Search Results (262)

Background: Cervical cancer remains a leading cause of cancer-related deaths among women in Nigeria. In 2023, the Government of Nigeria, with support from Gavi and partners, introduced the single-dose human papillomavirus (HPV) vaccine through a phased, school-based campaign. The first phase was launched in October 2023 across 16 states, followed by a second phase in May 2024 that expanded coverage to the remaining states and the Federal Capital Territory. This study evaluates the additional impact of a behavioral insights–informed digital intervention, comprising a social media campaign amplified by trained pharmacists serving as local influencers, implemented in 2025 to increase acceptance and uptake of HPV vaccination during routine immunization. Methods: A pre-test/post-test quasi-experimental design with a control group was implemented in three Nigerian states in 2025 to assess the additional impact of a behavioral insights–informed social media campaign designed to strengthen social approval for HPV vaccination, increase awareness of vaccination locations, and reinforce caregivers’ recognition of their adolescent daughters’ desire to be vaccinated. Messages were amplified by trained pharmacists who served as local influencers. Caregivers of adolescent girls aged 9–17 years were recruited online through targeted Facebook and Instagram advertisements during Nigeria’s transition from school-based HPV vaccination campaigns to routine immunization. Caregivers in treatment areas were exposed to geofenced social media advertisements on Facebook and Instagram and pharmacist counseling, while those in control areas were not. Logistic regression models using a difference-in-difference approach estimated the campaign’s effect on HPV vaccination, controlling for caregiver and adolescent characteristics. Additional statistical models assessed the campaign’s impact on caregivers’ motivation and ability—key drivers of behavior according to the Fogg Behavior Model. Results: HPV vaccination increased at a significantly higher rate in the treatment compared to the control area. The adjusted odds of an adolescent girl being vaccinated were 1.48 times higher in the treatment area at follow-up (95% CI: 1.14–1.92). Adjusted marginal effects indicated that exposure to the campaign increased the probability of vaccination by 8.9 percentage points relative to the control group. The rate at which caregivers’ motivation (aOR = 1.31, 95% CI: 1.00–1.70) and ability (knowing where to get vaccinated: aOR = 1.38, 95% CI: 1.07–1.79; ease of vaccination: aOR = 1.59, 95% CI: 1.22–2.06) increased was also higher in the treatment area. There was no relative increase in intervention versus control groups in factual knowledge regarding HPV vaccination. Conclusions: A behavioral insights–informed social media campaign in which pharmacists served as influencers was associated with higher HPV vaccine uptake during routine immunization. The higher rate of vaccination observed in intervention areas was associated with higher rates of caregiver motivation and ability but not with higher rates of caregiver knowledge. These findings are consistent with the potential of behavioral insights–informed digital campaigns to complement routine immunization efforts and improve vaccine uptake in low- and middle-income countries. Full article

Background/Objectives: Human papillomavirus (HPV) is the most common sexually transmitted infection worldwide and causes cervical cancer in women. Patients with human immunodeficiency virus (HIV) are particularly susceptible to this virus. An effective vaccine against high-risk HPV genotypes is available. This study sought to evaluate barriers to HPV vaccination in HIV-positive female patients between the ages of 18 and 65 in a county clinic in Houston. Methods: A cross-sectional survey was conducted in May–June 2025 with 131 patients at Thomas Street Health Center in Houston. The survey assessed patient demographics, attitudes toward and knowledge of HPV vaccination (at least one dose), as well as self-reported cervical dysplasia and HPV infection history. Clinical data on available cervical dysplasia history were also gathered from the electronic medical record. Descriptive statistics were compiled, and comparisons between vaccinated and unvaccinated participants were performed using one-way analysis of variance for continuous variables and chi-square tests for categorical variables in R. Results: 75% of patients had prior knowledge of the HPV vaccine, but only 33% reported receiving at least one dose. The most common reason for not receiving the vaccine was never having been offered the vaccine by a provider. Separately, almost 40% of unvaccinated individuals had never heard of the vaccine. Of note, only 8.6% of respondents reported fully understanding the implications of vaccination and still choosing to decline. In this cross-sectional study, there was no statistically significant association between vaccination status and either recent dysplasia history in the electronic record or reported dysplasia or HPV infection history. Among eligible unvaccinated participants, 41% received the HPV vaccine after completing the survey. Conclusions: Addressing gaps in HPV vaccine communication and supporting clinicians in delivering confident counseling may improve vaccination rates in this at-risk population. Full article

