Mortality impact of achieving WHO cervical cancer elimination targets: a comparative modelling analysis in 78 low-income and lower-middle-income countries

Barriers and facilitators for implementation of HPV-based cervical cancer screening in Tanzania: a qualitative study among healthcare providers, stakeholders, and Tanzanian women

BACKGROUND

Cervical cancer is the leading cause of cancer-related deaths in Tanzania and the most common form of cancer among Tanzanian women. Screening attendance remains among the lowest globally, necessitating improved attendance and screening methods.

OBJECTIVE

This study aims to assess the feasibility of implementing the World Health Organization's 2021 hPV-based screening guideline in Tanzania by identifying potential barriers and facilitators to HPV-based screening among screening clients, healthcare providers, and stakeholders.

METHODS

From October 2022 to February 2023, 25 semi-structured interviews were conducted with screening clients (n = 16) and healthcare providers and stakeholders (n = 9) in Moshi and Dar es Salaam. Data were analyzed using a deductive framework based on Bronfenbrenner's Social Ecological Model, supplemented with inductive subcategories from the transcripts.

RESULTS

Barriers and facilitators emerged across all levels of the Social Ecological Model. At the individual level, clinic-based screening and a one-visit approach were barriers, while HPV-self-sampling was a facilitator. Interpersonal barriers included limited social support, while referrals served as facilitators. Community-level barriers included fear and misconceptions, countered by facilitators such as increased awareness and health education. Health system challenges included restrictive age limits and urbanization of human resources, with uptake through other health services acted as a facilitator. Political barriers highlighted the need for a steady local supply chain, while cost reduction could serve as a facilitator for guideline implementation.

CONCLUSION

WHO's 2021 hPV-based screening guideline shows promise in Tanzania, but barriers such as clinic availability, fear, misconceptions, and supply chain issues must be addressed to ensure successful implementation.

The Value of P16 Protein Detection in the Screening for High-Grade Squamous Intraepithelial and Higher Lesions of the Cervix by the Combined Detection of HR-HPV and TCT

Liquid-based thin layer cytology (TCT) and HR-HPV detection are the most important screening methods for cervical cancer. These two methods have limited sensitivity and specificity, so some cervical lesions are still missed or misdiagnosed. This paper mainly discusses the value of P16 protein detection in cervical cancer screening. In particular, it is effective and practical in high-grade squamous epithelial and above cervical lesions (CINII+). In this retrospective study, the diagnostic specificity and positive predictive value (PPV) of P16 protein detection for cervical CINII+ lesions were significantly higher than that of TCT and HR-HPV detection, and the accuracy was the highest. P16 protein detection can also reduce the rate of missed diagnoses in HR-HPV-negative patients and reduce unnecessary colposcopic biopsies. Our data highlight the feasibility and significance of P16 protein detection in cervical disease screening.

Factors associated with cervical cancer screening: results from cross-sectional surveys in Kenya and Malawi

BACKGROUND

Cervical cancer screening is an essential public health intervention, and critical to meeting the Global Strategy for Cervical Cancer Elimination goals - yet most women in low- and middle-income countries are never screened. There is a need to understand context-specific factors that facilitate or prevent women from engaging in screening.

METHODS

This analysis leverages data collected in 2022-2023 from a national mobile phone-based survey in Kenya and from a household survey conducted in three districts of Malawi. Informed by the Health Belief Model, we assess whether women's reported cervical cancer screening history (ever or never screened) was associated with their perceived susceptibility (awareness of cervical cancer risk factors), perceived severity (knowing someone who was affected by cervical cancer), perceived barriers (access to services), perceived benefits (trust in information about cervical cancer prevention), self-efficacy (engagement in other preventive health behaviors), and cues to action (speaking with others about cervical cancer prevention).

RESULTS

Ever-screening for cervical cancer was reported by 49.7% of the 736 Kenyan respondents and 42.5% of the 261 Malawian respondents. There were few associations between women's demographic or socioeconomic characteristics and screening history. The strongest associations were seen for cues to action (women who had spoken about cervical cancer with health workers had 1.88 the adjusted risk ratio for screening in Kenya [95% CI 1.59, 2.24] and 1.89 the adjusted risk in Malawi [95% CI 1.41, 2.54] compared to women who never had these conversations); and for knowing someone who had, or who had died due to, cervical cancer (aRR 1.34 and 1.30 respectively in Kenya, and aRR 2.03 and 1.46 respectively in Malawi). In both countries, self-efficacy was also associated with screening, as was perceived severity in both countries (i.e., knowing someone who had, or who had died due to cervical cancer, which was reported by many Kenyan and Malawian respondents). In Kenya, knowledge of cervical cancer risk factors was also associated with women's screening history, as was access to other preventive health services in Malawi.

CONCLUSIONS

These results suggest promising areas for interventions aiming to increase cervical cancer screening in these contexts: encouraging health workers to discuss screening with eligible women, leveraging women's peers who have been affected by cervical cancer, and promoting screening during other preventive health services.

Burden of female diseases among adolescents and young adults aged 10-24 years in South Asia and Sub-Saharan Africa, 1990-2021: a systematic analysis from the Global Burden of Disease Study 2021

INTRODUCTION

Female diseases pose significant challenges in South Asia and Sub-Saharan Africa, particularly among adolescent girls and young women, who often receive insufficient attention.

OBJECTIVES

To report patterns and trends of female diseases among adolescent girls and young females aged 10-24 years in South Asia and Sub-Saharan Africa from 1990 to 2021.

METHODS

We used data from the Global Burden of Disease Study 2021 for 51 countries in South Asia and Sub-Saharan Africa between 1990 and 2021. Joinpoint Regression was used to calculate annual average percentage changes and 95 % confidence intervals to quantify temporal trends.

RESULTS

In 2021, South Asia and Sub-Saharan Africa had high mortality rates of maternal disorders of 6.04 (95 % uncertainty intervals 5.02, 7.39) and 17.69 (14.37, 21.78) per 100,000 population, respectively. The mortality rates for female cancers were approximately 0.98 in both regions, and the incidence rates for gynecological diseases were 16472.83 and 14480.99, per 100,000 population, respectively. From 1990 to 2021, there was an increasing trend in the number of maternal disorder deaths in Sub-Saharan Africa, as well as in all metric rates for most female cancers in both regions, and disability-adjusted life years, prevalence, and incidence rates for gynecological diseases in South Asia. Several female diseases varied across countries and were increasingly affecting younger adolescents aged 10-14 years in both regions. Although countries with lower Socio-demographic Index had a heavier burden of female diseases, no significant association was observed between the Universal Health Coverage effective coverage index and death rates for female cancers or gynecological diseases.

CONCLUSIONS

The burden of female diseases remains high among young females in South Asia and Sub-Saharan Africa, with younger adolescents being particularly affected. This underscores the urgent need for targeted interventions and increased investment in healthcare infrastructure to reduce the burden of female diseases in these regions.

Awareness, Practice, and Barriers Regarding Cervical Cancer Screening Among Women of Kageshwori Manohara Municipality, Nepal

Background: Cervical cancer remains a global public health concern occurring in most cases in developing countries. Furthermore, it is a highly preventable disease; it remains to be the most common cancer among Nepalese women. Assessing women's awareness of cervical cancer and identifying barriers to screening are of vital importance for the utilization of cervical cancer screening. Therefore, this study has been conducted to assess information regarding awareness, practice, and barriers to cervical cancer screening among the women of Kageshwori Manohara Municipality of Kathmandu district in Nepal. Methods: Community-based descriptive cross-sectional study was conducted among 249 women aged 30-60 years by using a systematic random sampling technique. Data were collected from 1st to 29th February 2024 through a self-constructed semistructured tool using a face-to-face interview technique. Descriptive statistics and the chi-square tests were used for statistical analysis. Results: Out of the total respondents, only 10.4% had adequate awareness regarding cervical cancer screening and 38.6% of the respondents had ever been screened for cervical cancer. Among the respondents who had ever been screened, the majority (86.5%) of their last time screening was within 5 years. A statistically significant association was found between levels of awareness with the age of the respondents (p=0.031), educational level (p=0.013), and number of children (p=0.003). However, no significant association was found with other variables such as age at marriage, ethnicity, occupation, and monthly family income. Absence of symptoms (54.6%), unaware of screening (17.7%), and feeling of embarrassment (11.6%) were the most mentioned barriers to practicing cervical cancer screening among the respondents. Conclusion: The result of this study showed most of the respondents had an inadequate level of awareness and low experience of practicing cervical cancer screening. Therefore, community-based awareness campaigns and screening health camps should be conducted to increase knowledge and practice of cervical cancer screening.

Outcomes following conization and factors on HPV regression among young females in Wuxi

PURPOSE

It is crucial to prioritize the detection of precancerous lesions in clinical practice, especially in young women who have not yet made decisions about family planning. Herein, we conducted a retrospective study to track HPV regression among young females who underwent conization in the past five years and identify predictors of persistent HPV infection.

METHODS

We involved 400 women under the age of 35, who underwent colposcopy-guided biopsy after primary infection with high-risk HPV at the affiliated Hospital of Jiangnan University and were histologically confirmed with LSIL/HSIL between June 2018 and December 2022. Follow-up data was collected at 3 months, 6 months, 12 months and 24 months postoperatively. Clinical characteristics, including age, BMI, marital status, gravidity, contraception method, sexual history, HPV infection duration, HPV vaccination status, preoperative HPV, and cytology status, were analyzed by SPSS 20.0 software.

RESULTS

A total of 400 patients aged 18 to 35 were included, with 354 (88.5%) undergoing cervical biopsy and 92 (23%) undergoing cervical conization. There were no significant differences in age, BMI, marital status, pregnancy history, and HPV vaccination between patients with persistent HPV infection and those with HPV regression after conization. However, the timing of first sexual activity and the use of condom contraception had a statistically significant impact on HPV status.

