Search Results (680)

Background: Human papillomavirus (HPV) is associated with multiple head and neck cancers, many of which are preventable with the 9-valent HPV vaccine. We developed an interactive HPV vaccination education program (IHVEP) to equip patients with HPV-associated cancers to serve as health educators. Objective: To pilot test the adapted IHVEP, evaluate its content using the Information-Motivation-Behavioral Skills (IMB) model and the Suitability Assessment of Materials (SAM) instrument, and identify factors relevant to optimizing digital health interventions. Methods: A previously developed cervical cancer–focused IHVEP was adapted for patients with oropharyngeal cancer. Participants completed the program and participated in semi-structured interviews. Feedback was analyzed and organized into themes aligned with the IMB and SAM frameworks. Results: Participants generally perceived the adapted IHVEP as informative, motivating, and empowering. Key motivators included physician recommendation and a desire to protect others. The program appeared to enhance participants’ perceived ability and self-efficacy to promote HPV vaccination. Modules were described as clear, well-organized, linguistically accessible, and culturally appropriate. Feedback identified areas for improvement related to technology, content, and functionality. Conclusions: Findings suggest that effective digital health interventions may benefit from incorporating training in evaluating health information, ensuring intuitive design and navigation, and including content featuring real individuals. These results will inform further refinement of IHVEP and the development of future digital health interventions. Full article

Human papillomavirus (HPV) infection is a necessary but insufficient cause of cervical cancer (CC) and reflects a long-standing host–virus equilibrium shaped by immune control, viral persistence, and latency. The transition from cytology-based screening to primary high-risk HPV testing has substantially improved early detection of cervical precancerous lesions but has also introduced new clinical challenges related to fluctuating test results, overdiagnosis, overtreatment, and patient anxiety, whose magnitude may vary across countries depending on screening organization and access to prevention services. This narrative review provides a clinically oriented overview of HPV-based CC screening in the context of evolving knowledge on HPV natural history, persistence, and immune interaction, and discusses the implications for the interpretation of test results and risk stratification. New emerging screening and triage approaches, including molecular biomarkers, exosome-based biomarkers, and artificial-intelligence-supported risk assessment, are reshaping CC prevention strategies by enabling more precise identification of women at risk for clinically significant disease. These tools may be particularly relevant in self-sampling-based screening pathways, where molecular triage strategies can reduce the need for additional clinician-collected samples and improve management of HPV-positive women. At the same time, improved understanding of viral latency and host-related determinants of progression supports a shift from binary test interpretation toward longitudinal and individualized risk assessment. Integrating biological insight with technological innovation may facilitate personalized screening strategies that maintain high sensitivity while reducing unnecessary interventions. An evolutionary-informed and risk-adapted approach to HPV-related disease management is essential to optimize prevention outcomes and preserve the benefits of population-based screening programs. Full article

Background: Human papillomavirus (HPV)-attributable cancers remain largely preventable but continue to generate increasing treatment costs where vaccination and screening coverage are limited. We estimated direct inpatient pharmaceutical reimbursement attributable to HPV-related cancers in Bulgaria and examined the drivers of expenditure growth. Methods: National Health Insurance Fund reimbursement data (2021–2025) were analysed for antineoplastic medicines used to treat eight HPV-associated cancer sites. Site-specific population-attributable fractions (PAFs) were applied to estimate HPV-attributable expenditure. Uncertainty in PAFs was quantified using 10,000 Monte Carlo simulations and discrete attribution scenarios. Expenditure growth was decomposed into price, volume, and net product-entry/exit effects using Fisher indices. Expenditure was additionally expressed in constant 2021 euros using the Harmonised Index of Consumer Prices. Results: Estimated HPV-attributable inpatient pharmaceutical reimbursement totalled EUR 54.2 million (probabilistic median; 95% uncertainty interval: EUR 53.3–55.0 million). Cervical cancer accounted for 81.8% of the total. Results varied by less than ±6% across attribution scenarios and remained EUR 44.6 million when head-and-neck cancers were excluded. Annual expenditure increased from EUR 3.67 million in 2021 to EUR 19.89 million in 2025, representing a 5.4-fold nominal and 4.2-fold inflation-adjusted increase. Growth was concentrated in cervical cancer and was driven primarily by the introduction of new therapies rather than higher prices or greater use of existing medicines. Net product entry explained 88.8% of total log growth, while reimbursement prices for continuing products declined by approximately 31%. Pembrolizumab, first reimbursed for cervical cancer in 2023, accounted for EUR 16.03 million of cervical cancer expenditure in 2025. Conclusions: These ecological estimates indicate a rapid increase in HPV-attributable inpatient pharmaceutical reimbursement in Bulgaria, largely driven by cervical cancer and the introduction of immunotherapy. The findings have implications for budget forecasting, procurement planning, and economic evaluation of HPV prevention strategies. Full article

