevalence of cervical cancer screening practice among female health workers in Ethiopia was 18%. Work place(OR = 2.858;95% CI: 0.412, 5.305),knowledge(OR = 3.457; 95% CI: 2.314, 4.601), work experience(OR = 5.421; 95% CI:4.178,6.664),being diagnosed(OR = 10.787; 95% CI: 06.197,15.377) and ever cared of cervical cancer patient (OR = 2.93; 95% CI: 2.004, 3.856) were the pooled associated factors that are significantly associated with cervical cancer screening practice among female health care worker.

CONCLUSION

The implementation of preventive measures for cervical cancer screening was found to be suboptimal. Our findings underscore the importance of enhancing awareness among this demographic, which is crucial in mobilizing local communities. It is imperative to provide continuous education to female health workers regarding cervical cancer. The Ministry of Health should collaborate with various organizations to ensure the accessibility of cost-effective screening services in all healthcare facilities.

Metal-based approaches to fight cervical cancer

Cervical cancer (CC) is one of the leading causes of death among women worldwide. The current treatments for this cancer consist of invasive methods such as chemotherapeutic drugs, radiation, immunotherapy and surgery, which could lead to severe side effects and hinder the patient's life quality. Although metal-based therapies, including cisplatin and ruthenium-based compounds, offer promising alternatives, they lack specificity and harm healthy cells. Combining metal nanoparticles with standard approaches has demonstrated remarkable efficacy and safety in the fight against CC. Overall, this review is intended to show the latest advancements and insights into metal-based strategies, creating a promising path for more effective and safer treatments in the battle against CC.

Determination of Opinions on HPV Infection and HPV Vaccine among Nursing Students by Focus Group Discussion

Purpose: This study aimed to determine nursing students' opinions about human papillomavirus (HPV) infection and HPV vaccine. Methods: This is a qualitative focus group discussion study, in which a state university in Western Turkey, undergraduate nursing students are recruited through purposive sampling. The research data were collected on an online platform with the focus group interview method by using the Participant Information Form and Semistructured Interview Form. Results: Three main themes (HPV infection/vaccine perception, severity perception, and suggestions and requests/facilitators) and eight subthemes were developed based on the thematic analysis of the research findings. Conclusions: According to the findings, it was concluded that nursing students' opinions on HPV infection and HPV vaccine were affected by factors related to cultural, religious, and sexual behaviors. Based on study results, it is suggested to organize national cervical screening programs to increase public's knowledge and awareness on the subject in accordance with the sociocultural norms of the society with the agreement and cooperation of educated health service providers, policy makers, and educators.

Utilising deep learning networks to classify ZEB2 expression images in cervical cancer

Aims/Background Cervical cancer continues to be a significant cause of cancer-related deaths among women, especially in low-resource settings where screening and follow-up care are lacking. The transcription factor zinc finger E-box-binding homeobox 2 (ZEB2) has been identified as a potential marker for tumour aggressiveness and cancer progression in cervical cancer tissues. Methods This study presents a hybrid deep learning system developed to classify cervical cancer images based on ZEB2 expression. The system integrates multiple convolutional neural network models-EfficientNet, DenseNet, and InceptionNet-using ensemble voting. We utilised the gradient-weighted class activation mapping (Grad-CAM) visualisation technique to improve the interpretability of the decisions made by the convolutional neural networks. The dataset consisted of 649 annotated images, which were divided into training, validation, and testing sets. Results The hybrid model exhibited a high classification accuracy of 94.4% on the test set. The Grad-CAM visualisations offered insights into the model's decision-making process, emphasising the image regions crucial for classifying ZEB2 expression levels. Conclusion The proposed hybrid deep learning model presents an effective and interpretable method for the classification of cervical cancer based on ZEB2 expression. This approach holds the potential to substantially aid in early diagnosis, thereby potentially enhancing patient outcomes and mitigating healthcare costs. Future endeavours will concentrate on enhancing the model's accuracy and investigating its applicability to other cancer types.

The cervical cancer related distribution, coinfection and risk of 15 HPV types in Baoan, Shenzhen, in 2017-2023

Cervical cancer is one of the most common malignant tumours. Human papillomavirus (HPV) infection is the main cause of this cancer so that it could be prevented by screening and early treatment. Developing reginal screen protocols of maximum public health efficacy requires in-depth understandings of local HPV distribution and consequential cancer risks. Therefore, test results of HPV genotyping, cytology testing (TCT) and colposcopy inspection with biopsy were collected in this retrospective research. Data included by this research involved 63,906 women received screen related tests from Shenzhen Baoan Shiyan People's Hospital and the subsidiary institutes between 2017.01 and 2023.05. 10,238 colposcopies were performed in this period collecting 8,716 samples and 814 high-grade CIN were discovered. Within the 763 high-grade CIN cases with both TCT and HPV testing results, 232 were tested cytologically normal but only 30 were negative in HPV test. Besides, the rates of high-grade CIN observed in coinfection were all lower than the estimated rates generated from related single infection. HPV 52, 58 and 16 were found to be the most common types in Baoan, Shenzhen. The result also suggested that HPV coinfections should not increase risk for cervical cancers.

Predicted Cervical Cancer Prevention: Impact of National HPV Vaccination Program on Young Women in South Korea

PURPOSE

This study aimed to evaluate the effectiveness of the national human papillomavirus (HPV) vaccination program of South Korea among its entire female population, particularly among younger age groups.

