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Cancers
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Cervical Cancer: Risk Factors, Screening, and Prevention Strategies
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Cervical Cancer: Risk Factors, Screening, and Prevention Strategies

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Causes, Screening and Diagnosis".

Deadline for manuscript submissions: closed (31 December 2024) | Viewed by 7271

Special Issue Editor

Dr. Francesco Cannone

E-Mail Website
Guest Editor
Department of Obstetrics and Gynaecology, Azienda di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Garibaldi Nesima, 95122 Catania, Italy
Interests: ovarian cancer; gynaecological cancer; endometriosis; pregnancy

Special Issue Information

Dear Colleagues,

Cervical cancer is a significant global health concern, primarily affecting women. It arises from abnormal cell growth in the cervix, the lower part of the uterus. While it remains a prevalent malignancy, advancements in risk assessment, screening methods, and preventive strategies have significantly contributed to its prevention and early detection.

We welcome original articles and comprehensive reviews focusing on high-quality basic and clinical research on cervical cancer. We look forward to receiving your contributions.

Dr. Francesco Cannone
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • cervical cancer
  • human papillomavirus (HPV)
  • risk factors
  • HPV vaccination
  • cervical screening
  • preventive strategies

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Published Papers (4 papers)

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Research

17 pages, 269 KiB  
Article
HPV-Related Knowledge and Impact of Patient–Provider Communication on HPV-Associated Cervical Cancer Awareness and Pap Smear Completion in US Women Aged 21–65 Years
by Adrienne Dean, Nada Eldawy, Jennifer Mendonca, Diana Lobaina, Yasmine Zerrouki, Goodness Okwaraji, Vama Jhumkhawala, Sara Burgoa, Chinenye Lynette Ejezie, Panagiota Kitsantas, Maria Mejia and Lea Sacca
Cancers 2025, 17(7), 1188; https://doi.org/10.3390/cancers17071188 - 31 Mar 2025
Viewed by 447
Abstract
Background: The United States (US) continues to face a substantial burden of cervical cancer, which has been the focus of many policies and public health prevention agendas. Of the numerous risk factors associated with cervical cancer, human papillomavirus (HPV) infection remains the leading [...] Read more.
Background: The United States (US) continues to face a substantial burden of cervical cancer, which has been the focus of many policies and public health prevention agendas. Of the numerous risk factors associated with cervical cancer, human papillomavirus (HPV) infection remains the leading and most preventable cause of this chronic disease. Therefore, one major public health prevention strategy to decrease cervical cancer cases is HPV vaccination. Another screening tool that enables cervical cancer prevention and early intervention is the Pap smear, the primary method of screening for abnormal cervical cells. However, barriers such as social determinants of health and ineffective patient–provider communication hinder access to such critical preventive measures. The purpose of this study was to provide a comprehensive overview of the knowledge level of US female adults, aged 21–65 years, concerning HPV infection and cervical cancer prevention using the Health Information National Trends Survey (HINTS) database. Additionally, it assessed associations between patient–provider communication and the completion of Pap smear tests. Methods: Descriptive statistics were computed to explore the sociodemographic characteristics of female survey participants as well as to gather frequency and percentages of responses related to knowledge of HPV, awareness of the HPV vaccine, and history of Pap smear. Chi-squared tests were carried out to examine the associations between awareness of a cervical cancer vaccine or HPV shot and whether the participant has had a Pap smear, heard of the HPV vaccine, and knowledge of HPV’s association with cervical cancer. Next, binary logistic regression models were built to determine the size and direction of the association between patient–provider communication metrics and measures of (1) having had a Pap smear, (2) participant knowledge of HPV, (3) participant awareness of causality between HPV and cervical cancer, and (4) participant knowledge of HPV vaccine and cervical cancer prevention measures. Results: A substantial majority of participants (81.8%) reported having heard of HPV. Among them, 72.1% recognized