Background: In primary care settings, cervical cancer screening and prevention are highly dependent on healthcare provider initiatives, particularly in countries like Türkiye where the HPV vaccine is not yet integrated into the national routine immunization schedule. Since HPV vaccines provide over 90% protection against cervical cancer, the proactive guidance of primary care providers is critical. This study evaluated family physicians’ knowledge levels and awareness of HPV infection and human papillomavirus (HPV) vaccines in primary care settings in Türkiye. Methods: A total of 238 family physicians working in Türkiye participated in this descriptive cross-sectional study using a convenience sampling method. Data were collected through an online questionnaire administered via Google Forms. The survey included a sociodemographic information form and a 33-item HPV knowledge scale. Data were analyzed using descriptive statistics, normality assessment, chi-square test, Mann–Whitney U test, Kruskal–Wallis test, and hierarchical logistic regression analysis. Results: Overall, 81.1% of participants recommended the HPV vaccine, and 83.6% believed it should be included in the national schedule. Notably, only 15.1% of the participating physicians had received the HPV vaccine themselves, whereas 40.6% of the unvaccinated subgroup (82/202) stated they were considering personal vaccination. HPV knowledge levels were generally high, but lower when regarding the current national program. Vaccine recommenders and female participants had significantly higher knowledge scores, while out-of-pocket vaccine cost emerged as a major barrier to clinical recommendation. In multivariable hierarchical logistic regression, individual knowledge domains did not emerge as independent standalone predictors after controlling for demographics, with only knowledge of the current national program showing a borderline trend (p = 0.066), although the inclusion of the knowledge variables as a collective block significantly improved the overall model explanatory power (p = 0.003). Conclusions: Family physicians in Türkiye showed generally high HPV-related knowledge and a high rate of HPV vaccine recommendation. This study clarifies that primary care advocacy is shaped by the combined influence of professional knowledge and overriding structural factors, rather than individual knowledge domains acting as independent standalone predictors. While future strategies must focus on developing targeted continuous medical education to bridge specific knowledge gaps and optimize opportunistic counseling, achieving optimal immunization coverage ultimately relies on integrating the vaccine into national programs to mitigate out-of-pocket cost barriers. Full article

Background/Objectives: Cervical cancer (CC), mainly caused by human papillomavirus (HPV), is one of the major cancers threatening women’s health in Algeria. However, despite the existence of a cost-effective vaccine, it has not yet been introduced into the national vaccination program. Recent information indicated that its introduction will be imminent. Thus, the current study was conducted to evaluate the level of awareness and knowledge about CC and HPV among the Algerian population as well as its attitudes toward HPV vaccination. Methods: A cross-sectional survey was carried out between 4 November 2022 and 8 May 2023 using a self-administered questionnaire that was diffused through social media platforms. Results: A total of 414 participants were included in our sample, with the dominance of those aged 18 to 30 years old (74.6%), those with university education (75.8%), and those with a medium financial level (77.5%). A high level of awareness was reported (76.3%), especially among healthcare workers (98.4%, OR: 17.099, 95% CI: 2.294–127.476, sig. = 0.06), participants aged more than 30 years (87.6%, OR: 2.78, 95% CI: 1.313–5.883, sig. = 0.008), and females (85.1%, OR: 2.02, 95% CI: 1.15–3.548, sig. = 0.014). However, the level of knowledge did not follow, since less than a third (32.1%) of the participants only were aware of HPV, and multiple gaps were reported regarding its epidemiology and its prevention. Moreover, while 30.8% of the participants were willing to get the HPV vaccine, 40.5% were hesitant, and 27.7% were resistant. The causes of rejection/hesitancy included mainly complacency, vaccine refusal, and the lack of confidence in the vaccine. In addition, hesitant and reluctant participants have shown a low level of knowledge and a high score of conspiracy beliefs. Conclusions: These results provide new insights into knowledge and attitudes towards CC and HPV vaccination. It reported that despite the high level of awareness about CC, gaps of knowledge remain and vaccination hesitancy/reluctance is persistent. These results suggest the need for raising awareness particularly about HPV which will consequently help to increase HPV vaccine acceptance. Full article