MATERIALS AND METHODS

We first predicted the incidence of cervical cancer over the next 20 years (2021-2040) using the Nordpred package based on Møller's age-period-cohort model under several scenarios for the national HPV vaccination program. We calculated the potential impact fractions and proportional differences under the current national vaccination programs, and alternative scenarios using the no-vaccination assumption as a reference.

RESULTS

We estimated that the current national vaccination program would prevent 4.13% of cervical cancer cases and reduce the age-standardized incidence rate (ASR) by 8.79% in the overall population by 2036-2040. Under the alternative scenario of implementing the nine-valent vaccine, 5.13% of cervical cancer cases could be prevented and the ASR reduced by 10.93% during the same period. In another scenario, expanding the vaccination age to 9-17 years could prevent 10.19% of cervical cancer cases, with the ASR reduced by 18.57% during the same period. When restricted to ages < 40 years, the prevention effect was remarkably greater. We predict that the current national HPV program will reduce its incidence by more than 30% between 2036 and 2040 in women aged < 40 years.

CONCLUSION

The effectiveness of the vaccination program in reducing the incidence of cervical cancer was confirmed, with a considerable impact anticipated in younger age groups.

Barriers to and opportunities for advancing racial equity in cervical cancer screening in the United States

BACKGROUND

In the United States (U.S.), racially minoritized people have higher rates of cervical cancer morbidity and mortality compared to white individuals as a result of racialized structural, social, economic, and health care inequities. However, cervical cancer screening guidelines are based on studies of predominately white individuals and do not substantially discuss or address racialized cervical cancer inequities and their social determinants, including racism.

METHODS

We conducted in-depth interviews with health care providers (N = 30) and key informants with expertise in health equity (N = 18). We utilized semi-structured interview guides that addressed providers' views and experiences delivering cervical cancer screening to racially minoritized individuals and key informants' recommendations for advancing racial equity in the development and implementation of cervical cancer screening guidelines. Interviews were analyzed using a template style thematic analysis approach involving deductive and inductive coding, memo writing, and matrix analysis for theme development.

RESULTS

Most health care providers adopted a universal, one-size-fits-all approach to cervical cancer screening with the stated goal of ensuring racial equality. Despite frequently acknowledging the existence of racialized cervical cancer inequities, few providers recognized the role of social inequities in influencing them, and none discussed the impact of racism. In contrast, key informants overwhelmingly recommended that providers adopt an approach to cervical cancer screening and follow-up care that recognizes the role of racism in shaping racialized cervical cancer and related social inequities, is developed in partnership with racially minoritized communities, and involves person-centered, structurally-competent, and trauma-informed practices that address racially minoritized peoples' unique lived experiences in historical and social context. This racism-conscious approach is not to be confused with race-based medicine, which is an essentialist and racist approach to health care that treats race as a biological variable rather than as a social and political construct.

CONCLUSIONS

Developers and implementers of cervical cancer screening guidelines should explicitly recognize and address the impact of racism on cervical cancer screening, follow-up care, and outcomes, meaningfully incorporate racially minoritized communities' perspectives and experiences, and facilitate provider- and institutional-level practices that foster racial equity in cervical cancer.

EPAS1, a hypoxia- and ferroptosis-related gene, promotes malignant behaviour of cervical cancer by ceRNA and super-enhancer

Hypoxia and Ferroptosis are associated with the malignant behaviour of cervical cancer. Endothelial PAS domain-containing protein 1 (EPAS1) contributes to the progression of cervical cancer. EPAS1 plays important roles in hypoxia and ferroptosis. Using the GEO dataset, machine-learning algorithms were used to screen for hypoxia- and ferroptosis-related genes (HFRGs) in cervical cancer. EPAS1 was identified as the hub gene. qPCR and WB were used to investigate the expression of EPAS1 in normal and cervical cancer tissues. The proliferation, invasion and migration of EPAS1 cells in HeLa and SiHa cell lines were detected using CCK8, transwell and wound healing assays, respectively. Apoptosis was detected by flow cytometry. A dual-luciferase assay was used to analyse the MALAT1-miR-182-5P-EPAS1 mRNA axis and core promoter elements of the super-enhancer. EPAS1 was significantly overexpressed in cervical cancer tissues. EPAS1 could increase the proliferation, invasion, migration of HeLa and SiHa cells and reduce the apoptosis of HeLa and SiHa cell. According to the double-luciferase assay, EPAS1 expression was regulated by the MALAT1-Mir-182-5p-EPAS1 mRNA axis. EPAS1 is associated with super-enhancers. Double-luciferase assay showed that the core elements of the super-enhancer were E1 and E3. EPAS1, an HFRG, is significantly overexpressed in cervical cancer. EPAS1 promotes malignant behaviour of cervical cancer cells. EPAS1 expression is regulated by super-enhancers and the MALAT1-miR-182-5P- EPAS1 mRNA axis. EPAS1 may be a target for the diagnosis and treatment of cervical cancer.