Background/Objectives: In the United States, adult human papillomavirus (HPV) vaccination coverage remains low at 20–50%, depending on age, and cervical cancer (CC) screening rates range from 68 to 76%. Few studies have evaluated characteristics of women who are both HPV vaccinated and up to date (UTD) with screening as an integrated outcome. The purpose of the present study was to classify women into four prevention categories and examine factors associated with being double protected compared to unprotected. Methods: Data were gathered via an online survey from a sample of low-income women (household income < USD 50,000) provided by a research survey company (n = 719). Women were classified into four categories: vaccinated only, screened only, both vaccinated and screened (double protected), or neither (unprotected). Sociodemographic characteristics, healthcare access, and Health Belief Model constructs were assessed. Multivariable logistic regression compared women who were double protected with those unprotected (n = 274). Results: Most women were UTD with screening only (57.8%), while 15.5% were double protected and 22.6% were unprotected. Younger age (Odds Ratio [OR = 0.93; 95% Confidence Interval [CI]: 0.89, 0.98), having ≥1 medical visit in the past year (OR = 4.16; 95% CI: 1.74, 9.95), higher perceived CC risk (OR = 3.65; 95% CI: 1.41, 9.43), greater perceived benefits of CC screening (OR = 1.96; 95% CI: 1.45, 2.66), and higher HPV knowledge (OR = 1.09; 95% CI: 1.01, 1.17) were associated with higher odds of being double protected. Conclusions: A substantial proportion of low-income women lack comprehensive CC prevention. Integrated, bundled prevention strategies that simultaneously promote HPV vaccination and screening may be important to reduce CC disparities. Full article

Human papillomavirus (HPV) is the most common sexually transmitted infection worldwide and is responsible for the majority of cervical, anal, and vaginal cancers. The first prophylactic HPV vaccine was introduced in the United States in 2006. Extensive evidence demonstrates the HPV vaccine is highly efficacious and effective, particularly when administered prior to HPV exposure. Despite strong safety data and proven cost-effectiveness, HPV vaccine uptake in the United States and globally remains suboptimal. Barriers to vaccination include limited knowledge, safety concerns, and logistical challenges. Current advancements focus on single-dose vaccine regimens, development of therapeutic vaccines, and higher-valent formulations. Expanding HPV vaccine coverage is essential to reduce HPV-related diseases, strengthen herd immunity, and advance cancer prevention efforts. Full article

Background: Human papillomavirus (HPV) vaccination is a major concern and highly effective strategy for preventing cervical cancer and other related diseases. Despite the inclusion of the HPV vaccine in the Saudi national immunization program and recent school-based initiatives, vaccine uptake remains suboptimal, mainly due to the hesitancy of parents. Evidence regarding HPV vaccine hesitancy in the Aseer region of Saudi Arabia is limited. Objectives: This study aimed to assess the level of the HPV vaccine hesitancy, knowledge, attitude and barriers among parents in the Aseer region of Saudi Arabia using the World Health Organization (WHO) HPV Vaccine Hesitancy Scale (VAS). Methods: A cross-sectional study was conducted among parents residing in the Aseer region, Saudi Arabia. Data were collected using a structured questionnaire that included sociodemographic characteristics, knowledge, barriers and the validated nine-item WHO HPV Vaccine Hesitancy Scale. Data was expressed in numbers (%) for categorical variables and mean ± SD for continuous variables. Independent t-tests and one-way ANOVA were used for inferential statistics. Results: A total of 379 parents participated in the study. Overall, 49% of parents exhibited high HPV vaccine hesitancy. The most frequently reported barriers were safety concerns (82.6%), insufficient information (80.3%) and fear of side effects (79.4). Lower hesitancy scores were observed among parents aged ≥ 46 years than among those aged 18–25 years (p = 0.022), and respondents with postgraduate education were less hesitant than those with a high school education or less (p = 0.030). Parents whose children were fully vaccinated exhibited significantly lower hesitancy scores compared with those whose children were unvaccinated (p = 0.004). Conclusions: The HPV vaccine hesitancy among parents in the Aseer region is greatly influenced by the age of the parents, their educational level, and the child’s vaccination history. Higher hesitancy among younger parents, those with lower educational levels, and parents of unvaccinated children highlights priority groups for targeted interventions. Strengthening healthcare-provider recommendations and implementing culturally tailored, evidence-based communication strategies may improve HPV vaccine acceptance and support national cervical cancer prevention efforts in Saudi Arabia. Full article