Background: Although cervical cancer is preventable, Latinas are twice as likely to receive a late diagnosis compared with non-Hispanic Whites (NHW). We currently know very little about the experiences of cervical cancer among middle- to older-age Latinas in the U.S. This study aimed to document Latina cervical cancer survivors’ journeys with an emphasis on improving the cervical cancer system of care to address inequities among a rapidly aging Latina population. Methods: We interviewed participants aged ≥ 40 years with a diagnosis of cervical cancer of three months or greater who identify as Latina. Recruitment was multi-pronged, including electronic healthcare records search, community tabling events, and snowball sampling. We conducted a qualitative study using the Database of Individual Patient Experiences (DIPEx) methodology and identified themes using grounded theory constructivist analysis. Results: A total of 20 Latinas (43 to 85 years old) participated, including 16 Spanish-language interviews. We identified three themes: formative experiences driving screening and prevention behaviors, provider communication that was suboptimal throughout the cancer continuum, and survivorship impacts including isolation and stigma with implications for the next generation. Conclusions: A central takeaway was the pervasiveness of Latinas’ feelings of shame, lack of communication, and isolation. Healthcare systems must improve culturally responsive communication, survivorship support, and screening equity for aging Latina populations. Abuelas, tias, and/or primas (grandmothers, aunts, and cousins) could play a critical role in raising awareness and increasing timely and early screening among the wider Latina population. Full article

Background: Although cervical cancer is a highly preventable malignancy, Romania continues to report critical mortality rates. This paradox is largely attributable to the suboptimal implementation of clinical guidelines and a passive, “opt-in” administrative framework. This cross-sectional study investigates the cognitive and behavioural determinants—specifically, human papillomavirus (HPV) knowledge, institutional trust in healthcare systems, and digital misinformation exposure—that modulate female attitudes toward HPV immunisation. Methods: An observational cross-sectional study was conducted between December 2025 and March 2026 across four obstetrics and gynaecology clinics. Data were collected via digital questionnaires administered to adult female patients aged 18 to 65 years. The assessment tool evaluated four primary domains: HPV knowledge, perceived vaccine safety, immunisation intention, and the degree of exposure to social media misinformation. Results: The cohort demonstrated a substantially low vaccination rate (28.6%). Statistical analysis elucidated significant positive correlations between HPV knowledge, trust in health authorities, and vaccination intention. Furthermore, reliance on official information sources strongly correlated with perceived vaccine safety. Conversely, exposure to negative online content exhibited a weak negative association with knowledge levels, yet it did not directly influence vaccination intention. Conclusions: Health literacy and institutional trust emerge as fundamental pillars for HPV vaccine acceptance. To overcome patient vaccine hesitancy, the national healthcare system must initiate a strategic paradigm shift, prioritising the neutralization of digital misinformation and transitioning from a passive model to a proactive, “opt-out” infrastructure. Full article