Circular RNAs and cervical cancer: friends or foes? A landscape on circRNA-mediated regulation of key signaling pathways involved in the onset and progression of HPV-related cervical neoplasms

Cervical cancer (CC) is a common gynecologic malignancy, accounting for a significant proportion of women death worldwide. Human papillomavirus (HPV) infection is one of the major etiological causes leading to CC onset; however, genetic, and epigenetic factors are also responsible for disease expansion. Circular RNAs (circRNAs), which are known as a particular subset of non-coding RNA (ncRNA) superfamily, with covalently closed loop structures, have been reported to be involved in the progression of diverse diseases, especially neoplasms. In this framework, abnormally expressed circRNAs are in strong correlation with CC pathogenesis through regulating substantial signaling pathways. Also, these RNA molecules can be considered as promising biomarkers and therapeutic targets for CC diagnosis/prognosis and treatment, respectively. Herein, we first review key molecular mechanisms, including Wnt/β-catenin, MAPK, and PI3K/Akt/mTOR signaling pathways, as well as angiogenesis and metastasis, by which circRNAs interfere with CC development. Then, diagnostic, prognostic, and therapeutic potentials of these ncRNA molecules will be highlighted in depth.

Overlapping cytoplasms segmentation via constrained multi-shape evolution for cervical cancer screening

Segmenting overlapping cytoplasms in cervical smear images is a clinically essential task for quantitatively measuring cell-level features to screen cervical cancer This task, however, remains rather challenging, mainly due to the deficiency of intensity (or color) information in the overlapping region Although shape prior-based models that compensate intensity deficiency by introducing prior shape information about cytoplasm are firmly established, they often yield visually implausible results, as they model shape priors only by limited shape hypotheses about cytoplasm, exploit cytoplasm-level shape priors alone, and impose no shape constraint on the resulting shape of the cytoplasm In this paper, we present an effective shape prior-based approach, called constrained multi-shape evolution, that segments all overlapping cytoplasms in the clump simultaneously by jointly evolving each cytoplasm's shape guided by the modeled shape priors We model local shape priors (cytoplasm-level) by an infinitely large shape hypothesis set which contains all possible shapes of the cytoplasm In the shape evolution, we compensate intensity deficiency for the segmentation by introducing not only the modeled local shape priors but also global shape priors (clump-level) modeled by considering mutual shape constraints of cytoplasms in the clump We also constrain the resulting shape in each evolution to be in the built shape hypothesis set for further reducing implausible segmentation results We evaluated the proposed method in two typical cervical smear datasets, and the extensive experimental results confirm its effectiveness.

HPV16 E6 promoting cervical cancer progression through down-regulation of miR-320a to increase TOP2A expression

BACKGROUND

Cervical cancer (CC) has become the fourth most common cancer worldwide and it is mainly caused by the infection of human papillomavirus (HPV), especially high-risk HPV16. Aberrant miRNA expression in CC is closely related to HPV16 infection, and the regulation of HPV16 E6 expression can affect a variety of miRNA expression. This study aims to exploring the miRNAs involved in E6 regulation in CC.

METHODS

Our study screened differentially expressed miRNAs in cervical cells of HPV16 infected and uninfected cervical cancer patients by analyzing the GSE81137 dataset of the gene expression omnibus database (GEO), and identified miR-320a that plays an anti-tumor role and is associated with good prognosis of cervical cancer. Explore the effect of HPV16 E6 on the expression of miR-320a in cervical cancer, and verify whether HPV16 E6 regulates the downstream target gene TOP2A expression through miR-320a, thereby affecting cervical cancer cell proliferation, apoptosis, migration, invasion, and EMT in vitro and in vivo.

RESULTS

The bioinformatic methods selected the miR-320a, which was differentially expressed in cervical cells from HPV16-infected patients compared to uninfected patients. We further demonstrated that miR-320a level was regulated by HPV16 E6, which promoted the CC cell proliferation, migration, invasion, and inhibited apoptosis. In addition, we predicted the downstream target genes of miR-320a and confirmed that TOP2A was one of its targeting proteins. Moreover, HPV16 E6 promoted the TOP2A expression in CC cells through down-regulating miR-320a, leading to promoting CC development.

CONCLUSIONS

We confirmed that HPV16 E6 promoted the TOP2A expression through down-regulation of miR-320a, thus promoting CC development, and the HPV16 E6/miR-320a/TOP2A axis may perform as a potential target for CC treatment.

Constructed competitive endogenous RNA network and patterns of immune infiltration revealing the prognostic signature for cervical cancer

Aim: To investigate the relationship between potential abnormal epigenetic modification and immune cell infiltration in patients with cervical carcinoma. Materials & methods: RNA expression profiles from The Cancer Genome Atlas database were used to explore the relationship between key biomarkers and tumor-infiltrating immune cells and for clinical specimen validation. Results: Two nomogram models were developed, one with specific ceRNA and the other based on biological markers of related tumor-infiltrating immune cells. Moreover, a key biomarker (RIPOR2), which was significantly relevant to CD8 T cells. Conclusion: RIPOR2 and CD8 T cells play a crucial role in the development and progression of cervical carcinoma, suggesting their potential as markers for guiding future therapeutic strategies.

Determinants of late-stage cervical cancer presentation in Ethiopia: a systematic review and meta-analysis

INTRODUCTION

Behind breast, colorectal, and lung cancers, cervical cancer is the fourth most common cancer affecting females. Despite, it is a preventable form of cancer both the incidence and mortality figures reflect it as a major reproductive health problem. Late-stage cervical cancer diagnosis is associated with complicated clinical presentation which can result in short survival time and increased mortality. Several factors contribute to the late-stage presentation of cervical cancer patients. In Ethiopia nationally summarized evidence on the level and the factors contributing to late-stage cervical cancer diagnosis is scarce. Therefore, this systematic review and meta-analysis aimed to assess the pooled prevalence of late-stage cervical cancer diagnosis and its determinants in Ethiopia.