CONCLUSIONS

Duration of sexual life may play a significant role in the development of cervical precancerous, showing a positive correlation. Condoms for contraception can promote HPV regression by creating a physical barrier that blocks the transmission of HPV. Regular follow-up intervals following cervical conization are of greater significance than HPV vaccination.

Parent-daughter agreement about HPV vaccination status in Kenya and Malawi

BACKGROUND

As more countries introduce the HPV vaccine, it is important to understand the validity of vaccination measures. This is especially true in low- and middle-income countries (LMICs) where public health monitoring of vaccination data may have delays or gaps, so alternative measurement approaches are often necessary. Parental report is a common approach for measuring routine childhood vaccination, but it has not been evaluated for HPV vaccination in LMICs.

METHODS

We conducted household surveys in Kenya (n = 146) and Malawi (n = 98) with parents/guardians and their daughters who were age-eligible for HPV vaccination. We compared parents'/guardians' reports of HPV vaccination status to daughters' reports; the latter was assumed to be the "gold standard" measure.

RESULTS

88 % of Kenyan parents/guardians and 82 % of Malawian parents/guardians agreed with their daughters' reported HPV vaccination status. It was more common for parents/guardians to under-report (i.e., to say their daughter was unvaccinated but the girl said she had received dose(s)) than the inverse. Agreement with one's daughter was higher among parents/guardians who reported data from vaccination cards versus using recall, and among parents/guardians who expressed more versus less confidence in their knowledge. We did not find many differences in accuracy of report by parent/guardian characteristics, although in Kenya there were small and statistically significant negative associations with parental age, household income, and more girls in the household (the latter was also significantly negatively associated with report accuracy in Malawi).

CONCLUSIONS

In countries where surveys will commonly be used to measure HPV vaccination status, we found very high agreement of parents/guardians with their daughters' reported receipt of the vaccine. These results are similar to findings from the literature about routine childhood vaccination measurement. This suggests that researchers, clinicians, and practitioners can use parent/guardian-reported HPV vaccination of their daughter as a relatively good proxy of her own reported immunization status especially in settings without universal use of vaccination cards or registries.

Correlates of cervical cancer awareness among women aged 30-49 in five sub-Saharan African nations: Evidence from the Demographic and Health Survey (DHS)-2017-2023

Cervical cancer is the leading cause of cancer-related mortality in low- and middle-income countries (LMICs). Prior studies associate high cervical cancer awareness with reductions in cervical cancer incidence. In this study, we utilize nationally representative Demographic and Health Surveys Program (DHS) to analyze correlates of cervical cancer awareness to inform global strategies. All DHS surveys between 2017-2023 were queried for questions on cervical cancer awareness. Socio-demographic variables (e.g., age, marital status), socioeconomic variables (e.g., education, wealth, literacy) and variables pertaining to healthcare decision making, distance traveled, intimate partner violence (IPV), and female genital mutilation/circumcision (FGC/M)) were extracted. Sample weights were applied, and logistic regressions were performed. Variables with p < 0.20 were included in multivariate analysis. Data was obtained from 30,214 women aged 30-49 years old living in Benin, Cameroon, Madagascar, Mauritania, and Mozambique, 19,403 of whom were asked questions on cervical cancer awareness. Cervical cancer awareness varied from 53% in Cameroon to 12% in Benin. Literacy, frequency of watching television, mobile telephone ownership, visiting a local healthcare facility and hormonal contraceptive use were associated with increased cervical cancer awareness, while lack of healthcare decision making independence was associated with decreased awareness after multivariate adjustment. Women who experienced emotional IPV were associated with increased awareness in Cameroon. Less than 4% of all women were screened for cervical cancer. Given the known association between awareness and screening, targeted efforts to increase awareness among women without communication modalities has the potential to reduce global cervical cancer disparities. Potential strategies include co-locating cervical cancer awareness programs with public health programs and implementing large-scale telecommunication outreach programs to improve awareness.

Clinical Staging for Psychiatry and Psychology

A global mental health crisis is threatening a generation of young people with a lifetime of symptoms that do not fit neatly into diagnostic systems. Optimal decisions regarding treatments, services, research, and policies are critically needed, yet such decisions are based on idiosyncratic categorization of clinical courses. This review suggests clinical staging approaches may unite mental health stakeholders around shared targets to reduce mental illness. It first presents key approaches to clinical staging and then outlines how clinical knowledge has been translated into a unified transdiagnostic staging heuristic and clinical service structure over the past 30 years. Directions for short-, medium-, and long-term action are recommended with global community engagement. With investment from the mental health community, staging could reduce suffering through the use of an ethical, organized, and targeted system of communication.

Methodological Approaches for Incorporating Marginalized Populations into HPV Vaccine Modeling: A Systematic Review

Background. Delineation of historically marginalized populations in decision models can identify strategies to improve equity but requires assumptions in both model structure and stratification of input data. Purpose. We sought to characterize alternative methodological approaches for incorporating marginalized populations into human papillomavirus (HPV) vaccine decision-support models. Data Sources. We conducted a systematic search of PubMed, CINAHL, Scopus, and Embase from January 2006 through June 2022. Study Selection. We identified simulation models of HPV vaccination that refine any model input to specifically reflect a marginalized population. Data Extraction. We extracted data on key methodological decisions across modeling approaches to incorporate marginalized populations, including stratification of inputs, model structure, attribution of prevaccine disparities, calibration, validation, and sensitivity analyses. Data Synthesis. We identified 30 models that stratified inputs by sexual behavior (i.e., men who have sex with men), HIV infection status, race, ethnicity, income, rurality, or combinations of these. We identified 5 common approaches used to incorporate marginalized groups. These included models based primarily on differences in sexual behavior (k = 6), HPV cancer incidence (k = 10), cancer screening and care access (k = 4), and HPV natural history (through either direct incorporation of data [k = 10] or calibration [k = 5]). Few models evaluated sensitivity around their conceptualization of the marginalized group, and only 5 models validated outcomes for the marginalized group. Limitations. Evaluated studies reflected a variety of settings and research questions, making it difficult to evaluate the implications of differences across modeling approaches. Conclusions. Modelers should be explicit about the assumptions and theory driving their model structure and input parameters specific to key marginalized populations, such as the causes of prevaccination differences in outcomes. More emphasis is needed on model validation and rigorous sensitivity analysis.HighlightsWe identified 30 unique HPV vaccination models that incorporated marginalized populations, including populations living with HIV, low-income or rural populations, and individuals of a marginalized race, ethnicity, or sexual behavior.Methods for incorporating these populations, as well as the assumptions inherent in the modeling structure and parameter selections, varied substantially, with models explicitly or implicitly attributing prevaccine differences to alternative combinations of biological, behavioral, and societal mechanisms.Modelers seeking to incorporate marginalized populations should be transparent about assumptions underlying model structure and data and examine these assumptions in sensitivity analysis when possible.

Advanced Feature Extraction for Cervical Cancer Image Classification: Integrating Neural Feature Extraction and AutoInt Models

Cervical cancer remains a significant global public health challenge, affecting over half a million women annually, with a mortality rate of approximately 60%, especially in resource-limited regions. This study presents an advanced methodology for cervical cancer diagnosis through deep learning techniques. Utilizing a publicly available cervical cancer image dataset, the research introduces a novel classification framework that integrates a Neural Feature Extractor (NFE) based on a pre-trained VGG16 architecture and an AutoInt model for automatic feature interaction learning. The extracted features are processed through machine learning classifiers such as KNN, LGBM, Extra Trees, and others for classification tasks. Among these classifiers, KNN achieved the highest accuracy of 99.96%, followed closely by LGBM at 99.92%. This study also assesses the computational complexity of various models, demonstrating that simpler models like LDA exhibit faster prediction times, while more complex models, such as KNN and LGBM, provide higher accuracy. These findings highlight the potential of deep learning frameworks in improving cervical cancer classification accuracy, especially in resource-limited environments.

Feasibility and acceptability of human papillomavirus self-sampling compared with clinician sampling in urban areas of western China: a cross-sectional survey

Introduction

Cervical cancer, driven by persistent high-risk human papillomavirus (hrHPV) infection, remains a global health challenge, especially in low- and middle-income areas such as western China. Despite the critical role of HPV testing in early detection, coverage in China remains low due to cultural, psychological, and other barriers. Self-collected urine and vaginal samples offer alternative methods for sample collection. This study aimed to evaluate the feasibility and acceptability of detecting hrHPV and cervical intraepithelial neoplasia grade 2 or worse (CIN2+) via urine and vaginal self-sampling compared with clinician sampling in urban areas of western China.

Methods

A cross-sectional survey was conducted from November 2022 to March 2023 in urban areas of western China. The participants provided self-collected urine and vaginal samples for hrHPV testing and completed questionnaires on acceptability of self-sampling. The HPV positivity, agreement, and kappa value were calculated to assess concordance between self- and clinician sampling. The sensitivity, specificity, agreement, predictive values, and likelihood ratios were used to evaluate the clinical performance of both methods for detecting CIN2+.

Results

A total of 2,228 female subjects aged 21-71 years were recruited, and self-collected urine samples, vaginal samples, and clinician-collected cervical samples were obtained. The sensitivity of clinician sampling, urine self-sampling and vaginal self-sampling were 80.00% (95% CI: 44.22-96.46), 70.00% (95% CI: 35.37-91.91) and 90.00% (95% CI: 54.12-99.48) for CIN2+; the specificity for

Conclusion

Self-collected urine and vaginal samples for the detection of hrHPV and CIN2+ demonstrate high diagnostic accuracy and acceptability, making them viable alternatives to clinician-collected samples. Self-sampling methods may improve screening accessibility and compliance, especially in resource-limited settings, thereby supporting the prevention and early detection of CIN2+.