Objective: To evaluate the level of knowledge, attitudes, and practices of Hungarian general practitioners (GPs) concerning human papillomavirus (HPV) infection, cervical cancer prevention, and HPV vaccination, and to identify physician-level factors associated with proactive recommendation practices. Methods: A cross-sectional nationwide survey was conducted between 30 April and 1 June 2024. The online questionnaire was distributed to practicing Hungarian GPs listed in the National Health Insurance Fund database. Anonymous responses were collected on demographic data, knowledge of HPV transmission and oncogenic potential, awareness of vaccination guidelines, and clinical counseling habits. Descriptive and inferential statistical analyses were performed. A total of 413 responses were received. Results: Most respondents were female (72.6%) with an average of 22.4 ± 9.6 years of professional experience. Although 89.8% correctly identified the causal link between HPV and cervical cancer, only 56.2% were aware of the complete vaccination schedule recommended for adolescents initiating after age 15. Knowledge scores were significantly higher among female physicians, urban practitioners, and those with postgraduate preventive medicine training. While the overall attitude toward HPV vaccination was positive (mean 4.6/5), 38.4% of respondents reported parental hesitancy as a common barrier, often citing misinformation regarding vaccine safety (64.9%) and lack of perceived need for boys (58.7%). Regression analysis revealed that familiarity with WHO and national vaccination guidelines independently predicted proactive vaccine recommendation (β = 0.43, p < 0.001). Conclusions: Hungarian general practitioners demonstrate good baseline awareness of HPV and its oncogenic role; however, knowledge gaps persist regarding vaccination schedules and counseling practices. Enhancing continuous medical education and communication training could strengthen GPs’ role as key advocates in HPV vaccine promotion. Full article

Background: Modulated electro-hyperthermia (mEHT) is one of the latest advancements in the field of oncological hyperthermia. Previous studies investigating mEHT revealed that it is safe and effective; however, no meta-analysis was conducted either in cervical or ovarian cancer. Methods: A single-institute pilot case series and a meta-analysis were conducted. Advanced stage cervical and ovarian cancer cases were included. In the pilot study, mEHT treatments were conducted using the Oncotherm EHY-2000+ and the EHY-2030 devices with 2–3 treatment sessions per week. Results: For the meta-analysis, a total of five studies were identified, with 160 and 31 cervical and ovarian cancer patients, respectively. In addition, 175 standard-of-care-treated cervical cancer patients were also identified as controls. The 1- and 2-year survival rate of the cervical cancer patients treated with mEHT was 87.61% [95% confidence interval (CI): 71.31–100%] and 78.13% (95% CI: 53.02–100%). Compared to the controls, the 2-year survival rates (78.13% vs. 58.86%) were significantly better in the mEHT-treated cohorts (odds ratio: 0.4143, p = 0.0441; hazard rate: 0.6607, p = 0.0103). The 1- and 2-year survival rates of ovarian cancer patients were 45.46% (95% CI: 5.97–84.95%) and 32.83% (95% CI: 0–79.57%), respectively. The result of our institutional data strengthened the results of the meta-analysis. Conclusions: Using mEHT, a significantly higher 2-year survival rate can be achieved in cervical cancer. In this setting, a wider testing/application of the modality is warranted. In the case of ovarian tumors, the available knowledge is minimal, and applicability and efficacy studies are urgently needed. Full article