Background/Objectives: Extra virgin olive oil (EVOO), a key component of the Mediterranean diet, has attracted research interest because olive-derived phenolics demonstrate potential anticancer activity in experimental models. This review summarizes evidence concerning whole EVOO, phenolic-enriched EVOO, olive phenolic extracts, and the isolated compounds hydroxytyrosol, oleuropein, oleocanthal, and oleacein. Methods: A structured narrative search of PubMed, Web of Science, ScienceDirect, and Google Scholar was conducted for literature published between 2015 and 2025. Evidence was reviewed for breast, prostate, colorectal, pancreatic, bone, oral, liver, gastric, hematological, and brain cancers. Comparatively limited evidence concerning cervical, endometrial, ovarian, melanoma, non-melanoma skin, and thyroid cancers was summarized separately. Results: The molecular evidence was derived primarily from cell culture and animal studies using isolated phenolics and concentrated extracts. Preclinical studies indicate that EVOO phenolics may demonstrate anticancer activity through multiple mechanisms, including antioxidant activity, anti-inflammatory effects, cell cycle arrest, induction of apoptosis, inhibition of metastasis, anti-angiogenic activity, and modulation of key signaling pathways, such as PI3K/AKT/mTOR, MAPK/ERK, NF-κB, JAK/STAT, Wnt/β-catenin, p53, and epithelial–mesenchymal transition-related pathways. Most molecular and pathway-level evidence was obtained using isolated phenolic compounds in cell culture or animal models, whereas evidence directly examining whole EVOO consumption was largely observational and substantially more limited. Experimental studies also reported that oleocanthal induced lysosomal membrane permeabilization, whereas hydroxytyrosol and oleuropein promoted mitochondria-mediated apoptosis. Furthermore, preclinical combination studies suggested enhanced tumor-cell sensitivity to selected chemotherapeutic, targeted, and immunotherapeutic agents. However, these effects have not been established in patients. Human evidence remains limited mainly to observational dietary associations and small exploratory interventions, with no conclusive demonstration of cancer prevention or therapeutic efficacy. Conclusions: Isolated EVOO-derived phenolic compounds demonstrated promising anticancer mechanisms in preclinical models. However, these results should not be directly extrapolated to dietary EVOO because experimentally administered doses, bioavailability, metabolism, and food-matrix interactions differ substantially from human dietary exposure. Therefore, well-designed studies using chemically characterized EVOO, pharmacokinetic investigations, and controlled human trials are required before dietary or clinical recommendations can be made. Full article

Background/Objectives: Cancer screening is a key strategy for reducing cancer-related morbidity and mortality. This study assessed adherence to breast, cervical, and colorectal cancer screening among Spanish women and identified factors independently associated with participation. Methods: A cross-sectional study was conducted using data from the 2023 Spanish Health Survey. Women eligible for mammography (40–69 years), cervical cytology (25–65 years), and fecal occult blood testing (FOBT; 50–69 years) were included. Weighted prevalence estimates were calculated, and multivariable logistic regression models were fitted separately for each screening test. Results: A total of 7454 women aged 25–69 years were analyzed. Adherence was highest for mammography (71.1%), followed by cervical cytology (64.1%) and FOBT (36.8%). Only 24.4% of women eligible for all three programs were adherent to all screening tests simultaneously. Across all screening programs, adherence was consistently associated with being born in Spain, living with a partner, greater social support, healthcare utilization, private health insurance coverage, and physical activity. Strong social support was independently associated with participation in mammography (OR 1.72; 95% CI 1.35–2.20), cervical cytology (OR 1.58; 95% CI 1.29–1.94), and FOBT uptake. Participation in one screening program was strongly associated with participation in the others, particularly between mammography and cervical cytology (OR 4.37; 95% CI 3.84–4.98). Conclusions: Adherence to cancer screening among Spanish women remains suboptimal, particularly for colorectal cancer. Participation appears to reflect a broader preventive health behavior pattern, with social support emerging as one of the strongest and most consistent determinants across all three screening programs. Full article

Background/Objectives: This study was conducted to determine the effect of a Health Belief Model–based education program implemented in Family Health Centers on women’s cervical cancer knowledge and their attitudes and beliefs toward HPV vaccination. Methods: This quasi-experimental pretest–posttest control group study was conducted between March and May 2026 at the Tuşba Training Family Health Center in Van, eastern Türkiye. The study included 150 women aged 18–49 years who had adolescent daughters aged 10–18 years. Data were collected using the Descriptive Information Form, the Cervical Cancer Knowledge Scale, and the Carolina HPV Immunization Attitudes and Beliefs Scale. The intervention group received a structured education program based on the Health Belief Model focusing on cervical cancer, HPV infection, and HPV vaccination. Descriptive statistics, chi-square tests, independent samples t-tests, paired samples t-tests, and mixed-design analysis of variance (ANOVA) were used for data analysis. Results: Following the educational intervention, cervical cancer knowledge scores increased from 2.13 ± 0.79 to 7.24 ± 0.84 in the intervention group, whereas no significant change was observed in the control group (p < 0.001). Total CHIAS scores increased from 24.32 ± 5.30 to 41.23 ± 2.51, accompanied by significant improvements in HPV vaccination attitudes and beliefs (p < 0.001). Significant Group × Time interaction effects were observed for cervical cancer knowledge, total CHIAS scores, and all CHIAS subdimensions (p < 0.001). Conclusions: The findings indicated that the Health Belief Model–based education program was associated with improved knowledge about cervical cancer and HPV and with more favorable attitudes and beliefs toward HPV vaccination. Structured educational programs implemented in primary healthcare settings may support the promotion of preventive health behaviors. Full article