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Key Words

• acceptability
• cervical cancer screening
• cervical intraepithelial neoplasia
• human papillomavirus testing
• urine self-sampling
• vaginal self-sampling

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MESH Headings

• Humans
• Female
• Cross-Sectional Studies
• China
• Adult
• Middle Aged
• Papillomavirus Infections/diagnosis
• Specimen Handling/methods
• Feasibility Studies
• Aged
• Uterine Cervical Neoplasms/diagnosis
• Uterine Cervical Neoplasms/virology
• Papillomaviridae/isolation & purification
• Early Detection of Cancer/methods
• Surveys and Questionnaires
• Urban Population/statistics & numerical data
• Patient Acceptance of Health Care/statistics & numerical data
• Young Adult
• Self Care
• Vaginal Smears/methods
• Uterine Cervical Dysplasia/diagnosis
• Sensitivity and Specificity
• Human Papillomavirus Viruses

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Affiliation(s)

Shaolong Xue Department of Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
Xi Zeng Department of Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
Jing Li West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
Leni Kang National Office for Maternal and Child Health Surveillance, West China Second University Hospital, Sichuan University, Chengdu, China
Mingrong Xi Department of Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
Lian Xu Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China Department of Pathology, West China Second University Hospital, Sichuan University, Chengdu, China
Ping Fu Chengdu Shuangliu District Maternity and Child Healthcare Hospital, Chengdu, China
Min Zhou Chengdu Shuangliu District Maternity and Child Healthcare Hospital, Chengdu, China
Mengyin Ao Department of Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
Xiaoxi Yao Department of Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
Dongmei Li Department of Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
Guangdong Liao Department of Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China

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Epithelial and macrophage cell interaction in cervical cancer through single-cell RNA-sequencing and spatial analysis

Background

Cervical cancer (CC) is a major global health issue, ranking sixth in cancer-related mortality. The tumor microenvironment (TME) plays a crucial role in tumor growth. This study explored the cellular composition and immunological landscape of CC using various genomic data sources.

Methods

Data from the Cancer Genome Atlas and Gene Expression Omnibus were analyzed, including single-cell RNA sequencing, spatial transcriptome analysis, and survival data. Gene set variation analysis (GSVA) identified pathways in CD8+ cells, macrophages, and epithelial cells. Immunohistochemistry assessed marker expression in CC and normal tissues. Tumor immune dysfunction and exclusion (TIDE) scores differentiated high- and low-macrophage groups. Cell-cell communication analyses highlighted interactions between macrophages and epithelial cells.

Results

Macrophage markers correlated with overall survival (OS) and disease-free survival (DFS). Epithelial cell subgroups 1 and 4, along with CD8+ T cells, were associated with OS. TIDE scores varied between groups. Specific ligand-receptor interactions were found between macrophages and epithelial cell subgroup 1. Triptolide was effective in epithelial cell subgroup 1, while memantine was more effective in macrophages.

Conclusion

Epithelial-macrophage interactions in the TME are crucial for CC progression and treatment, offering a potential immunotherapeutic strategy.

Lnc-CNNM3-DT as a protective factor in cervical cancer: regulation of LIAS expression and intracellular copper levels

Background

Cervical cancer (CC) is the fourth leading cause of cancer-related death in women globally.While early screening has reduced mortality, tumor metastasis remains a significant concern, particularly in developing countries. Recent studies have identified cuproptosis, a copper-dependent cell death mechanism, as a potential factor in tumor progression. Long non-coding RNAs (lncRNAs) are key regulators of tumor progression. This study investigates the role of cuproptosis-related lncRNA (CRL) CNNM3-DT in CC, focusing on its impact on LIAS expression, intracellular copper levels, and tumor progression.

Methods

We analyzed the expression of lnc-CNNM3-DT and LIAS in clinical samples and CC cell lines using Real-time Polymerase Chain Reaction (RT-qPCR), Western blot, and immunohistochemistry (IHC). Functional assays, including CCK-8, wound healing, transwell invasion, and flow cytometry, were used to evaluate the effects of lnc-CNNM3-DT overexpression on cell proliferation, migration, invasion, and apoptosis. Intracellular copper ion levels were measured, and correlations between lnc-CNNM3-DT, LIAS, and clinicopathological features were analyzed.

Results

Lnc-CNNM3-DT expression was significantly higher in paracancerous tissues and normal cervical epithelial cells compared to tumor tissues and CC cell lines. Overexpression of lnc-CNNM3-DT suppressed proliferation, migration, and invasion of HeLa and SiHa cells while enhancing apoptosis. Additionally, lnc-CNNM3-DT overexpression downregulated LIAS expression and decreased intracellular copper ion levels. Correlation analysis indicated that lnc-CNNM3-DT expression was negatively associated with tumor diameter and depth of invasion, while LIAS expression showed no significant correlation with clinicopathological features.

Conclusion

Our findings suggest that lnc-CNNM3-DT functions as a protective factor in CC by inhibiting tumor progression through downregulation of LIAS expression and reduction of intracellular copper levels. These results highlight lnc-CNNM3-DT as a potential biomarker and therapeutic target in CC.

The socioeconomic burden of cervical cancer and its implications for strategies required to achieve the WHO elimination targets

INTRODUCTION

Cervical cancer is almost entirely preventable by vaccination and screening. Population-based vaccination and screening programs are effective and cost effective, but millions of people do not have access to these programs, causing immense suffering. The WHO Global Strategy for the elimination of cervical cancer as a public health problem calls for countries to meet ambitious vaccination, screening, and treatment targets.

AREAS COVERED

Epidemiological evidence indicates marked socioeconomic gradients in the burden of cervical cancer and vaccination, screening, and treatment coverage. The unacceptable socioeconomic burden of cervical cancer is largely a function of inequitable access to these programs. We discuss these inequities, and highlight strategies enabled by new evidence and technology. Single dose HPV vaccination, HPV-based screening, and the rapidly moving technology landscape have enabled task-shifting, innovation in service delivery and the possibility of scale. Equitable access to optimal care for the treatment of invasive cancers remains a challenge.

EXPERT OPINION

Cervical cancer can be eliminated equitably. It will require global political will, sustained public and private investment, and community leadership to safely and sustainably embed proven tools, technology and infrastructure in local health and knowledge systems.

NF-κB Activation Is Essential for Cervical Cell Proliferation and Malignant Transformation

NF-κB, a multifunctional transcription factor, is linked to cancer initiation and progression. As a key immune mediator, it may play a crucial role in HPV-induced cervical carcinogenesis. However, consensus is lacking on the activation timing of NF-κB during the transition from cervical intraepithelial neoplasia (CIN) to cervical squamous cell carcinoma (CSCC). In this study, immunohistochemical analysis was performed to examine RELA, one of the important members of the NF-κB family, and phospho-RELA expression in different cervical lesions. Then, we analyzed NF-κB regulation of differentially expressed genes (DEGs) in cervical lesions vs. normal tissues. Gene enrichment identified oncogenic DEGs, followed by expression and survival analyses. The impact of NF-κB activation on cervical cell proliferation, migration, and oncogenic regulation, as well as the effects of inhibiting NF-κB, were examined. Our study showed that NF-κB activation starts in cervical simple hyperplasia and intensifies as CIN evolves to CSCC. NF-κB-regulated DEGs show stage-specific functions: immune regulation in CIN and cancer promotion in CSCC. Short-term NF-κB activation boosts cervical cell proliferation and migration, which is reversible by an NF-κB inhibitor. Long-term NF-κB activation promotes the expression of cancer-promoting genes in normal cells and also maintains them in cancer tissues, which is linked to poorer prognosis. Inhibiting NF-κB downregulates these genes in cancer cells and suppresses the oncogenic abilities of cervical cancer cells. Collectively, NF-κB activation initiates during the simple hyperplasia stage of cervical cells, stimulating proliferation, migration, and oncogene expression. Throughout the transition from CIN to CSCC, NF-κB activation progressively intensifies, and its long-term activation promotes carcinogenesis. Thus, NF-κB is crucial in mediating cervical oncogenic transformation.

Secular trend of cervical cancer mortality in Brazil and regions

The scope of this study was to describe the secular trend of cervical cancer mortality in Brazil and its various regions from 1980 to 2021. It involved a populational and ecological study, based on data available at the Department of Informatics of the Unified Health System, using codes 180 and C53. Crude rates, age-specific rates, and age-standardized rates were calculated for the Brazilian and world population. The Average Annual Percent Change (AAPC) was obtained by trend analysis using the Joinpoint Regression Program, with a significance level of 0.05 and 95% confidence intervals (95%CI). There were 171,793 deaths from cervical cancer. In Brazil (AAPC -0.3; CI95%-1.0; 0.4), North (AAPC 0.6; 95%CI -0.1; 1.3) and South (AAPC 0.0; 95%CI -0.5; 0.5) the trends were stationary, increasing in the Northeast (AAPC 0.6; 95%CI 0.3; 0.8) and in the Midwest (AAPC -1.3; 95%CI -1.5; -1.1), and decreasing in the Southeast (AAPC -0.9; 95%CI -1.4; -0.5). Regional differences indicate that public policies need to be improved regarding women's access to a health system that offers adequate prevention, screening and treatment through management strategies that include the most vulnerable population.

Therapeutic Potential of IL-37 in Cervical Cancer: Suppression of Tumour Progression and Enhancement of CD47-Mediated Macrophage Phagocytosis

As a promising therapeutic approach, immunotherapy is being extensively investigated in cervical cancer. Although immunotherapy has been validated to improve progression-free survival and overall survival in clinical trials, the overall response rate for cervical cancer remains inadequate, necessitating further improvement. Interleukin (IL)-37, an emerging immunomodulator, exhibits antitumour potentials by inhibiting tumour progression and regulating tumour-associated macrophage recognition. We found a significant downregulation of IL-37 expression in cervical cancer, correlated with a poor prognosis. Moreover, the upregulation of IL-37 expression exhibited a suppressive effect on various tumorigenic processes, suppressing the proliferation, invasion, migration, apoptosis and angiogenesis of tumour cells. We also found that the upregulation of IL-37 suppressed cluster of differentiation 47 (CD47) expression in tumour cells via suppression of the signal transducer and activator of transcription 3 (STAT3) expression and phosphorylation, thereby enhancing macrophage recognition and phagocytosis to tumour cells, ultimately reducing immune evasion. Overall, our study highlighted the crucial role of IL-37 in antitumour efficacy and downregulating the expression of CD47 in tumour cells to reduce immune evasion, suggesting the potential of IL-37 as a prognostic biomarker in cervical cancer and offering innovative therapeutic strategies to improve cancer treatment outcomes.