METHOD

A systematic review and meta-analysis were conducted using PRISMA guidelines. Comprehensive literature was searched in PubMed, Embase, Google Scholar, and African Online Journal to retrieve eligible articles. A weighted inverse variance random effect model was used to estimate pooled prevalence. Cochrane Q-test and I2 statistics were computed to assess heterogeneity among studies. Funnel plot and Egger's regression test were done to assess publication bias.

RESULT

Overall, 726 articles were retrieved and finally 10 articles were included in this review. The pooled prevalence of late-stage cervical cancer diagnosis in Ethiopia was 60.45% (95%CI; 53.04%-67.85%). Poor awareness about cervical cancer and its treatment (AOR = 1.55, 95% CI: (1.03 - 2.33, longer delay to seek care (AOR = 1.02, 95% CI: (1.01 - 1.03)) and rural residence (AOR = 2.07, 95% CI:( 1.56 - 2.75)) were significantly associated to late-stage diagnosis.

CONCLUSION

In Ethiopia, six in every ten cervical cancer cases are diagnosed at the late stage of the disease. Poor awareness about cervical cancer and its treatment, long patient delay to seek care, and rural residence were positively associated with late-stage diagnosis. Therefore intervention efforts should be made to improve public awareness about cervical cancer, minimize patient delay to seek care, and expand screening services specifically in the rural residing segment of the population to detect the disease early and improve survival.

Age and cancer type: associations with increased odds of receiving a late diagnosis in people with advanced cancer

PURPOSE

In order to deliver appropriate and timely care planning and minimise avoidable late diagnoses, clinicians need to be aware of which patients are at higher risk of receiving a late cancer diagnosis. We aimed to determine which demographic and clinical factors are associated with receiving a 'late' cancer diagnosis (within the last 12 weeks of life).

METHOD

Retrospective cohort study of 2,443 people who died from cancer ('cancer decedents') in 2013-2015. Demographic and cancer registry datasets linked using patient-identifying Community Health Index numbers. Analysis used binary logistic regression, with univariate and adjusted odds ratios (SPSS v25).

RESULTS

One third (n = 831,34.0%) received a late diagnosis. Age and cancer type were significantly associated with late cancer diagnosis (p < 0.001). Other demographic factors were not associated with receiving a late diagnosis. Cancer decedents with lung cancer (Odds Ratios presented in abstract are the inverse of those presented in the main text, where lung cancer is the reference category. Presented as 1/(OR multivariate)) were more likely to have late diagnosis than those with bowel (95% Confidence Interval [95%CI] Odds Ratio (OR)1.52 (OR1.12 to 2.04)), breast or ovarian (95%CI OR3.33 (OR2.27 to 5.0) or prostate (95%CI OR9.09 (OR4.0 to 20.0)) cancers. Cancer decedents aged > 85 years had higher odds of late diagnosis (95%CI OR3.45 (OR2.63 to 4.55)), compared to those aged < 65 years.

CONCLUSIONS

Cancer decedents who were older and those with lung cancer were significantly more likely to receive late cancer diagnoses than those who were younger or who had other cancer types.

MLNet: Metaheuristics-Based Lightweight Deep Learning Network for Cervical Cancer Diagnosis

One of the leading causes of cancer-related deaths among women is cervical cancer. Early diagnosis and treatment can minimize the complications of this cancer. Recently, researchers have designed and implemented many deep learning-based automated cervical cancer diagnosis models. However, the majority of these models suffer from over-fitting, parameter tuning, and gradient vanishing problems. To overcome these problems, in this paper a metaheuristics-based lightweight deep learning network (MLNet) is proposed. Initially, the hyper-parameters tuning problem of convolutional neural network (CNN) is defined as a multi-objective problem. Particle swarm optimization (PSO) is used to optimally define the CNN architecture. Thereafter, Dynamically hybrid niching differential evolution (DHDE) is utilized to optimize the hyper-parameters of CNN layers. Each particle of PSO and solution of DHDE together represent the possible CNN configuration. F-score is used as a fitness function. The proposed MLNet is trained and validated on three benchmark cervical cancer datasets. On the Herlev dataset, MLNet outperforms the existing models in terms of accuracy, f-measure, sensitivity, specificity, and precision by 1.6254%, 1.5178%, 1.5780%, 1.7145%, and 1.4890%, respectively. Also, on the SIPaKMeD dataset, MLNet achieves better performance than the existing models in terms of accuracy, f-measure, sensitivity, specificity, and precision by 2.1250%, 2.2455%, 1.9074%, 1.9258%, and 1.8975%, respectively. Finally, on the Mendeley LBC dataset, MLNet achieves better performance than the competitive models in terms of accuracy, f-measure, sensitivity, specificity, and precision by 1.4680%, 1.5845%, 1.3582%, 1.3926%, and 1.4125%, respectively.

SERPINB7 as a prognostic biomarker in cervical cancer: Association with immune infiltration and facilitation of the malignant phenotype

Purpose

The purpose of this study was to investigate the expression patterns, predictive significance, and roles in the immune microenvironment of Serpin Family-B Member 7 (SERPINB7) in cervical squamous cell carcinoma and endocervical adenocarcinoma (CESC).