Human Papillomavirus (HPV) infection is the leading cause of cervical cancer, presenting a significant global health challenge. While natural infection is widespread, the resulting immune response is often characterized by weak, delayed, and type-specific antibody production, offering unreliable protection against reinfection. This review provides a comparative analysis of natural versus vaccine-induced immunity, focusing on antibody kinetics, duration of protection, and cancer prevention efficacy. A comprehensive search of the literature from the last decade was conducted using PubMed, ScienceDirect, and Web of Science. The findings demonstrate that, unlike natural immunity, which is dominated by cellular responses with often incomplete seroconversion, prophylactic vaccination induces high titers of neutralizing IgG antibodies against the L1 capsid protein. These responses are durable, with protection persisting for over a decade, and recent data support the high efficacy of single-dose regimens. Furthermore, vaccination has shown utility in reducing infection persistence in HPV-positive individuals and provides critical protection in immunocompromised groups. Consequently, vaccine-induced immunity is consistently superior to naturally acquired immunity, supporting World Health Organization recommendations for universal vaccination as the primary intervention for reducing the global burden of HPV-related malignancies. Full article

Background and Objectives: HPV vaccination is critical for cervical cancer prevention, but HPV vaccination coverage stays low among young women in China. While various factors shaping vaccination willingness have been explored, the role of personality traits remains insufficiently understood. This study investigated the relationships between Big Five personality traits and three facets of HPV vaccination willingness (consideration, determination, recommendation) among female healthcare undergraduates. We also specifically examined whether academic major moderated the association between extraversion and vaccination willingness. Methods: A cross-sectional survey was conducted among 703 female undergraduates enrolled in healthcare majors at a medical college in Chengdu using a stratified cluster sampling method. Data were collected via online questionnaires, including the 10-item Big Five Inventory (BFI-10) and a scale measuring three motivational facets of HPV vaccination willingness: consideration, determination and recommendation. Descriptive statistics, correlation analysis and hierarchical regression analysis were performed to examine the research questions. Results: A total of 672 valid questionnaires were analyzed. Distinct associations were found between personality dimensions and each facet of vaccination willingness. Agreeableness (β = 0.193, p < 0.01) and openness (β = 0.079, p < 0.05) correlated with vaccination consideration (ΔR² = 0.061). Extraversion (β = 0.103, p < 0.05), agreeableness (β = 0.113, p < 0.01) and conscientiousness (β = 0.096, p < 0.05) correlated with determination (ΔR² = 0.049). Extraversion (β = 0.125, p < 0.01), agreeableness (β = 0.129, p < 0.01), conscientiousness (β = 0.102, p < 0.01) and neuroticism (β = 0.081, p < 0.05) were positively related to recommendation willingness (ΔR² = 0.061). Academic major did not exert a significant moderating effect. Conclusions: The findings highlight the complexity of the relationships between personality traits and vaccination attitudes and behaviors. While the observed associations were modest in magnitude, this study provides preliminary empirical evidence that may inform personality-sensitive HPV vaccination promotion strategies. Tailored, multi-dimensional interventions that consider diverse population characteristics could be considered to optimize HPV vaccination outreach, though their effectiveness awaits further validation. Full article