Cervical cancer stigma - A silent barrier to the elimination of cervical cancer

Stigma presents a unique and underexplored barrier to cervical cancer control. Novel methods to reduce stigma can be employed to reduce the global burden of this disease.

Modelling epidemiological and economics processes - the case of cervical cancer

Different types of mathematical models can be used to forecast the development of diseases as well as associated costs and analyse the cost-effectiveness of interventions. The set of models available to assess these parameters, reach from simple independent equations to highly complex agent-based simulations. For many diseases, it is simple to distinguish between infectious diseases and chronic-degenerative diseases. For infectious diseases, dynamic models are most appropriate because they allow for feedback from the number of infected to the number of new infections, while for the latter Markov models are more appropriate since this feedback is not required. However, for some diseases, the aforementioned distinction is not as clear. Cervical cancer, for instance, is caused by a sexually transmitted virus, and therefore falls under the definition of an infectious disease. However, once infected, the condition can progress to a chronic disease. Consequently, cervical cancer could be considered an infectious or a chronic-degenerative disease, depending on the stage of infection. In this paper, we will analyse the applicability of different mathematical models for epidemiological and economic processes focusing on cervical cancer. For this purpose, we will present the basic structure of different models. We will then conduct a literature analysis of the mathematical models used to predict the spread of cervical cancer. Based on these findings we will draw conclusions about which models can be used for which purpose and which disease. We conclude that each type of model has its advantages and disadvantages, but the choice of model type often seems arbitrary. In the case of cervical cancer, homogenous Markov models seem appropriate if a cohort of newly infected is followed for a shorter period, for instance, to assess the impact of screening programs. For long-term consequences, such as the impact of a vaccination program, a feedback loop from former infections to the future likelihood of infections is required. This can be done using system dynamics or inhomogeneous Markov models. Discrete event or agent-based simulations can be used in the case of cervical cancer when small cohorts or specific characteristics of individuals are required. However, these models require more effort than Markov or System Dynamics models.

"ARVs is for HIV and cream is for HPV or precancer:" Women's Perceptions and Perceived Acceptability of Self-Administered Topical Therapies for Cervical Precancer Treatment: A Qualitative Study from Kenya

Background

Women in low- and middle-income countries (LMICs) bear a disproportionate burden of cervical cancer, despite being a preventable disease. Prevention efforts in LMICs are hindered in part by lack of access to cervical precancer treatment, due to weak health infrastructure and a lack of adequate human resources to deliver current provider-administered precancer treatments. Innovative strategies are urgently needed to close the cervical precancer treatment gap in LMICs, including the use of self-administered topical therapies such as 5-fluorouracil and imiquimod, for which efficacy evidence is available from high-income settings. We investigated African women's perceptions and perceived acceptability of these therapies for cervical precancer treatment.

Methods

Between November 2022 and April 2023, we conducted five focus group discussions (FGDs) with women ages 25-65 years undergoing cervical cancer screening or precancer treatment in Kisumu, Kenya. The FGDs explored women's experiences with screening and precancer treatment, their acceptability of topical therapies for precancer treatment, and perceived barriers and facilitators to uptake. The FGDs were moderated by local qualitative research assistants, conducted in local languages, transcribed, coded, and analyzed using qualitative description using NVIVO software.

Results

Twenty-nine women participated, with a mean age of 35.4 years (SD 6.5). All had undergone cervical cancer screening, and 25 (83%) had a history of precancer treatment with ablation or excision. Multiple themes were identified related to women's perceptions of topical therapies. Participants were highly receptive of topical treatments, with many favoring the option of self-administration compared to provider-administration of such therapies. Self-administration of topical therapies was felt to help address challenges associated with current treatment methods, including difficulty in access, pain with procedures, cost, and lack of privacy with pelvic exams. Participants had a preference for topical therapies that are used less frequently compared to those used daily.

Conclusions

Among Kenyan women with a history of cervical precancer treatment, self-administered topical therapies for precancer are acceptable and have the potential to address barriers, including access, privacy, and cost, that hinder precancer treatment in LMICs. If supported by efficacy studies in LMICs, self-administered topical therapies offer a scalable approach to closing the precancer treatment gap in LMICs.

Women's experiences and acceptability of self-administered, home delivered, intravaginal 5-Fluorouracil cream for cervical precancer treatment in Kenya

Background

Innovative strategies are essential to meet the World Health Organization's 90/70/90 cervical cancer elimination targets, aiming for 90% access to precancer treatment globally by 2030. In low-and middle-income countries (LMICs) where most cervical cancer cases occur, access to precancer treatment is severely limited. Scalable solutions like self-administered topical therapies can help close this gap. In a recent Phase I trial (ClinicalTrials.gov NCT05362955), we demonstrated safety and adherence to self-administered intravaginal 5% 5-Fluorouracil (5FU) cream as an adjuvant therapy for cervical precancer among women living with HIV (WLWH) in rural Kenya. To understand women's experiences with self-administered 5FU, we evaluated the acceptability of this intervention among trial participants.

Methods

All 12 participants from the Phase I trial completed a structured questionnaire and in-depth semi-structured interviews in their preferred language, focusing on their experiences with 5FU self-administration, challenges faced, and overall acceptability of the intervention, including whether they would use it again or recommend it to someone who needed it. Quantitative data were analyzed using descriptive statistics. In the qualitative study, acceptability was defined as "the perception that a given treatment is agreeable, palatable, or satisfactory." A thematic analysis was conducted using five dimensions of acceptability: content, complexity, comfort, delivery, and credibility.

Results

The mean age was 43.9 years (SD 4.4), and seven (58%) had primary education or less. While some participants reported feelings of uncertainty when they started using 5FU, at the end of the study, all 12 participants strongly agreed that the cream was safe and were confident they used it correctly. Most participants (91.7%) experienced no discomfort with the vaginal applicator, and most reported using tampons overnight after 5FU use, as recommended. Qualitative findings revealed that favorable perceptions of self-administered 5FU were driven by its ease of use, the discrete nature of the treatment, and the comfort of home application. The main challenges included correctly measuring the study drug, finding a private place at home to self-administer, and the need to use condoms during treatment. Compared to their previous ablation or excision treatments, participants found 5FU to be less painful, and all would prefer a self-administered treatment instead of a procedure if it were an option.

Conclusion

Self-administered intravaginal 5FU as an adjuvant treatment for cervical precancer among women living with HIV in Kenya was highly acceptable. Randomized studies of 5FU and other topical therapies in LMICs are needed to evaluate their use in closing the current precancer treatment gaps in these settings.

Global cervical cancer elimination: quantifying the status, progress, and gaps

BACKGROUND

To address the public health concern of cervical cancer (CC), 194 countries committed to eliminate it at the initiative of the World Health Organization (WHO). We summarised quantitative results concerning CC elimination across these countries, including the progress in implementing three prevention levels (human papillomavirus [HPV] vaccination, CC screening, and treatment for patients with CC) and achievement of interim Global Strategy for Cervical Cancer Elimination targets.

METHODS

Data were obtained from the International Agency for Research on Cancer, WHO, United Nations International Children's Emergency Fund, and country responses to the WHO National Capacity Survey on Non-Communicable Diseases. This retrospective analysis examined data from 194 countries and regions, stratified by national income (high-income countries (HICs) vs low- and middle-income countries (LMICs)) and geographic location (continents such as Europe, Asia, and North America). A quantitative assessment evaluated global progress in primary, secondary, and tertiary CC prevention.

RESULTS

By 2020, four countries had achieved Target 1 (90% of girls fully vaccinated against HPV by age 15). A total of 115 countries (51 (44.35%) HICs and 64 (55.65%) LMICs)) included HPV vaccination in their national immunisation programs. As of 2021, 133 countries (50 (37.59%) HICs and 83 (62.41%) LMICs)) implemented CC screening programs. Most of these were in Europe (41, 30.83%), Asia (32, 24.06%), and North America (20, 15.04%). Additionally, 126 countries (44 (34.92%) HICs and 82 (65.08%) LMICs)) had published national guidelines on CC management. These countries were primarily in Asia (32, 25.40%) and Europe (32, 25.40%). Furthermore, 69 countries provided palliative care under both scenarios. The 10 countries with the highest annual opioid consumption (excluding methadone) for CC, in oral morphine equivalence per capita (2017), were all HICs.

CONCLUSIONS

Major inequalities persist in CC vaccination and screening across 194 countries, and access to these services is limited in most LMICs. Focusing on vulnerable populations with lower incomes and regions with stunted economic growth may help alleviate inequity and accelerate CC elimination. We also found that tertiary prevention was achieved in most LMICs, but the indicator-reported annual opioid consumption in oral morphine equivalents indirectly illustrates the under-utilisation of cancer treatment services.

Coupling CRISPR-Cas and a personal glucose meter with an enzymatic reporter for portable detection of human papillomavirus in biological samples

Significant efforts and resources have been dedicated to developing CRISPR-Cas based point-of-care testing (POCT) and self-diagnosis methods for nucleic acid pathogens, aiming to complement the gold standard quantitative PCR tests, particularly in settings where centralized facilities, trained personnel, or resource-intensive equipment are unavailable. However, the reliance on stationary, high-cost readout machinery hinders their full deployment at the point of care. We aimed to develop a solid-phase invertase-labeled reporter (ILR) system that enables convenient readout of CRISPR-Cas reactions, facilitate HPV detection in a POCT-compatible manner. Methods: Through multiple chemical couplings, invertase is immobilized onto magnetic microbeads via a nucleic acid linker that responds to target nucleic acid-induced CRISPR-Cas activation. This activation releases active invertase, which then converts sucrose to glucose in proportion to the target's abundance. Enzymatic signal amplification by Cas12a/Cas13a and invertase compensates for the moderate sensitivity of personal glucose meters (PGMs). Results: When applied to human papillomavirus detection, the HPV18-targeted LAMP-Cas12a/ILR/PGM system can detect as few as 7 HPV18-positive HeLa cells out of 7,000, achieving 95.8% sensitivity and 100% specificity in cervical cell samples. Furthermore, minimal reagent adjustments allow for the rapid establishment of HPV16 and HPV52-targeted LAMP-Cas12a/ILR/PGM systems, offering satisfactory sensitivity, specificity, and cross-species detection. Conclusion: These findings demonstrate a highly efficient testing platform for a range of nucleic acid pathogens, suitable for both point-of-care and household use.

