Search Results (851)

Cancer remains a growing public health concern in South Africa, particularly in underserved communities where disparities in awareness and access to care contribute to delayed diagnosis. This study evaluated the impact of a culturally tailored educational intervention based on an adapted Cancer-Community Awareness Access Research and Education (c-CARE) module in Johannesburg and iLembe districts. A pilot study using a quasi-experimental pre–post design was conducted to assess changes in knowledge and attitudes among 210 traditional health practitioners, community health workers, and faith-based leaders. Structured surveys measured awareness of multiple myeloma, prostate, lung, breast, and cervical cancers. Data were captured in REDCap and analyzed using SPSS version 30. Significant improvements in knowledge were observed across all cancers. Awareness of lung cancer increased from 74.3% to 96.7%, multiple myeloma from 26.7% to 96.7%, prostate cancer from 52.5% to 98.3%, breast cancer from 93.4% to 98.7%, and cervical cancer from 84.8% to 96.0%. Participants demonstrated improved understanding of screening modalities and risk factors, including tobacco-related harms. Despite these gains, screening-related fears remained evident. These findings demonstrate that contextually adapted, community-based training can strengthen cancer literacy and support early detection strategies in underserved settings. Full article

Background/Objective: Cervical intraepithelial neoplasia grade 2 (CIN2) shows heterogeneous clinical behavior, with substantial rates of spontaneous regression under active surveillance. Reliable molecular biomarkers are needed to distinguish regressive from transforming lesions and reduce overtreatment. We evaluated the prognostic role of host and viral DNA methylation, alone and combined with HPV genotyping, in predicting CIN2 regression. Methods: This subanalysis derives from a prospective, multicenter Italian cohort of women with histologically confirmed CIN2 managed conservatively. Among 319 enrolled women, 134 with single HPV infections and valid host (FAM19A4/miR124-2) and viral (HPV L1 region) methylation results were included. HPV genotyping was performed with partial stratification (HPV16/18 vs. non-16/18). Clinical outcomes at 24 months were classified as regression versus persistence/progression. Logistic regression models assessed associations between biomarkers and regression. Results: At 24 months, 50% of women showed regression. Host and viral methylation positivity rates were more frequent in non-regressive lesions (40.3% vs. 19.4%, p = 0.01, and 52.2% vs. 32.8%, p = 0.02, respectively). Negative host methylation was significantly associated with regression (Odds Ratio OR = 0.37, 95% CI 0.17–0.81, p = 0.02), as was negative viral methylation (OR = 0.47, 95% CI 0.23–0.96, p = 0.04). Conclusions: Both host and viral methylation are inversely associated with CIN2 regression. Combining methylation markers did not substantially improve predictive accuracy; however, methylation negativity emerged as a potential molecular reassurance marker. When integrated with HPV genotyping, the highest probability of regression was observed among women with non-HPV16/18 infections and negative methylation results. These results endorse DNA methylation testing as a molecular tool for the conservative management of CIN2. Full article

This study investigates the phytochemical and pharmacological profiles of Crinum asiaticum L. var. anomalum Baker from Vietnam. Phytochemical screening identified diverse secondary metabolites, including polyphenols, flavonoids, and alkaloids. Gas chromatography–mass spectrometry analysis of the n-hexane fractions revealed 19 major compounds. While all extracts showed moderate antioxidant activity, the chloroform fraction exhibited superior antidiabetic potential via α-amylase inhibition (IC₅₀ = 83.13 ± 6.67 µg/mL). Furthermore, at non-cytotoxic concentrations (3.13 to 50 µg/mL), this fraction effectively rescued mouse β-TC6 insulinoma cells from thapsigargin. In anti-inflammatory assays, the n-hexane fraction significantly suppressed nitric oxide production in RAW 264.7 macrophages (IC₅₀ = 53.12 ± 1.63 µg/mL). Notably, the extracts displayed remarkable selective anticancer activity, particularly the chloroform fraction against HeLa cervical and HepG2/Huh-7 hepatoma cell lines. In silico ADMET and Lipinski’s Rule of Five analyses confirmed that the key bioactive constituents possess favorable pharmacokinetic profiles and drug-likeness. These findings demonstrate C. asiaticum L. var. anomalum Baker as a promising natural source for developing multitarget therapeutic agents against inflammation, diabetes, and cancer. Full article