Although estrogen signaling plays an important role in gynecological cancers, its function is highly context-dependent and often contradictory. Estrogen receptors have been associated with both tumor-promoting and tumor-suppressive effects depending on the tumor type, disease stage, and cellular environment. This review summarizes the current evidence on estrogen receptor signaling in cervical, ovarian, and endometrial cancers, focusing on receptor subtype balance, isoform diversity, cellular and subcellular localization, and epigenetic regulation. Rather than a static marker, estrogen receptor expression is revealed as a dynamic and plastic signaling network. In cervical cancer, estrogen signaling persists despite the loss of epithelial estrogen receptor α (ERα) through stromal signaling, alternative ERα isoforms, ERβ, and non-classical receptors such as G protein-coupled estrogen receptor 1 (GPER1). In ovarian cancer, epigenetic silencing of ERβ and ERα predominance drives oncogenic signaling while also creating specific biological vulnerabilities. In endometrial cancer, estrogen signaling shifts from hormone-dependent initiation to progressive oncogenic autonomy through receptor rewiring and non-genomic pathways. By integrating these mechanisms, this review highlights estrogen receptor plasticity as a unifying concept across gynecological malignancies and outlines key knowledge gaps that are relevant for future endocrine strategies. Full article

Background: In young women with cervical cancer, fertility preservation remains challenging, as chemoradiotherapy can severely compromise ovarian reserve and endometrial function. Although ovarian transposition prior to pelvic radiotherapy is well established in early-stage disease, evidence regarding ovarian and endometrial outcomes in advanced stages, particularly in the International Federation of Gynecology and Obstetrics (FIGO) stage IIIC1, remains extremely limited. Case Presentation: We report the case of a 31-year-old nulliparous woman with a histopathologically confirmed FIGO IIIC1 cervical squamous cell carcinoma who underwent a lateral ovarian transposition followed by external beam radiotherapy (ERBT) of the pelvis and interstitial high-dose-rate (HDR) brachytherapy combined with five cycles of cisplatin-based chemotherapy. A detailed dosimetrical analysis demonstrated extremely low ovarian radiation exposure (mean dose < 2 Gy bilaterally). Menstruation resumed seven months after treatment completion, with regular 27–30-day cycles. A day-3 hormonal assessment showed a partial preservation of the ovarian reserve, and the pelvic ultrasound confirmed a thickness of 7 mm in the proliferative phase, implying endometrial function despite full-dose pelvic irradiation. Conclusions: To our knowledge, this is a very unique case of preserved menstruation after ovarian transposition and chemoradiotherapy for FIGO IIIC1 cervical carcinoma. This case challenges the conventional assumptions regarding ovarian failure and endometrial destruction in such cases, suggesting that reproductive potential may occasionally be retained. Although fertility remains a challenging point, this case report underscores the need for individualized counseling and prospective oncofertility research. Full article

Background: Human papillomavirus (HPV) has been identified as the causative agent of cervical cancer and other cancers of the genital area, head and neck, on a worldwide scale. Despite the proven effectiveness of the vaccine in preventing HPV-related diseases, vaccination uptake remains low in many countries. It is crucial to understand how adolescents and young adults perceive HPV and its vaccine in order to design effective public health strategies and targeted awareness campaigns. Aim: This systematic review examined the attitudes, perceptions, and opinions of young people regarding HPV and HPV vaccination, with the goal of identifying factors that shape vaccine acceptance. Methods: A systematic literature search of PubMed and Scopus identified 293 articles published between January 2014 and February 2025. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. Eligible studies included primary qualitative and analytical cross-sectional research published in English that explored views on HPV and vaccination among individuals aged 15–24 years. Due to substantial heterogeneity in study design and outcome measures, findings were synthesized narratively and no meta-analysis was performed. The methodological quality and risk of bias of the included studies were assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklists (2017) for qualitative and analytical cross-sectional designs. Results: Ten studies met the eligibility criteria, representing 15,776 young people across six countries. The included studies comprised eight cross-sectional surveys and two qualitative studies. Across these studies, knowledge and awareness of HPV and its vaccine were generally moderate, while vaccination coverage remained low. The highest awareness levels were reported in the United States (95.3% for HPV; 90.6% for the vaccine), whereas lower levels were noted in Brazil, Greece, and Italy. Influential factors associated with vaccine acceptance included parental attitudes, healthcare-provider recommendations, cultural norms, and the presence of misinformation. Conclusions: The level of awareness regarding HPV among adolescents and young adults in the included countries is moderate, yet the vaccination coverage remains low across the included countries. The provision of targeted educational interventions, in conjunction with the consistent guidance and training provided by healthcare professionals, is of considerable importance in order to increase vaccination rates. Findings should be interpreted in light of heterogeneity across studies and reliance on self-reported outcomes. Future research should adopt a mixed-methods approach to more effectively address the social, cultural and informational influences shaping young people’s perceptions, and to develop more effective communication strategies that promote HPV vaccination. Full article