Development, validation, and clinical application of a machine learning model for risk stratification and management of cervical cancer screening based on full-genotyping hrHPV test (SMART-HPV): a modelling study

Background

High-risk human papillomavirus (hrHPV) full genotyping facilitates risk stratification and efficiency in cervical cancer screening, widely verified and adopted in various screening settings. We aimed develop a cervical cancer predictive model that can guide referrals for colposcopy using hrHPV full genotyping data in a setting where screening rate is low.

Methods

We developed, compared and validated four machine learning models (eXtreme gradient boosting [XGBoost], support vector machine [SVM], random forest [RF], and naïve bayes [NB]) for cervical cancer prediction, using data from a national cervical cancer screening project conducted in 267 healthcare centers in China. Cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and CIN3+ were the primary and secondary outcomes. In various screening settings across China, the performance of discrimination was evaluated using area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, area under the precision-recall curve (AUPRC), and accuracy. Calibration and clinical utility were assessed with brier score, calibration curve and decision curve analysis (DCA).

Findings

1,112,846 women were recruited, of whom 599,043 were included in the analysis based on hrHPV full genotyping. Of these, 254,434 (age [years, median, IQR]: 48, 42-54), 297,479 (49, 43-55), 38,500 (37, 32-44), 1950 (38, 33-46), 1590 (53, 47-58), 779 (38, 31-49) and 4311 (40, 33-50) were in the development, temporal validation and external validation 1-5 datasets, respectively. The final simplified clinical risk prediction model includes hrHPV, number of HPV genotypes, cervical cytology, HPV16, HPV18, age, HPV52, HPV39 and gynecological examination. The final optimal XGBoost model for predicting CIN2+ showed good discrimination (AUROC, maximum 0.989 [0.987-0.992]; minimum 0.781 [0.74-0.819]), and calibration (brier score, maximum 0.118 [0.099-0.137]) in the five external validation sets. DCA showed that when the clinical decision threshold probability for optimal XGBoost model was less than 0.80, the model for predicting CIN2+ provided a superior standardized net benefit. The optimal XGBoost model obtained similar results in predicting CIN3+.

Interpretation

We developed a cervical cancer screening risk prediction model that employs hrHPV full genotyping and simple test results to achieve risk prediction and stratified management for colposcopy referrals. This predictive tool is particularly suitable for settings with low screening rates.

Funding

National Natural Science Foundation of China; Major Scientific Research Program for Young and Middle-aged Health Professionals of Fujian Province, China; Fujian Province Central Government-Guided Local Science and Technology Development Project; Fujian Province's Third Batch of Flexible Introduction of High-Level Medical Talent Teams; Fujian Provincial Natural Science Foundation of China; Fujian Provincial Science and Technology Innovation Joint Fund.

HPV18 E6/E7 activates Ca2+ influx to promote the malignant progression of cervical cancer by inhibiting Ca2+ binding protein 1 expression

Mounting studies have shown that the oncoproteins E6 and E7 encoded by the human papillomavirus (HPV) genome are essential in HPV-induced cervical cancer (CC). Ca2+ binding protein 1 (CABP1), a downstream target of HPV18-positive HeLa cells that interferes with E6/E7 expression, was identified through screening the GEO Database (GSE6926). It was confirmed to be down-regulated in CC through TCGA prediction and in vitro detection. Subsequent in vitro experiments revealed that knocking down E6/E7 inhibited cell proliferation, migration, and invasion, whereas knocking down CABP1 promoted these processes. Simultaneously knocking down CABP1 reversed these effects. Additionally, the results were validated in vivo. Previous studies have indicated that CABP1 can regulate Ca2+ channels, influencing Ca2+ influx and tumor progression. In this study, it was observed that knocking down CABP1 enhanced Ca2+ inflow, as demonstrated by flow cytometry and confocal microscopy. Knocking down E6/E7 inhibited these processes, whereas simultaneously knocking down E6/E7 and CABP1 restored the inhibitory effect of knocking down E6/E7 on Ca2+ inflow. To further elucidate that E6/E7 promotes CC progression by inhibiting CABP1 expression and activating Ca2+ influx, BAPTA/AM treatment was administered during CABP1 knockdown. It was discovered that Ca2+ chelation could reverse the effect of CABP1 knockdown on CC cells. In conclusion, our results offer a novel target for the diagnosis and treatment of HPV-induced CC.

Barriers to breast and cervical cancer screening among adolescent girls and young women in Kenya: A nationwide cross-sectional survey

Promoting regular screening remains one of the primary preventive measures for breast and cervical cancer. The study aimed to assess the prevalence and barriers to breast and cervical cancer screening among adolescent girls and young women (AGYW) in Kenya. The study used data from the 2022 Kenya Demographic and Health Survey (KDHS), with 12,026 AGYW who were selected by multistage sampling. The outcomes of interest were breast and cervical cancer screening. Multivariable logistic regression was used to assess factors negatively associated with the outcome variables, using SPSS (version 29.0). Of the 12,026 AGYW included in this study, only 6.0% (95%CI: 5.6-6.8) and 5.1% (95%CI: 4.8-6.0) had undertaken breast and cervical cancer screening, respectively. Low education (AOR = 0.08, 95%CI: 0.02-0.34 and AOR = 0.48, 95%CI: 0.28-0.83), not working (AOR = 0.67, 95%CI: 0.46-0.97 and AOR = 0.59, 95%CI: 0.42-0.82), low wealth index (AOR = 0.55, 95%CI: 0.32-0.92 and AOR = 0.45, 95%CI: 0.25-0.81), no visit to a healthcare facility in the last 6 months (AOR = 0.48, 95%CI: 0.33-0.69 and AOR = 0.50, 95%CI: 0.35-0.71), and no birth record (AOR = 0.29, 95%CI: 0.13-0.62 and AOR = 0.58, 95%CI: 0.27-0.74), were the major barriers to both breast and cervical cancer screening, respectively. Moreover, having no access to newspaper (AOR = 0.67, 95%CI: 0.46-0.97) was a significant barrier to breast cancer screening while having big problems with distance to a healthcare facility (AOR = 0.49, 95%CI: 0.33-0.73) and not using modern contraception (AOR = 0.60, 95%CI: 0.42-0.86) hindered cervical cancer screening. In conclusion, more efforts are needed from both the government and cancer stakeholders to increase accessibility of breast and cervical cancer screening services, especially to those with low social economic status. More targeted education and sensitization, improving livelihoods of AGYW through various women empowerment efforts, and improving screening capacity of low-grade healthcare facilities are among the useful strategies to improve the low screening rates.

Prevention of gynecological cancers: cervical cancer screening in Turkey: a role model for the world

PURPOSE OF REVIEW

This review examines Turkey's cervical cancer screening programme, highlighting its evolution from a cytology-based approach to a more effective HPV-based strategy. The review is timely given the global push to reduce cervical cancer incidence through improved screening practices, and it positions Turkey's programme as a potential model for other countries facing similar public health challenges.

RECENT FINDINGS

Recent advances in cervical cancer screening in Turkey include the nationwide introduction of HPV DNA testing, centralized laboratory systems and innovative management software. The programme has significantly improved screening coverage and early detection rates, particularly in underserved communities. However, challenges remain in areas such as training healthcare workers, raising awareness of HPV vaccination, and integrating self-sampling methods into the screening process.

SUMMARY

The Turkish experience demonstrates that a well organized HPV-based cervical cancer screening programme can overcome significant cultural and logistical barriers and lead to improved public health outcomes. Future efforts should focus on refining triage strategies, exploring new molecular tests, and expanding the use of self-sampling to further improve the effectiveness of cervical cancer prevention efforts worldwide.

Strategies for strengthening cervical cancer screening programmes in Gwanda district, Zimbabwe: a qualitative study

BACKGROUND

Numerous studies have been conducted on barriers to cervical cancer screening in low resourced settings. Few have however explored the factors that motivate women to make the decision for screening. This study therefore aimed at identifying strategies that could strengthen the utilisation of screening services, with the goal of informing the development of context for enhancing cervical cancer programmes in Gwanda district, Zimbabwe. The socio-ecological model that implies individual, inter-personal, community, and health system factors as influencers of screening behaviours guided the study.

METHODS

A cross sectional qualitative design using five focus group discussions with 36 screening-eligible women aged 25-50 years, and 25 in-depth interviews of health providers with varied responsibilities in the screening programme were conducted. Data were analysed thematically with the aid of the Web Atlas.ti software.

RESULTS

Key findings suggest that women's willingness to be screened, on-going awareness campaigns and an increasing number of screening sites and nurses trained in screening procedures promote the uptake of screening. Concomitantly, awareness and knowledge about cervical cancer screening, male support, and community involvement in planning and implementation of programmes were seen as facilitators to screening, with accessibility of cervical cancer screening services being recognised as the most important.

CONCLUSIONS

To exploit on women's willingness to be screened, delivery of screening services need to be re-engineered through development of strategies for increased and sustained educational programmes and increase of screening facilities. This could effectively address the prevalent barriers and enhance the facilitators for screening uptake.