Methods

The expression of SERPINB7 and its prognostic relevance were evaluated using RNA-seq data from The Cancer Genome Atlas. SERPINB7 regulation of CESC cell growth and metastasis was investigated using MTT, scratch, and Transwell assays. In vivo effects of SERPINB7 were examined in xenograft model mice and differentially expressed genes (DEGs) associated with SERPINB7 were identified to explore its functional role in oncogenesis. Associations between SERPINB7 levels, chemosensitivity, and immune infiltration were assessed, and mutations and methylation of SERPINB7 were evaluated using the cBioPortal and MethSurv databases, respectively.

Results

SERPINB7 was up-regulated in CESC samples as well as in other tumors, and patients with higher SERPINB7A mRNA levels exhibited shorter overall survival. The area under the curve for the use of SERPINB7 in CESC diagnosis was above 0.9, and the gene was shown to regulate tumor cell proliferation and metastasis in vitro and in vivo. Overall, 398 DEGs enriched in key CESC progression-related signaling pathways were identified. SERPINB7 expression was additionally correlated with intratumoral immune infiltration and immune checkpoint activity. Patients expressing higher SERPINB7 levels exhibited distinct chemosensitivity profiles, and methylation of the SERPINB7 gene was linked to CESC patient prognostic outcomes.

Conclusion

SERPINB7 was found to be a crucial regulator of CESC progression, prognosis, and the tumor immune microenvironment, highlighting its potential as a diagnostic and prognostic biomarker and target for CESC immunotherapy.

Barriers to adherence to cytology exam: a case study in low-income Colombian women

BACKGROUND

Cervical cytology is essential for the early detection of cervical cancer. However, in Colombia, only 50% of women with subsidized health insurance were screened in 2019, compared to 100% of women with contributory insurance. This disparity highlights significant barriers that must be addressed. This study aimed to identify the factors that contribute to or hinder adherence to cervical cytology screening among low-income women with subsidized health insurance in a public primary care network in Cali, Colombia, from 2014 to 2018.

METHODS

In a qualitative case study, the experience of women and health care and administrative personnel was recovered. Forty-seven women participated in seven focus group discussions. Five other women using the program participated in in-depth interviews. Finally, we interviewed eight people from the healthcare area and the health services administration. The qualitative data collected underwent content analysis, guided by the theoretical framework of Social Determinants of Health. Within this framework, five interconnected dimensions that influence adherence were incorporated.

RESULTS

Adherence is a multifactorial phenomenon, and in relation to attendance at cervical cytology, the analysis delved into the mechanisms that affect it in a low-income context. Barriers to adherence were identified across multiple dimensions, including social and economic factors, health conditions, and patient-related factors, among both adherent and non-adherent women. Among adherent women, barriers and facilitators related to the healthcare team and system, as well as patient-related factors, were identified.

CONCLUSIONS

The findings of this research can be useful in developing personalized interventions and strategies to improve adherence and screening outcomes in low-income settings. It is necessary to increase the resources of health insurance entities to establish effective communication channels with women who attend the cervical cancer prevention program.

Interfraction variations in doses at OARs during three-dimensional high dose rate brachytherapy planning of cervix cancer

Objective

The American Brachytherapy (BT) Society recommends that BT must be included as a component of the definitive radiation therapy for cervical carcinoma because recurrences and complications are decreased when BT is used in addition to external beam radiotherapy. The aim of this study is to quantify the interfraction dose variations (VARacts) during high dose rate (HDR) BT, the effect of variation in dose in terms of excess "unrecognized" dose to OAR and to conclude the reason of the variation in reference of applicator position/geometry versus deformation of the organ at risk (OAR) concerned.

Materials and Methods

Total 30 patients of carcinoma cervix, biopsy proven, between June 2018 and May 2019, were taken for the study. All patients were treated with external beam radiation therapy to a dose of 50 Gy in 25 fractions over 5 weeks, followed by three fractions of HDR intracavitary brachytherapy (ICBT) (7.5 Gy to point A in each fraction) by two-dimensional (2D) X-ray-based planning. Before treatment in the first and last fraction of BT, computed tomography (CT) scan was done for every patient. Then, a 3D-based planning was performed with CT images on our HDR Plus software with image sequence option. VARact was calculated. Rigid image registration of consecutive fraction images was used for quantification of the hypothetical variation in dose (VARhypo) arising exclusively due to changes in applicator placement and geometry.

Results

The mean contoured rectal volumes for the first and third fractions were 41.49 cc and 44.72 cc, respectively, while the respective volumes for bladder were 9.33 cc and 9.35 cc cm. These differences were statistically insignificant (P value: 0.263 and 0.919 for rectum and bladder, respectively). The mean equivalent dose in 2 Gy fraction (EQD2) bladder D2cc was 5.68 Gy and 5.79 Gy in the first and third fraction ICBT, respectively. The mean EQD2 for the rectal D2cc was 11.63 Gy and 12.85 Gy in the first and third fraction ICBT, respectively. None of the patients had an actual cumulative EQD2 more than 90 Gy for bladder, but 36.66% of the patients had a rectal dose exceeding the tolerance (75 Gy). Regression plots showed that VARhypo alone could predict about 42.2% of the VARact in the rectum and 19.2% of the VARact in the bladder. Thus, the remaining variation was due to the organ deformation-related dose variations between the two fractions.