that HPV could cause cervical cancer. Awareness of the HPV vaccine was reported by 88.1%, suggesting a relatively high reach of effective public health messaging. Regarding Pap tests, 43.3% of participants had undergone testing within the past year, but 12.6% had not been tested in over five years, and 3.6% have never been tested. Bivariate analysis using chi-squared tests revealed significant associations between participants’ history of Pap smears and their knowledge of HPV infection, its role in cervical cancer, and HPV vaccination as a prevention tool. Participants who had undergone a Pap test were more likely to have heard of HPV (p < 0.001), were knowledgeable of the HPV vaccine (p < 0.001), and were more aware of the HPV vaccine (p < 0.001). Participants reporting “never” for certain communication criteria significantly had an increased risk of having lower knowledge levels about the HPV vaccine and other cervical cancer prevention measures. They also had almost twice the risk of having lower knowledge levels about HPV prevention measures when reporting “never” (RR = 1.997, 95% CI (1.018–3.916) for “spending enough time with patients” compared to those selecting “always”. Additionally, participants responding “sometimes” (RR = 1.889, 95% CI (1.187–3.005) rather than “always” to feeling involved in healthcare decisions had a significantly higher risk of being unaware of the vaccine or other cervical cancer prevention measures. Conclusions: Strengthening provider communication and education skills not only encourages greater patient knowledge and adherence to preventative measures, such as HPV and cervical cancer screening, but also reduces disparities in healthcare stemming from limited health literacy. Full article
(This article belongs to the Special Issue Cervical Cancer: Risk Factors, Screening, and Prevention Strategies)
15 pages, 696 KiB  
Article
Agreement Between High-Risk Human Papillomavirus Testing in Paired Self-Collected and Clinician-Collected Samples from Cervical Cancer Screening in Spain
by Raquel Ibáñez, Esther Roura, Francisca Morey, Miguel Andújar, Miquel Ángel Pavón, Amelia Acera, Laia Bruni and Silvia de Sanjosé
Cancers 2025, 17(1), 63; https://doi.org/10.3390/cancers17010063 - 29 Dec 2024
Viewed by 1017
Abstract
Background: Implementing self-sampling (SS) in cervical cancer screening requires comparable results to clinician-collected samples (CCS). Agreement measures are essential for evaluating HPV test performance. Previous studies on non-paired samples have reported higher viral cycle threshold (Ct) values in SS compared to CCS, [...] Read more.
Background: Implementing self-sampling (SS) in cervical cancer screening requires comparable results to clinician-collected samples (CCS). Agreement measures are essential for evaluating HPV test performance. Previous studies on non-paired samples have reported higher viral cycle threshold (Ct) values in SS compared to CCS, affecting sensitivity for detecting cervical intraepithelial neoplasia grade 2 or worse (CIN2+). Objectives: We aimed to evaluate the agreement of high-risk (hr)HPV testing results between SS and CCS using paired samples and to explore differences in Ct values. Methods: Women aged 30 to 65 years attending cervical cancer screening in two regions of Spain were invited to participated in this study. For each woman there was: CCS collected during the screening visit using liquid-based cytology and cytobrush, and a SS using a brush at home one month later. A PCR-based assay was used for hrHPV detection. Agreement in hrHPV results among both samples, Ct value differences, and their association with screening outcomes were analyzed. Results: This study included 981 women with paired samples. SS had a higher hrHPV prevalence than CCS (overall ratio of 1.3). Positive agreement for all hrHPV genotypes, HPV16, HPV18, and other hrHPV types were 85%, 91.3%, 66.7%, and 83.3%, respectively. Negative agreement was >95% for all results. Median Ct values was slightly higher in SS than in CSS (32.9 vs. 30.6, p = 0.02). Seven CIN2+ cases HPV positive were detected by both methods. One CIN3 case was missed by SS. Conclusions: This study showed a good agreement between SS and CCS for hrHPV testing in a routine screening in Spain. Despite the slightly higher Ct values for SS, no significant impact on sensitivity could be determined due to the low incidence of CIN2+ cases. Further research on larger paired samples is needed to assess the implications of Ct values on test sensitivity. Full article
(This article belongs to the Special Issue Cervical Cancer: Risk Factors, Screening, and Prevention Strategies)