High burden of abnormal cervical smears in South African primary health care: health programmes implications

Cervical cancer is the second most common malignancy among South African women and the load of abnormal cervical smears has clinical, programmatic and policy implications. This cross-sectional study of women who presented for cervical cancer screening aimed to determine the prevalence of abnormal cervical smears and associated factors in primary health care (PHC) facilities in Gauteng-the most densely populated province in South Africa. A questionnaire collected data on socio-demography, tobacco use, sexual behaviours, HIV status, past treatment for sexually transmitted infections (STI) and cervical cancer screening in the past 10 years. Cytology reports were extracted from the laboratory reports. Of 749 participants, most were black (89.7%), aged 30-49 years (62.2%), single (57.5%) and attained high school education (76.8%). About 43.9% were HIV positive with almost all (97.2%) on antiretroviral therapy. Cytology results were available for 612 (81.9%) participants. Of these, 25.8% (159) were abnormal: 13.2% low-grade squamous intraepithelial lesion; 5.7% atypical squamous cells of undetermined significance and 4.9% high-grade squamous intraepithelial lesion. In bivariate and multivariable analysis, abnormal cervical cytology was not associated with any sociodemographic characteristics, HIV status, tobacco use status, sexual behaviours or past treatment for STI. In conclusion, the prevalence of abnormal cervical smears is high across all demographic groups and irrespective of HIV status and highlights the need to increase screening uptake, including advocacy for self-sampling. It also calls for capacity building to allow for the devolution of some downstream clinical care from specialist to district hospitals and large PHC facilities.

Women's experiences and acceptability of self-administered, home delivered, intravaginal 5-Fluorouracil cream for cervical precancer treatment in Kenya

BACKGROUND

Innovative strategies are essential to meet the World Health Organization's 90/70/90 cervical cancer elimination targets, aiming for 90% access to precancer treatment globally by 2030. In low-and middle-income countries (LMICs) where most cervical cancer cases occur, access to precancer treatment is severely limited. Scalable solutions like self-administered topical therapies can help close this gap. In a recent Phase I trial (ClinicalTrials.gov NCT05362955), we demonstrated safety and adherence to self-administered intravaginal 5% 5-Fluorouracil (5FU) cream as an adjuvant therapy for cervical precancer among women living with HIV (WLWH) in rural Kenya. To understand women's experiences with self-administered 5FU, we evaluated the acceptability of this intervention among trial participants.

METHODS

All 12 participants from the Phase I trial completed a structured questionnaire and in-depth semi-structured interviews in their preferred language, focusing on their experiences with 5FU self-administration, challenges faced, and overall acceptability of the intervention, including whether they would use it again or recommend it to someone who needed it. Quantitative data were analyzed using descriptive statistics. In the qualitative study, acceptability was defined as "the perception that a given treatment is agreeable, palatable, or satisfactory." A thematic analysis was conducted using five dimensions of acceptability: content, complexity, comfort, delivery, and credibility.

RESULTS

The mean age was 43.9 years (SD 4.4), and seven (58%) had primary education or less. While some participants reported feelings of uncertainty when they started using 5FU, at the end of the study, all 12 participants strongly agreed that the cream was safe and were confident they used it correctly. Most participants (91.7%) experienced no discomfort with the vaginal applicator, and most reported using tampons overnight after 5FU use, as recommended. Qualitative findings revealed that favorable perceptions of self-administered 5FU were driven by its ease of use, the discrete nature of the treatment, and the comfort of home application. The main challenges included correctly measuring the study drug, finding a private place at home to self-administer, and the need to use condoms during treatment. Compared to their previous ablation or excision treatments, participants found 5FU to be less painful, and all would prefer a self-administered treatment instead of a procedure if it were an option.

CONCLUSION

Self-administered intravaginal 5FU as an adjuvant treatment for cervical precancer among women living with HIV in Kenya was highly acceptable. Randomized studies of 5FU and other topical therapies in LMICs are needed to evaluate their use in closing the current precancer treatment gaps in these settings.

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.

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

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

A scoping review of evidence on routine cervical cancer screening in South Asia: investigating factors affecting adoption and implementation

NEED: Cervical cancer is a major global public health issue, particularly affecting low and middle-income countries, distinctly in the South Asian region. This geographical region lacks a well-organized routine cervical screening program. Consequently, this scoping review aimed to investigate the evidence on factors influencing the adoption and implementation of routine cervical cancer screening in South Asia.

METHODS

Adopting the "Arksey and O'Malley and Levac et al." methodology, databases such as PubMed, CINAHL, Web of Science, and Scopus were scrutinized in the pursuit of relevant studies. Subsequently, the collected data were synthesized by adopting the Consolidated Framework for Implementation Research (CFIR) model.

RESULTS

A total of 837 records were initially identified and screened for eligibility, including 55 studies. The successful adoption and implementation of cervical cancer screening in South Asia encounter numerous obstacles within the health system, including the absence of a comprehensive program protocol for screening, inadequate health infrastructure, and the presence of multiple sociocultural factors, such as social stigma, low levels of education, and concerns related to modesty.

CONCLUSION

To optimize adoption and implementation, it is imperative to construct a customized policy framework that incorporates a risk communication strategy tailored to the specific contexts of these nations. Drawing insights from the experiences of South Asian countries in executing cervical cancer screening programs can inform the formulation of policies for similar healthcare initiatives aimed at facilitating the expansion of HPV vaccination efforts.

Biochemical mechanisms and molecular interactions of vitamins in cancer therapy

Recently, the potential role of vitamins in cancer therapy has attracted considerable research attention. However, the reported findings are inconsistent, with limited information on the biochemical and molecular interactions of different vitamins in various cancer cells. Importantly, the presence of vitamin receptors in tumor cells suggests that vitamins play a significant role in the molecular and biochemical interactions in cancers. Additionally, studies on the efficacy of vitamin supplementation and dosage levels on tumor progression and mortality risk have yielded inconsistent results. Notably, molecular and biochemical investigations have reported the function of vitamins in the proliferation, growth, and invasiveness of tumor cells, as well as in cell cycle arrest and inflammatory signaling. Additionally, different vitamins may regulate the cancer microenvironment by activating various molecular pathways. Vitamins significantly affect immunological function, antioxidant defense, inflammation, and epigenetic control, and can improve treatment outcomes by affecting cell behavior and combating stress and DNA damage. However, further research is necessary to confirm the efficacy of vitamins, establish ideal dosages, and develop effective cancer prevention and treatment plans. Individualized supplementation plans guided by medical knowledge are crucial to achieving optimal results in clinical and preclinical settings. In this review, we critically evaluated the effects of different vitamins on the risk and development of cancer. Additionally, we examined the potential of vitamin supplements to enhance the efficacy of drug therapy and counteract resistance mechanisms that often arise during cancer treatment.

Parental willingness of HPV vaccination in Mainland China: A meta-analysis

This meta-analysis aimed to systematically review and analyze parental awareness of human papillomavirus (HPV) and its vaccine, as well as parental willingness of the HPV vaccine in China. The literature search selected studies that met the following criteria: study published between 2009 and 2023, study design involving parents with at least one child aged ≤ 18 years, sample sizes exceeding 300, availability of data on parental willingness of the HPV vaccine or sufficient information to calculate effect sizes, and studies published in either English or Chinese. Studies that did not meet one of the above points were excluded. From an initial pool of 660 papers, 33 studies were included, encompassing a total sample size of 92,802. The analysis revealed that the pooled awareness rates of HPV and the HPV vaccine among Chinese parents were 45.0% (95% CI: 36.1-54.0%) and 41.4% (95%CI: 30.7-52.5%), respectively. The overall parental willingness for vaccinating children against HPV was 61.0% (95% CI: 53.5-68.3%). Both parental awareness and willingness of the HPV vaccine in China were found to remain low when compared to other countries.

SlipChip Enables the Integration of CRISPR-Cas12a and RPA for Fast and Stand-Alone HPV Detection

Human papillomavirus (HPV) screening is vital for the early detection and prevention of cervical cancer. However, existing methods often face challenges related to speed, simplicity, and multiplexing, especially in resource-limited settings. Here we developed a portable SlipChip-based multiplexed and rapid nucleic acid testing platform, named SMART, designed to simultaneously detect HPV16 and HPV18. SMART allows seamless integration of the RPA and Cas12a assays on the SlipChip and includes a heating membrane to regulate the on-chip assay temperatures. This allows SMART to operate as a stand-alone platform without additional control instruments. The platform also features an All-in-One imaging mode for rapid on-chip data acquisition, enhancing its performance. SMART enables sensitive detection of HPV16 and HPV18 DNA across multiple samples in just 36 min with a detection limit of approximately 6 copies per reaction. Testing of 56 clinical samples at risk of HPV infection validated SMART's performance, showing 97.7% sensitivity and 100% specificity. In summary, SMART offers a stand-alone system capable of rapidly distinguishing between the two most harmful HPV subtypes, showcasing the significant potential for rapid, multiplexed nucleic acid testing in various applications.

How well does vaccine literacy predict intention to vaccinate and vaccination status? A systematic review and meta-analysis

This review quantified the association of vaccine literacy (VL) and vaccination intention and status. PubMed, Scopus, and Web of Science were searched. Any study, published until December 2022, that investigated the associations of interest were eligible. For each outcome, articles were grouped according to the vaccine administrated and results were narratively synthesized. Inverse-variance random-effect models were used to compare standardized mean values in VL domain(s) between the two groups: individuals willing vs. unwilling to get vaccinated, and individuals vaccinated vs. unvaccinated. This review of 18 studies shows that VL strongly predicts the vaccination intention while its association with vaccination status is attenuated and barely significant, suggesting that other factors influence the actual vaccination uptake. However, given the scarce evidence available, the heterogeneity in the methods applied and some limitations of the studies included, further research should be conducted to confirm the role of VL in the vaccination decision-making process.