Conclusions

There were no statistically significant variations in the volumes or doses of OAR between the two fractions. However, a significant proportion of patients may have a higher dose to the OAR in the third fraction in the absence of individualized planning. This increase is likely to be more detrimental where higher doses per fraction are used. Variations in OAR doses may be caused by organ deformation and/or changes in applicator placement/geometry.

Female students' perspectives on cervical cancer screening inclusion in pre-admission university requirements in Ghana

Cervical cancer is a huge contributor to cancer-related deaths and the commonest gynecological cancerous growth among women globally. Nevertheless, evidence suggests that cervical cancer incidence and mortality could be reduced through early diagnosis. Regardless of the accessibility of cervical cancer screening in Ghana, low reports of cervical screening had been recorded among female students and women in Ghana. The study objectives were to explore.Female students' opinions on the inclusion of cervical cancer screening in the pre-university admission screening requirement in Ghana. The facilitators and barriers to cervical cancer screening among female University students.Qualitative exploratory-descriptive design was employed for the purpose of this study. The target population was female students in a public university in Ghana who were purposively selected. Content analysis was employed for the data analysis. In all, 30 female students were selected to engage in face-face interviews using a semi-structured interview guide. Two categories and seven sub-categories were generated from the study analysis. It was interesting to know that majority 20 (66.66%) of the students supported adding CCS to the preadmission screening requirement with few refuting it. Others also recommended compulsory screening as a means of enhancing screening practices. The reasons for refusing this proposal by a few 10 (33.3%) of the participants were it being burdensome, time-consuming, and capital intensive. Other reasons for refusing it were sexual inactiveness following the screening, fear of discomfort, and the screening results. In conclusion, the study found that students were willing to undergo CCS if made mandatory for admission and suggested it be included in pre-admission screening requirements to encourage more Ghanaian women to participate. As CCS is effective in reducing cervical cancer incidence and burden, the proposal of including it in pre-university screening should be considered to increase uptake.

A population-based cross-sectional study on the situation of cervical cancer screening in Liaoning, China

Background

Cervical cancer (CC) screening is currently recognized as an effective intervention for CC. Previous studies found that the proportion of screening was low in China, especially in Liaoning. Therefore, we performed a population-based cross-sectional survey to investigate the situation of cervical cancer screening and analyze their related factors for providing a decision-making basis for sustainable and effective development of cervical cancer screening.

Methods

This population-based cross-sectional study involved aged 30 to 69 years in nine counties/districts in Liaoning from 2018 to 2019. Data were collected using the quantitative data collection methods, and analyzed in SPSS version 22.0.

Results

Overall, only 22.37% of 5334 respondents reported having ever been screened for cervical cancer in past 3 years, and 38.41% of respondents reported having the willingness for cervical cancer screening in next 3 years. In the rate of CC screening, multilevel analysis indicated that age, marital status, education level, type of occupation, medical insurance, family income, place of residence and regional economic level had a significant impact on proportion of screening. In the rate of CC screening willingness, multilevel analysis indicated that age, family income, health status, place of residence, regional economic level and CC screening still had a significant impact, but marital status, education level and medical insurance type had no significant impact. There was no significant difference in marital status, education level and medical insurance type after the factors of CC screening were added in the model.

Conclusion

Our study found both proportion of screening and willingness were at a low level, and age, economic and regional factors were the main factors for implementation of CC screening in China. In the future, targeted policies should be formulated according to the characteristics of different groups of people, and reduce the gap in the current health service capacity between different regions.

The temporal trend of women’s cancer in Changle, China and a migrant epidemiological study

Background

Although the etiology of women’s cancer has been extensively studied in the last few decades, there is still little evidence comparing the temporal pattern of these cancers among different populations.

Methods

Cancer incidence and mortality data from 1988 to 2015 were extracted from the Changle Cancer Register in China, and cancer incidence data for Los Angeles were extracted from Cancer Incidence in Five Continents plus database. A Joinpoint regression model was used to analyze the temporal trends of incidence and mortality for breast, cervical, corpus uteri and ovarian cancers. The standardized incidence ratios were applied to compare the cancer risk across populations.

Results

An increasing trend of incidence rate for breast, cervical, corpus uteri and ovarian cancer was observed in Changle, although the rate leveled off for breast and cervical cancer after 2010, although not statistically significant. The mortality rate of breast and ovarian cancer was slightly increased during this period, while we found a decreased mortality of cervical cancer from 2010. The mortality of corpus uteri cancer showed a decreasing and then increasing trend. The incidence of breast, corpus uteri and ovarian cancer in Chinese American immigrants in Los Angeles was significantly higher than indigenous Changle Chinese and lower than Los Angeles whites. However, the incidence of cervical cancer in Chinese American immigrants shifted from significantly exceeding to lower than Changle Chinese.

Conclusion

The incidence and mortality of women’s cancers in Changle were generally on the rise, and this study concluded that environmental changes were important factors affecting the occurrence of these cancers. Appropriate preventive measures should be taken to control the occurrence of women’s cancers by addressing different influencing factors.