Background: Canada’s cervical cancer elimination plan is challenged by suboptimal screening participation and rising incidence of cervical cancer over the past decade. Cytology, the primary cervical screening method in Canada, is being replaced with HPV testing, which offers superior sensitivity for detecting pre-cancerous lesions and supports initiating screening at age 25 or older and extending screening intervals to five years. Research has shown that women’s insufficient knowledge and negative attitudes toward HPV screening represent a significant barrier to screening uptake. Methods: We conducted a web-based national survey using Best–Worst Scaling (trade off utilities) to quantify women’s preferences for screening test modality, age of initiation, and screening intervals. We also assessed preferences for information sources, provider type, and communication methods. Underscreened individuals were oversampled. Results: Among adequately screened (N = 1778) and underscreened (N = 1570) individuals, preferences favoured co-testing (cytology plus HPV testing), initiating screening at age 21, and three-year screening intervals. Underscreened participants showed relatively higher preference for HPV self-sampling, and as opposed to adequately screened participants, preferred screening by a gynecologist rather than a family physician. Across groups, participants preferred receiving screening-related information and communication by email over postal mail. Conclusions: The misalignment between women’s preferences and current HPV test-based screening implementation plans requires immediate education interventions and modernized, user-preferred communication channels for cervical screening-eligible individuals in Canada. Full article

Background/Objectives: Unequal access to cervical cancer screening and treatment remains a significant contributor to preventable morbidity and mortality for women in the Amazon Basin, compounded by geographic, social and infrastructural barriers. Given the fragmented nature of the existing evidence, this systematic review aims to synthesize available findings on barriers to cervical cancer screening and treatment for this region. The implications of these findings are examined to inform the development of actionable strategies to improve equity in prevention and care. Methods: This systematic review was conducted in accordance with PRISMA 2020. Searches were conducted on 7 November 2025, in PubMed/MEDLINE, Web of Science, and SciELO, utilizing combinations of MeSH terms, keywords, and free-text expressions. Studies were considered eligible if they addressed barriers to cervical cancer screening or treatment among women living in the Amazon Region. Two reviewers independently screened the studies and extracted the relevant data. The risk of bias was assessed using the JBI checklists, the Newcastle–Ottawa Scale, and the MMAT. A narrative synthesis summarized the results. Results: Of 57 studies identified, 11 were included. Organizational and health-system barriers were reported most frequently, including scheduling difficulties, long wait times, a shortage of professionals, and equipment unavailability. Socioeconomic barriers were most often related to younger age, low income, limited schooling, and care related expenses. Cultural factors were frequently linked to fear of the procedure and insufficient knowledge about cervical cancer. Geographic barriers included rural residence and travel difficulties. Conclusions: This systematic review indicates that disparities in cervical cancer screening in the Amazon region are primarily associated with organizational and health-system-related barriers, together with socioeconomic, cultural, and geographic factors. These findings highlight the need for equitable, multisectoral interventions to strengthen service organization, improve health literacy, and expand timely access to screening and treatment for underserved women. Full article