M6A modification regulates tumor suppressor DIRAS1 expression in cervical cancer cells

DIRAS family GTPase 1 (DIRAS1) has been reported as a potential tumor suppressor in other human cancer. However, its expression pattern and role in cervical cancer remain unknown. Knockdown of DIRAS1 significantly promoted the proliferation, growth, migration, and invasion of C33A and SiHa cells cultured in vitro. Overexpression of DIRAS1 significantly inhibited the viability and motility of C33A and SiHa cells. Compared with normal cervical tissues, DIRAS1 mRNA levels were significantly lower in cervical cancer tissues. DIRAS1 protein expression was also significantly reduced in cervical cancer tissues compared with para-cancerous tissues. In addition, DIRAS1 expression level in tumor tissues was significantly negatively correlated with the pathological grades of cervical cancer patients. DNA methylation inhibitor (5-Azacytidine) and histone deacetylation inhibitor (SAHA) resulted in a significant increase in DIRAS1 mRNA levels in C33A and SiHa cells, but did not affect DIRAS1 protein levels. FTO inhibitor (FB23-2) significantly down-regulated intracellular DIRAS1 mRNA levels, but significantly up-regulated DIRAS1 protein levels. Moreover, the down-regulation of METTL3 and METTL14 expression significantly inhibited DIRAS1 protein expression, whereas the down-regulation of FTO and ALKBH5 expression significantly increased DIRAS1 protein expression. In conclusion, DIRAS1 exerts a significant anti-oncogenic function and its expression is significantly downregulated in cervical cancer cells. The m6A modification may be a key mechanism to regulate DIRAS1 mRNA stability and protein translation efficiency in cervical cancer.

Predictors of delay in the cervical cancer care cascade in Kampala, Uganda

Background

Cervical cancer is the fourth most common cancer among women with significant global disparities in disease burden. In lower-resource settings, where routine screening is uncommon, delays in diagnosis and treatment contribute to morbidity and mortality. Understanding care delays may inform strategies to decrease time to treatment, improving patient outcomes.

Methods

We collected sociodemographic, reproductive health and care journey data from 268 Ugandan women newly diagnosed with cervical cancer. We explored the influence of patient, health provider, system, and disease factors on time to presentation (patient interval), diagnosis (diagnostic interval) and treatment (treatment interval) using survival analysis.

Results

Median patient, diagnostic and treatment intervals were 74 days (IQR 26-238), 83 days (IQR 34-229), and 34 days (IQR 18-58), respectively. Patient interval was delayed by belief that symptoms would resolve (aHR 0.37, 95% CI 0.24-0.57), confusion about where to seek care (aHR 0.64, 95% CI 0.47-0.88), and utilization of traditional care (aHR 0.70, 95% CI 0.51-0.96). Patient interval facilitators included perceiving symptoms as serious (aHR 2.14, 95% CI 1.43-3.19) and suspecting cancer (aHR 1.82, 95% CI 1.12-2.97). Diagnostic interval delays included symptomatic bleeding (aHR 055, 95% CI 0.35-0.85) and visiting > 2 clinics (aHR 0.69, 95% CI 0.49-0.97); facilitators included early-stage disease (aHR 1.41, 95% CI 1.03-1.95) and direct tertiary care presentation (aHR 2.13, 95% CI 1.20-3.79). Treatment interval delays included anticipating long waits (aHR 0.68, 95% CI 0.46-1.02) and requiring blood transfusions (aHR 0.63, 95% CI 0.37-1.07); no facilitators were identified.

Conclusions

We identified potentially modifiable barriers and facilitators along the cervical cancer care cascade. Interventions targeting these factors may improve care timeliness but are unlikely to significantly improve morbidity or mortality. Expanding cervical cancer screening and vaccination are of utmost importance.

Intervention-amenable factors associated with lack of HPV vaccination in Kenya: Results from a large national phone survey

BACKGROUND

Coverage of human papillomavirus (HPV) vaccination remains suboptimal in many countries, but the determinants are not well-understood particularly in low- and middle-income countries. We undertook a random digit dialed phone survey across Kenya between July-October 2022, with parents/caregivers of preadolescent girls, to identify intervention-amenable factors associated with respondents' daughter's HPV vaccination status.

METHODS

Informed by the World Health Organization Behavioral and Social Drivers of Vaccination framework, we collected information about respondents' knowledge about and hesitancy toward HPV vaccine, perceived risk of cervical cancer, social norms around HPV vaccination, trust in institutions, and access to HPV vaccination services.

RESULTS

1416 parents/caregivers completed the survey (97.4 % of those eligible), of whom 38.2 % said that age-eligible girl(s) in their household had received any doses of the HPV vaccine. Knowledge/perceptions: In multivariable models adjusted for sociodemographic characteristics, respondents with less HPV vaccine hesitancy and fewer concerns about safety were more likely to have vaccinated daughter(s), as were those with greater knowledge about HPV vaccine and knowing someone who had died from cervical cancer. Social norms: Having spoken with others about HPV vaccination, although reported by less than half of respondents, and believing that other parents have vaccinated their daughters were associated with having vaccinated daughter(s). Respondents with more trust in information about HPV vaccination from health systems, and with higher trust in institutions, had greater odds of having vaccinated daughter(s). Access: One-fifth of respondents had experienced, or anticipated experiencing, challenges accessing HPV vaccination services, and these respondents had approximately half the odds of having a vaccinated daughter compared to their counterparts.

CONCLUSIONS

Promising areas for intervention include: targeted messaging about safety of the HPV vaccine, increasing parents'/caregivers' knowledge about the vaccine, and leveraging trusted messengers including health workers, faith leaders, and peer parents/caregivers.

Compliance Rate With Triage Test and Treatment for Participants Screening Positive in Cervical Cancer Screening Programs: A Systematic Review and Meta-analysis

OBJECTIVE

To assess the rates of adherence to triage testing after positive screening results and referral to treatment for precancerous lesions in global cervical cancer screening programs.

DATA SOURCES

We searched three electronic databases (Medline, EMBASE, and Web of Science) for articles published in the English language from January 1, 2018, to December 31, 2023. We included studies reporting the compliance rate of triage testing and precancer treatment in cervical cancer screening programs. ClinicalTrials.gov was reviewed, and no more studies were identified.

METHODS OF STUDY SELECTION

The combined search strategies identified 1,673 titles, of which 858 titles and abstracts were screened and 113 full-text articles were assessed for eligibility. A total of 33 studies met the inclusion criteria and were included in the meta-analysis.

TABULATION, INTEGRATION, AND RESULTS

Thirty-three studies were included in the systematic review and meta-analysis. The average compliance rate for women screening positive was 77.1% for triage testing and 69.4% for referral to treatment. Compliance varied by country income level, screening guideline approach, and target population.

CONCLUSION

The current compliance rate was lower than the 90% target set by the World Health Organization's global strategy to eliminate cervical cancer. Inadequate follow-up of participants screening positive revealed a gap between the screening program and clinical care.

Integrated cervical cancer screening uptake and associated factors among women attending primary care services at public health centres in Addis Ababa, Ethiopia: a multicentre cross-sectional study

Background

Cervical cancer (CC) is a major health problem in Ethiopia. Integrated healthcare approaches have been suggested as a way to increase access to and utilisation of screening services. Limited data exists on integrated CC screening (CCS) uptake at the primary care facilities where most women access healthcare. This study aimed to determine integrated CCS uptake and associated factors among women attending primary care services at health centres (HCs) in Addis Ababa, Ethiopia.

Methods

A multicentred cross-sectional study design was conducted among 1366 women attending primary care services at HCs in Addis Ababa. A systematic random sampling method was used to reach the study participants. Sexually active women aged 30-49 years attending primary care services in HCs were included in the study. A multivariable logistic regression model, with Stata/MP V.17.0 software, was used to identify the factors associated with integrated CCS service utilisation at a p value<0.05. Findings were presented using adjusted OR (AORs) with 95% CI.

Result

Only 15.6% (95% CI: 13.7 to 17.6) of women used the CCS that was integrated into the primary care services that they initially sought. Being single (AOR: 4.10; 95% CI: 2.19 to 7.68), divorced (AOR: 2.33; 95% CI: 1.04 to 5.21), attending college and above (AOR: 5.86; 95% CI: 2.32 to 14.79), being in the richest wealth index (AOR: 2.76; 95% CI: 1.46 to 5.22), husband's sexual behaviour (AOR: 6.8; 95% CI: 4.09 to 11.21), having a favourable attitude towards CCS (AOR: 2.24; 95% CI: 1.52 to 3.29) and visiting postnatal clinic (AOR: 8.06; 95% CI: 2.33 to 27.8) were associated with utilisation of CCS services, while preference of a specific gender of healthcare provider (HCP) (AOR: 0.04; 95% CI: 0.02 to 0.13) was associated with non-utilisation of CCS.

Conclusion

The study found low integrated CCS uptake among women in Addis Ababa, influenced by factors like marital status, education, wealth, husband's sexual behaviour, attitude towards CCS, postnatal clinic visits and preferred gender of HCPs. Taking these factors into consideration by stakeholders could promote CCS utilisation.

Performance of a Full-Coverage Cervical Cancer Screening Program Using on an Artificial Intelligence- and Cloud-Based Diagnostic System: Observational Study of an Ultralarge Population

BACKGROUND

The World Health Organization has set a global strategy to eliminate cervical cancer, emphasizing the need for cervical cancer screening coverage to reach 70%. In response, China has developed an action plan to accelerate the elimination of cervical cancer, with Hubei province implementing China's first provincial full-coverage screening program using an artificial intelligence (AI) and cloud-based diagnostic system.

OBJECTIVE

This study aimed to evaluate the performance of AI technology in this full-coverage screening program. The evaluation indicators included accessibility, screening efficiency, diagnostic quality, and program cost.

METHODS

Characteristics of 1,704,461 individuals screened from July 2022 to January 2023 were used to analyze accessibility and AI screening efficiency. A random sample of 220 individuals was used for external diagnostic quality control. The costs of different participating screening institutions were assessed.