Background: High-risk human papillomavirus (HPV) is a leading cause of cervical cancer, particularly in settings with high-risk sexual behaviours and limited preventive care. HPV prevalence peaks in adolescence and early adulthood due to early sexual initiation, multiple partners, inconsistent condom use, anal intercourse, and oral–genital contact. To assess the prevalence and associated risk factors for high-risk HPV infections among female students in Benin City, Nigeria. A faith-based college in Benin City, Nigeria. Methods: A cross-sectional study was conducted among 133 female nursing students. Self-collected genital swabs were analysed using real-time fluorescence quantitative PCR to detect 14 high-risk HPV types. Participants completed a structured questionnaire on sexual behaviour, contraceptive use, and HPV knowledge. Results: The overall high-risk HPV prevalence was 45/133 (33.8%), with 39 (29.3%) presenting multiple infections. HPV66, 58, and 56 were the most common types detected. Significant associations were observed with oral contraceptive use (OR = 3.2, 95% CI = 1.01–9.97) and abnormal vaginal discharge (p = 0.028). Conclusions: The predominance of HPV66, HPV58, and HPV56 highlights the increasing importance of non-vaccine HPV genotypes and shows the need for targeted screening and vaccination. Associations with abnormal vaginal discharge and oral contraceptive use emphasize the importance of sexual health education and routine gynaecological care among young women. This study underscores the need for targeted HPV screening, vaccination, and sexual health education to reduce cervical cancer risk among young women in Nigeria. Full article

Deaf, deafblind, and hard-of-hearing (DDBHH) American Sign Language (ASL) users assigned female at birth experience disparities in cervical cancer screening. There is a need to further clarify the roles of education status and English proficiency in adherence to the U.S. Preventive Services Task Force (USPSTF) screening guidelines. Using the NCI Health Information National Trends Survey in ASL, we surveyed participants; those who reported being female and within the USPSTF age-eligible range (21–65) were included in analyses. Associations were determined using Pearson Chi-squared tests. A two-sided p ≤ 0.05 was considered significant. Six hundred and forty-three participants, recruited between July 2023 and October 2025, answered questions in ASL and English, with 65% self-reporting screening adherence. Chi-square results indicated that more years of education were significantly associated with screening adherence [X2 (2) = 9.72, p = 0.008]. Consistent with the results, English proficiency was not a significant predictor of screening adherence [Fisher’s exact p = 0.267]. Those who self-report as HS graduates and/or have left college demonstrate lower adherence as well. These findings suggest that educational attainment may be an important factor associated with screening adherence among DDBHH ASL users and warrants further investigation in efforts to improve adherence toward Healthy People 2030 targets. Full article

Background/Objectives: Endocrine-disrupting chemicals (EDCs) interfere with hormonal homeostasis and have been implicated in gynecological malignancy pathogenesis. This narrative review synthesizes current evidence regarding EDC exposure and breast, endometrial, ovarian, and cervical cancers, examining molecular mechanisms, epidemiology, and diagnostic and clinical implications. Methods: We conducted a literature review using PubMed/MEDLINE, Embase, Scopus, and Cochrane databases through April 2026, including systematic reviews, meta-analyses, prospective cohorts, case-control studies, and mechanistic investigations examining EDC-cancer associations. Methodological quality was appraised using the Newcastle-Ottawa Scale and AMSTAR-2, with overall certainty of evidence rated using the GRADE framework. Results: Major EDC classes—bisphenol compounds, phthalates, polychlorinated biphenyls, organochlorine pesticides, and per- and polyfluoroalkyl substances—demonstrate carcinogenic potential through estrogen receptor modulation, epigenetic alterations, oxidative stress, and oncogenic signaling disruption. Breast cancer shows the strongest evidence, with prenatal and early-life DDT/DDE exposure associated with up to a 3.7-fold increased risk. Endometrial cancer demonstrates associations with xenoestrogen mixtures exhibiting non-monotonic dose-responses, whereas ovarian and cervical cancers show emerging but limited associations. Common mechanisms include receptor crosstalk, epigenetic dysregulation with transgenerational effects, oxidative genomic instability, metabolic reprogramming, and cancer stem cell enrichment. Conclusions: Evidence supports EDC contributions to gynecological malignancy through convergent pathways, though causal inference remains constrained by observational epidemiology, long latency periods, and challenges in characterizing real-world mixture exposures. Diagnostic and prevention strategies should integrate EDC exposure into risk-prediction models, leverage multi-omics biomarkers for early detection, and emphasize exposure reduction during critical developmental windows alongside regulatory reform. Full article