Research Progress in the Relationship Between P2X7R and Cervical Cancer

Cervical cancer is one of the most common and serious tumors in women. Finding new biomarkers and therapeutic targets plays an important role in the diagnosis, prognosis, and treatment of cervical cancer. Purinergic ligand-gated ion channel 7 receptor (P2X7R) is a purine ligand cation channel, activated by adenosine triphosphate (ATP). Studies have shown that P2X7R plays an important role in a variety of diseases and cancers. More and more studies have shown that P2X7R is also closely related to cervical cancer; therefore, the role of P2X7R in the development of cervical cancer deserves further discussion. The expression level of P2X7R in uterine epithelial cancer tissues was lower than that of the corresponding normal tissues. P2X7R plays an important role in the apoptotic process of cervical cancer through various mechanisms of action, and both antagonists and agonists of P2X7R can inhibit the proliferation of cervical cancer cells, while P2X7R is involved in the antitumor effect of Atr-I on cervical cancer cells. This review evaluates the current role of P2X7R in cervical cancer in order to develop more specific therapies for cervical cancer. In conclusion, P2X7R may become a biomarker for cervical cancer screening, and even a new target for clinical treatment of cervical cancer.

Adherence to Cervical Cancer Screening Programs in Migrant Populations: A Systematic Review and Meta-Analysis

Organized cervical cancer screening programs to promote the early identification of precancerous lesions have proven to be effective in decreasing the burden associated with cervical cancer, but knowledge regarding screening adherence among migrant women compared to that of native women has not been summarized. A systematic search of the literature on PubMed, Scopus and Embase led to the identification of 772 papers that were published up to July 2022 and reported population-based data regarding adherence to cervical screening. The screening participation rates among migrant women, compared to native women, were pooled using a random-effects meta-analysis. A total of 18 papers were included in the review, with most of them being conducted in Europe (83.3%). Overall, migrants showed a significantly lower participation rate compared to native women (OR for screening adherence: 0.54, 95% CI = 0.42-0.70). This discrepancy was especially evident for migrant women from North Africa and Sub-Saharan Africa (OR = 0.47, 95% CI = 0.35-0.63, and OR = 0.35, 95% CI = 0.24-0.49, respectively). The results of this systematic review emphasize the importance of increasing cervical cancer screening adherence among migrant women. A significant heterogeneity in screening adherence was observed based on the country of origin. Interventions aimed at reducing the disparities in screening participation should specifically consider how to improve the recruitment of migrant women.

Cervical cancer management in Zimbabwe (2019-2020)

BACKGROUND

Globally, cervical cancer is the fourth most commonly diagnosed cancer amongst women, and it is especially common in low- and middle-income countries (LMICs). The aim of the study was to determine the current patterns and characteristics of CC management in Zimbabwe in the HIV pandemic era, including the knowledge, attitude and practice of patience.

METHODS

The study was a mixed method which incorporated a cross-sectional survey of 408 CC patients which was conducted from October 2019 to September 2020 using an interviewer administered paper questionnaire. The study was conducted at Parirenyatwa hospital, the only cancer treating public health facility in Harare, Zimbabwe. Differences in study outcome by categorical variables were assessed using the Person Chi-square (χ2) test. Odds ratios (unadjusted and adjusted) and 95%CIs for potential risk factors associated with the outcome were estimated using logistic regression model.

RESULTS

From a total of 408 CC patients recruited into the study no prevention mechanism was available or known to these patients and only 13% knew that CC is caused by Human papillomavirus. Only 87 (21%) had ever been screened for CC and 83 (97%) of those who had been screened had the visual inspection with acetic acid procedure done. Prevention (screening uptake) is statistically high among the educated (with secondary education OR = 9.497, 95%CI: 2.349-38.390; with tertiary OR = 59.381, 95%CI: 11.937-295.380). Late presentation varied statistically significantly with marital status (high among the divorced, OR = 2.866; 95% CI: 1.549-5.305 and widowed OR = 1.997; 95% CI: 1.112-3.587), was low among the educated (Tertiary OR = .393; 95% CI: .166-.934), low among those living in the rural (OR = .613; 95% CI: .375-.987), high among those with higher parity OR = 1.294; 95% CI: 1.163-1.439). Less than 1% of the patients had surgery done as a means of treatment. Radiotherapy was administered to 350 (86%) of the patients compared to chemotherapy administered to 155 (38%). A total of 350 (86%) have failed to take medication due to its unavailability, while 344 (85%) missed taking medication due to unaffordability. Complementary and alternative medicines were utilized by 235 (58%). Majority, 278 (68%) were HIV positive, mainly pronounced within age (36-49 years OR = 12.673; 95% CI: 2.110-76.137), among those with higher education (secondary education OR = 4.981; 95%CI: 1.394-17.802 and in those with no co-morbidities (893.956; 95%CI: 129.611-6165.810).

CONCLUSION

CC management was inadequate from prevention, screening, diagnosis, treatment and palliative care hence there is need to improve CC management in Zimbabwe if morbidity and mortality are to be reduced to acceptable levels. Education helped improve prevention, but reduces chances of diagnosis, working as a doubled edged sword in CC management Prevention was high among the educated. Those in rural areas experience poor CC management. It should be noted that general education is good; however it must be complimented by CC awareness to improve CC management outcomes holistically. Cervical cancer management services need to be decentralized so that those in rural areas have easy access. Given that those with co-morbidities and high parity have better CC management, CC services need to be tied to co-morbidity and antenatal/post-natal care and management services.