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12 pages, 911 KiB  
Article
Diagnostic Accuracy of DNA-Methylation in Detection of Cervical Dysplasia: Findings from a Population-Based Screening Program
by Narcisa Muresu, Mariangela V. Puci, Giovanni Sotgiu, Illari Sechi, Manuela Usai, Andrea Cossu, Marianna Martinelli, Clementina Elvezia Cocuzza and Andrea Piana
Cancers 2024, 16(11), 1986; https://doi.org/10.3390/cancers16111986 - 23 May 2024
Cited by 3 | Viewed by 2185
Abstract
Background: Epigenetic biomarkers in cancer have emerged as promising tools for early detection, prognosis, and treatment response prediction. In cervical cells, hypermethylation of the host and viral HPV-genome increases with the severity of lesions, providing a useful biomarker in the triage of hr-HPV-positive [...] Read more.
Background: Epigenetic biomarkers in cancer have emerged as promising tools for early detection, prognosis, and treatment response prediction. In cervical cells, hypermethylation of the host and viral HPV-genome increases with the severity of lesions, providing a useful biomarker in the triage of hr-HPV-positive women and during treatment. The present study focuses on evaluating the clinical performance of the FAM19A4/miR124-2 methylation test in a population-based cervical screening program. Methods: Previously collected cervical samples, after bisulfite-converted DNA, were analyzed by PreCursor-M+ kit (distributed by Fujirebio Europe), for DNA methylation. The sensitivity, specificity, and negative/positive predictive values of DNA methylation were compared to histology, colposcopy, the HPV-DNA test, and cytology results. Results: Among the 61-sample set, the specificity of methylation vs. positive histology (≥CIN2) and colposcopy (≥G2) were 87% and 90%, whereas the sensitivity was 50% and 33.3%, respectively. The combination of methylation analysis with standard methods increases diagnostic accuracy. Conclusions: Overall, we found a good specificity of DNA methylation in comparison to currently used techniques. Further larger studies could support the use of FAM19A4/miR124-2 as reliable biomarkers in the prevention of cervical cancer as triage in the screening protocol. Full article
(This article belongs to the Special Issue Cervical Cancer: Risk Factors, Screening, and Prevention Strategies)
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15 pages, 553 KiB  
Article
Clinical Validation of the Vitro HPV Screening Assay for Its Use in Primary Cervical Cancer Screening
by Beatriz Bellosillo, Raquel Ibáñez, Esther Roura, Laura Monfil, Laura Asensio-Puig, Isabel Álvarez, Mercè Muset, Yolanda Florencia, Sonia Paytubi, Álvaro de Andrés-Pablo, Susana Calvo, Laia Serrano-Munné, Miguel Ángel Pavón and Belen Lloveras
Cancers 2024, 16(7), 1322; https://doi.org/10.3390/cancers16071322 - 28 Mar 2024
Cited by 1 | Viewed by 2904
Abstract
Many scientific societies have issued guidelines to introduce population-based cervical cancer screening with HPV testing. The Vitro HPV Screening assay is a fully automatic multiplex real-time PCR test targeting the L1 GP5+/GP6+ region of HPV genome. The assay detects 14 high risk (HR) [...] Read more.
Many scientific societies have issued guidelines to introduce population-based cervical cancer screening with HPV testing. The Vitro HPV Screening assay is a fully automatic multiplex real-time PCR test targeting the L1 GP5+/GP6+ region of HPV genome. The assay detects 14 high risk (HR) HPV genotypes, identifying individual HPV16 and HPV18 genotypes, and the HPV-positive samples for the other 12 HR HPV types are subsequently genotyped with the HPV Direct Flow Chip test. Following international guidelines, the aim of this study was to validate the clinical accuracy of the Vitro HPV Screening test on ThinPrep-collected samples for its use as primary cervical cancer screening, using as comparator the validated cobas® 4800 HPV test. The non-inferiority analysis showed that the clinical sensitivity and specificity of the Vitro HPV Screening assay for a diagnosis of cervical intraepithelial neoplasia of grade 2 or worse (CIN2+) were not inferior to those of cobas® 4800 HPV (p = 0.0049 and p < 0.001 respectively). The assay has demonstrated a high intra- and inter-laboratory reproducibility, also among the individual genotypes. The Vitro HPV Screening assay is valid for cervical cancer screening and it provides genotyping information on HPV-positive samples without further sample processing in a fully automated workflow. Full article
(This article belongs to the Special Issue Cervical Cancer: Risk Factors, Screening, and Prevention Strategies)
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