RESULTS

Cervical cancer screening services were extended to all administrative districts, especially in rural areas. Rural women had the highest participation rate at 67.54% (1,147,839/1,699,591). Approximately 1.7 million individuals were screened, achieving a cumulative coverage of 13.45% in about 6 months. Full-coverage programs could be achieved by AI technology in approximately 1 year, which was 87.5 times more efficient than the manual reading of slides. The sample compliance rate was as high as 99.1%, and compliance rates for positive, negative, and pathology biopsy reviews exceeded 96%. The cost of this program was CN ¥49 (the average exchange rate in 2022 is as follows: US $1=CN ¥6.7261) per person, with the primary screening institution and the third-party testing institute receiving CN ¥19 and ¥27, respectively.

CONCLUSIONS

AI-assisted diagnosis has proven to be accessible, efficient, reliable, and low cost, which could support the implementation of full-coverage screening programs, especially in areas with insufficient health resources. AI technology served as a crucial tool for rapidly and effectively increasing screening coverage, which would accelerate the achievement of the World Health Organization's goals of eliminating cervical cancer.

Evaluation of a real-time optoelectronic method for the detection of cervical intraepithelial neoplasia and cervical cancer in patients with different transformation zone types

We aimed to evaluate the diagnostic value of TruScreen, a real-time diagnostic technology, for cervical lesions in patients with different transformation zone (TZ) types. A total of 1908 women aged 34.0 ± 7.3 years who have received cytology, human papillomavirus (HPV) testing, TruScreen, and colposcopy were recruited. The clinical performances of these tests were evaluated for their detection of high-grade squamous intraepithelial lesion (HSIL), adenocarcinoma in situ (AIS), or more severe lesions in patients with different TZ types. For the detection of HSIL, AIS, or more severe lesions, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of TruScreen were 65.08%, 64.76%,11.55%, and 96.33%, respectively, which were similar to cytology (all P values > 0.05). For the detection of HSIL + in patients with type 3 TZ, the sensitivity, specificity, PPV, and NPV of TruScreen were 72.29%, 67.59%, 13.86%, and 97.13%, respectively, which were significantly higher than the sensitivity (51.16%, P = 0.029), specificity (59.59%, P = 0.001), PPV (7.94%, P = 0.016), and NPV (94.71%, P = 0.049) in type 1 and type 2 TZs. TruScreen has detection accuracy comparable to cytology and performs even better in patients with type 3 TZ.

Cervical precancer screening using self-sampling, HPV DNA testing, and mobile colposcopy in a hard-to-reach community in Ghana: a pilot study

BACKGROUND

The World Health Organization has set ambitious goals to eliminate cervical cancer, necessitating evidence on increasing coverage and access to screening and treatment in high-burden areas. We implemented a pilot program to assess the feasibility of obtaining self-collected specimens for high-risk human papillomavirus (hr-HPV) testing in Nzulezo stilt village, a hard-to-reach community in Ghana, and inviting only hr-HPV-positive women to a central location for colposcopy and possible treatment. Subsequently, this study aimed to investigate the prevalence of hr-HPV infection and cervical lesions among the women and to explore factors potentially associated with hr-HPV infection among them.

METHODS

This pilot community-based cross-sectional study utilized data from screening sessions held from 2 to 20 November 2021 with specimens collected by participants using Evalyn brushes. HPV DNA testing was performed using the Sansure MA-6000 platform, while visual inspection utilized the Enhanced Visual Assessment (EVA) mobile colposcope. Univariate and multivariable nominal logistic regression was employed to explore factors associated with hr-HPV positivity.

RESULTS

Among 100 women screened (mean age, 43.6 ± 14.5 years), the overall hr-HPV prevalence rate was 39.0% (95% CI, 29.4-49.3). The prevalence rates of hr-HPV genotypes were stratified as follows: HPV16-8.0% (95% CI, 3.5-15.2), HPV18-5.0% (95% CI, 1.6-11.2), and other genotype(s) - 31.0% (95% CI, 22.1-41.0). Single-genotype infections with HPV16 and HPV18 were found in 4.0% (95% CI, 1.1-9.9) and 3.0% (95% CI, 0.6-8.5) of women, respectively. Mixed infections were observed in 1.0% (95% CI, 0.0-5.4) for HPV16 + 18, 3.0% (95% CI, 0.6-8.5) for HPV16 + other type(s), and 1.0% (95% CI, 0.0-5.4) for HPV18 + other type(s). The prevalence of cervical lesions among hr-HPV-positive women screened via colposcopy was 11.4% (95% CI, 3.2-26.7). In the multivariable model, reliance on other sources for medical bill payment was associated with hr-HPV infection (aOR, 0.20; 95% CI, 0.04-0.93), whereas age was not (aOR, 1.02; 95% CI, 0.99-1.05).

CONCLUSIONS

A high hr-HPV infection prevalence was recorded among the women. Utilizing technologies such as self-sampling, HPV DNA testing, and mobile colposcopy enables screening and treatment in remote and hard-to-reach communities where access to cervical cancer screening and treatment would otherwise be limited. Further research is warranted to assess the value and scalability of this approach in similar remote areas and its potential implementation in future programs.

Population-based cross-sectional survey of cervical cancer screening prevalence and socio-demographic correlates in Bangladeshi women

BACKGROUND

Cervical cancer, albeit preventable, is the second-most deadly gynecological cancer in developing nations. Little is known about cervical cancer among Bangladeshi women. This study aims to estimate the prevalence of cervical cancer screening and demographic correlates to identify potential variabilities in screening rates among different demographic groups and regions.

METHODS

This study used secondary data from the WHO STEPS 2018 Survey. We used Bayesian regression to perform the bivariate analyses between the outcome and each explanatory factor, as it generates more acceptable results and improves parameter estimates. The top-ranked socio-demographic factors were identified using a two-step cluster analysis. This method determines the relevance of predictor variables and automatically establishes the number of clusters.

RESULTS

The prevalence of Bangladeshi women who had ever been screened for cervical cancer was 6.2%. In the adjusted model, women with the following socio-demographic factors had a higher likelihood of developing cervical cancer: being 18-29 years old (AOR = 3.3, 95% CI: 0.24, 15.27) or 45-59 years old (AOR = 2.8, 95% CI: 1.22, 6.0), currently married (AOR = 2.3, 95% CI: 1.36, 3.70), and employed (AOR = 2.4, 95% CI: 1.40, 4.06). Women in the Barisal division were found to have higher odds of being screened for cervical cancer (AOR = 21, 95% CI: 0.66, 121.97). Cluster analysis found residence status predisposes women to cervical cancer screening.

CONCLUSION

There is a significant potential for substantial reductions in the burden of cervical cancer in Bangladesh by strengthening the application of cervical cancer screening. Future studies should examine how socioeconomic status, culture, and healthcare access affect cervical cancer screening trends for different divisions in Bangladesh. An independent national cancer registry is urgently needed to evaluate screening trends and outcomes.

A comparative study of self-collected versus clinician-collected specimens in detecting high-risk HPV infection: a prospective cross-sectional study

OBJECTIVE

The primary objective of this study was to compare the detection rate of high-risk human papillomavirus (HPV) infection between self-sampling to collect vaginal specimens and clinician sampling to collect cervical specimens, as well as the correlation between the two techniques. The secondary objective was to assess satisfaction with selfsampling for HPV testing.

METHODS

From October 2021 to September 2022, women positive for HPV 16/18 and other 12 high-risk HPV genotypes and cytological Ascus were enrolled. All participants were instructed on the method for self-collection of HPV samples. Self-collected vaginal samples and clinician-collected cervical samples were subjected to HPV DNA typing.

RESULTS

Paired self- and clinician-collected specimens were obtained from 104 women with positive HPV-positive results. The detection rate of high-risk HPV infection was comparable between the two techniques: 79/98 (80.6%) vs. 81/98 (82.7%) for the self-sampling and clinician-sampling techniques, respectively (McNemar's test; P=0.774). The agreement in detecting HPV infection was substantial, with a kappa coefficient of 0.75. More than 90% of the participants rated self-collection as satisfactory to very satisfactory because of its convenience and safety. Regarding methods of further follow-up, 51% of the participants chose self-sampling, whereas the remaining participants preferred collection by clinicians. No intervention-related complications were observed.

CONCLUSION

The self-sampling technique for HPV testing was as effective as the clinician-sampling technique, and both techniques were substantially correlated in detecting high-risk HPV infection. The self-sampling method appears to be highly satisfactory and may provide better compliance for the detection of cervical HPV infection.

Population-level health impact of hypothetical waning 1-dose human papillomavirus vaccination and 2-dose mitigation strategies in a high cervical cancer burden setting

BACKGROUND

We simulated the impact of hypothetical waning scenarios of a 1-dose human papillomavirus (HPV) vaccination paired with switching to 2-dose mitigation strategies guided by empirical vaccine trial reporting timelines.

METHODS

Using 2 independent mathematical models fitted to a high-burden setting, we projected the cumulative cervical cancer cases averted over 85 years for alternative HPV vaccination scenarios under 2 program adoption timelines: 1) de novo introduction of a 1-dose HPV vaccination and 2) a switch from an existing 2-dose HPV vaccination program to a 1-dose vaccination. We assumed 80% vaccination coverage with the bivalent vaccine and an average duration of a 1-dose HPV vaccine protection of either 30 or 25 years with 100% efficacy. We varied the eligible age group(s) at program introduction and the 2-dose mitigation (single-age cohort or multi-age cohort). If needed for mitigation, reintroduction of 2-dose vaccination was assumed to occur in 2036 (ie, 30 years after initiation of the Costa Rica Vaccine Trial).

RESULTS

Under both vaccine adoption timelines, the models projected that countries could achieve the same level of health benefits by switching to 2 doses in 2036 using a multi-age cohort approach as with initiating a 2-dose or 1-dose vaccination program with no waning. With only a single-age cohort 2-dose mitigation approach, 98%-99% of cases would be prevented compared with the health benefits of 2 doses or a noninferior, durable 1 dose.

CONCLUSIONS

Countries hesitant to adopt a 1-dose HPV vaccination program may have opportunities to leverage the benefits and efficiency of a 1-dose schedule while awaiting longer-term reporting from 1-dose durability studies, including Costa Rica Vaccine Trial.