COVID-19 and inequities in colorectal and cervical cancer screening and diagnosis in Washington State

INTRODUCTION

Studies have shown that cancer screenings dropped dramatically following the onset of the coronavirus diseases 2019 (COVID-19) pandemic. In this study, we examined differences in rates of cervical and colorectal cancer (CRC) screening and diagnosis indicators before and during the first year of the COVID-19 pandemic.

METHODOLOGY

We used retrospective data from a large healthcare system in Washington State. Targeted screening data included completed cancer screenings for both CRC (colonoscopy) and cervical cancer (Papanicolaou test (Pap test)). We analyzed and compared the rate of uptake of colorectal (colonoscopies) and cervical cancer (Pap) screenings done pre-COVID-19 (April 1, 2019-March 31, 2020) and during the pandemic (April 1, 2020-March 31, 2021).

RESULTS

A total of 26,081 (12.7%) patients underwent colonoscopies in the pre-COVID-19 period, compared to only 15,708 (7.4%) patients during the pandemic, showing a 39.8% decrease. A total of 238 patients were referred to medical oncology for CRC compared to only 155 patients during the first year of the pandemic, a reduction of 34%. In the pre-COVID-19 period, 22,395 (10.7%) women were administered PAP tests compared to 20,455 (9.6%) women during the pandemic, for a 7.4% reduction. period 1780 women were referred to colposcopy, compared to only 1680 patients during the pandemic, for a 4.3% reduction.

CONCLUSION

Interruption in screening and subsequent delay in diagnosis during the pandemic will likely lead to later-stage diagnoses for both CRC and cervical cancer, which is known to result in decreased survival.

IMPACT

The results emphasize the need to prioritize cancer screening, particularly for those at higher risk.

MRI Using Artificial Intelligence Algorithm to Evaluate Concurrent Chemoradiotherapy for Local Recurrence and Distant Metastasis of Cervical Squamous Cell Carcinoma

The aim of this study was to investigate the magnetic resonance imaging (MRI) features of patients with local recurrence and distant metastasis of cervical squamous cell carcinoma before and after concurrent chemoradiotherapy based on artificial intelligence algorithm. In this study, 100 patients with cervical squamous cell carcinoma with local recurrence and distant metastasis who underwent concurrent chemoradiotherapy were collected as the research subjects, and all underwent MRI multisequence imaging scans. At the same time, according to the evaluation criteria of solid tumor efficacy, patients with complete remission were classified into the effective group, and patients with partial remission, progressive disease, and stable disease were classified into the ineffective group. In addition, an image segmentation algorithm based on Balloon Snake model was proposed for MRI image processing, and simulation experiments were carried out. The results showed that the Dice coefficient of the proposed model segmentation of the reconstructed image was significantly higher than that of the level set model and the greedy algorithm, while the running time was the opposite (P < 0.05). The lesion volume (38.76 ± 5.34 cm3) in the effective group after treatment was significantly smaller than that in the noneffective group (46.33 ± 4.64 cm3), and the rate of lesion volume shrinkage (28.71%) was significantly larger than that in the noneffective group (12.49%) (P < 0.05). The relative apparent diffusion coefficient (rADC) value and rADC value change rate of the lesion after treatment in the effective group were significantly greater than those in the noneffective group (P < 0.05). In summary, the image segmentation and reconstruction algorithm based on Balloon Snake model can not only improve the quality of MRI images but also shorten the processing time and improve the diagnostic efficiency. The volume regression rate and rADC value change rate of cervical squamous cell carcinoma lesion can reflect the early efficacy of concurrent chemoradiotherapy for cervical squamous cell carcinoma and have predictive value.

Awareness and knowledge associated to Human papillomavirus infection among university students in Morocco: A cross-sectional study

Worldwide, cervical cancer is a real health issue, however, gaps exist in the public’s awareness of the causal role of Human papillomavirus (HPV) in the development of this disease. This study aims to determine the level of awareness, knowledge and the associated factors on HPV among university students in Morocco. A cross-sectional study was conducted with a descriptive and analytical aim, among students attending Ibn Zohr University, in Agadir, Morocco. An interview questionnaire was used to collect information about the participants: demographic data, awareness and level of knowledge on HPV infection, and awareness of cervical cancer. Logistic regression analyses were used to determine the associated factors with awareness and level of knowledge on HPV. A total of 479 students participated in this study (mean age 21.82 ± 2.091). Most participants n = 391 (81.6%) were aware of cervical cancer, while only n = 7 (1.5%) identified HPV as a sexually transmitted infection. Among students, 10.0% (n = 48) were aware of HPV but only half of them n = 23 (47.9%) confirmed that HPV is associated with cervical cancer, and n = 29 (60.4%) showed low knowledge on HPV. Multivariate analysis revealed that HPV awareness has a strong association with a higher level of education (OR 4.04; 95% CI: 1.92–8.52), and with being a biology student (OR 5.20; 95% CI: 2.12–12.73), while high HPV knowledge was only associated with the female gender (OR 3.76; 95% CI: 1.01–13.92). The data suggest that university students in Morocco did not show sufficient knowledge of HPV infection and its consequences. This supports that earlier incorporation of sexual health education programs, especially related to HPV and cervical cancer, must be implemented in the university to reduce the burden of HPV-associated diseases among the population at risk.