Background/Objectives: Human papillomavirus (HPV) is a major cause of cervical, penile, anal, and oropharyngeal cancers. HPV vaccination is the most effective public health strategy for its prevention. Understanding the factors influencing vaccination intentions is critical for developing effective public health policies and improving population-level vaccine uptake. Therefore, in this scoping review, we aimed to examine HPV vaccination research conducted in Korea, identify common trends and gaps in study populations and influencing factors, and provide evidence-based recommendations for public health policies. Methods: We systematically searched four Korean databases—Research Information Sharing Service (RISS), DBpia, Korean Studies Information Service System (KISS), and National Digital Science Library (NDSL)—for studies published from their respective inception dates to January 2025, using “human papillomavirus,” “HPV,” “vaccination,” and “intention” as keywords. Thirty-six studies were ultimately included. Study characteristics, populations, theoretical frameworks, and key variables were extracted and analyzed using descriptive statistics and content analysis. Results: Of the included studies, 61.1% and 38.9% targeted vaccination-eligible individuals (adolescents and adults) and parents/guardians, respectively, with 50% focusing exclusively on women. The major factors influencing HPV vaccination intention were attitude (47.2%), subjective norms (38.9%), and perceived behavioral control (30.9%). Attitude and knowledge were critical for vaccination-eligible individuals (Direct group), whereas subjective norms were key for parents/guardians (Indirect group). Conclusions: Korean HPV vaccination intention research has predominantly focused on women and parents, with insufficient attention to adolescents and men. Public health strategies must employ multilevel interventions tailored to each group’s decision-making structures, including school-based programs for adolescents, gender-inclusive policies for men, and community-based approaches to address social norms among parents. These findings provide evidence for policy development aligned with the WHO cervical cancer elimination goals. Full article

Cervical cancer remains the main etiology of high morbidity and mortality among women in developing world despite the screening plans. In South Africa, screening policies are low. Attitude, knowledge, and practices (AKP) play a pivotal role in diagnosis, prevention and screening. The review explores AKP towards cervical cancer and screening including global and regional burden, and determinants of screening uptake. Previous empirical studies identifying factors influencing adherence to screening services were identified. Studies from 2020–2025 were searched using PubMed and Google databases. Identified terms and topics were combined using Boolean Operators and PRISMA guidelines. Keywords were “attitudes”, “knowledge”, “practice”, “current cervical cancer screening”, AND “South Africa”, “global”, “regional”, “burden”, “cervical cancer”, “screening uptake determinants ” and “cervical cancer screening”, “factors influencing adherence”, and “cervical cancer screening”, “practices and pap smear tests”, “strengths”, “limitations”, “future research”, AND (“cervical cancer screening”). Key findings: many women know cervical cancer or Pap smears but lack detailed knowledge about risk factors and screening protocols, actual Pap smear uptake is low. Fear of outcome of procedure, pain, or embarrassment are primary barriers, and lack of service access. A multidisciplinary approach involving healthcare providers, government and non-governmental organizations is crucial in addressing gaps in cervical cancer screening. Full article

Background: Vaccination against human papillomaviruses (HPVs) and cervical cancer screening represent effective tools for preventing this neoplasia, but access to health services is limited for vulnerable women. We investigated prevalence of high-risk HPV and abnormal cervical cytology, as well as knowledge about HPV and the HPV vaccine, among homeless and migrant women in Rome, Italy. Methods: Cytologic samples in PreservCyt (Hologic) were employed for liquid-based cytology (ThinPrep Processor 5000, Hologic) and high-risk HPV DNA testing (Xpert HPV assay, Cepheid). Socio-demographic data, anamnestic, and behavioral data were retrieved from electronic archives. A questionnaire was employed to assess knowledge about HPV and HPV vaccination. Results: A total of 134 women were included (median age: 43 years; interquartile range, IQR: 34–50), mostly coming from Central–South America (69, 51.5%). Of the 127 cytologic specimens collected, one (0.8%) was invalid for the HPV test and five (3.9%) were unsatisfactory for the morphological evaluation. High-risk HPV positivity was found in 18 women of the 126 women with a valid HPV test (14.3%). A total of 10 women of the 122 women with an adequate cytology (8.2%) had abnormal cytology. Overall, 57/134 women (42.6%) had never heard of HPV or were unsure about it. Only 29 of the 77 women who had heard of HPV (37.7%) knew of the HPV vaccine, and only 2 had been vaccinated in the entire study group (1.5%). Conclusions: Tailored preventive strategies and comprehensive information campaigns should be developed and implemented to enhance awareness of HPV infection and actively promote vaccination among women in vulnerable groups. Full article