Background: Stroke remains a leading cause of mortality, disability, and health-system burden in Korea’s rapidly aging population. We aimed to describe national stroke incidence trends from 2011 to 2023, characterize ecological associations between stroke incidence and health-screening indicators, and generate model-based projections through 2028 to support health-system planning. Methods: This retrospective ecological longitudinal analysis used three publicly available aggregate national data sources: (1) NHIS annual aggregate statistics on crude and age-standardized stroke incidence, stroke case counts, first-onset vs. recurrent stroke, and case-fatality rates (2011–2023); (2) regional standardized health-awareness survey rates for stroke symptoms, myocardial infarction symptoms, blood pressure, and blood glucose (2017–2025); and (3) national cancer-screening outcome tallies for breast and cervical cancer (2010–2024). All analyses used pre-aggregated annual summary data; individual-level NHIS records were not used. Annual trends were modeled with ordinary least-squares linear regression (n = 13 annual observations). Pearson correlations were computed only for overlapping observation windows. Model-based projections are presented with 95% prediction intervals and are explicitly distinguished from observed NHIS values. This study is purely descriptive and ecological; no causal inference is made. Results: Crude stroke incidence increased from 199.2 to 221.1 per 100,000 (2011–2023; slope +2.32/year, R² = 0.83), whereas age-standardized incidence declined from 158.3 to 113.2 per 100,000 (slope −3.41/year, R² = 0.96), a pattern consistent with demographic aging as a contributing factor to growing absolute burden, though formal age-decomposition analysis would be required to confirm this inference. Total cases increased from 99,837 to 113,098; the 30-day case-fatality rate declined from 8.5% to 7.5%. Ecological correlations showed that blood glucose awareness was strongly negatively correlated with age-standardized incidence (r = −0.944, p = 0.001, n = 7), though these are ecological associations and must not be interpreted as individual-level causal relationships. Model-based projections estimate crude incidence near 230.7 (95%PI 219.2–242.2) and age-standardized incidence near 103.2 (95%PI 95.7–110.8) per 100,000 by 2026. Conclusions: Concurrent increase in crude burden and decline in age-standardized incidence reflects demographic aging as the primary driver of Korea’s stroke burden. Projections support integrated cardiovascular prevention, public health education, and age-sensitive service planning. All projections are short-horizon statistical extrapolations intended for policy scenario planning only and must not be interpreted as observed future NHIS outcomes. Full article

Cervical intraepithelial neoplasia grade 1 (CIN1) is usually managed conservatively, but uncertainty remains about the subsequent risk of clinically significant high-grade disease, particularly after repeated CIN1. We conducted a retrospective population-based cohort study using anonymized cervical cytology, HPV, and histopathology records from Northern Norway from 2011 to 2025. We described temporal trends in screening-related outcomes and estimated the 5-year risk of CIN3+ after histologically confirmed CIN1 diagnosed in a single calendar year or in two consecutive calendar years. Across 2011–2025, the annual datasets comprised 334,471 screening records; 35,796 had ASC-US+ cytology (10.7%), 29,723 had a positive HPV test (8.9%), 35,416 underwent biopsy (10.6%), and 7870 were diagnosed with CIN2+ (2.4%). HPV positivity increased from 0.9% in 2011 to 15.7% in 2025, whereas CIN2+ detection peaked at 3.1% in 2018 and declined to 1.8% in 2025. In person-based analyses, the 5-year risks after CIN1 diagnosed in a single calendar year versus two consecutive calendar years were 4.3% versus 3.4% for CIN3+, 0.2% versus 0.1% for cervical cancer, and 15.4% versus 14.3% for CIN2+. Repeated CIN1 was not associated with higher subsequent CIN3+ risk, supporting conservative, risk-based follow-up after CIN1 biopsy. Full article

Human papillomavirus (HPV) infection remains the principal etiological factor in cervical cancer development worldwide, with Eastern Europe continuing to demonstrate disproportionately high cervical cancer incidence and mortality rates. Regional disparities in screening implementation, vaccination coverage, and HPV genotype distribution contribute substantially to the persistent burden of HPV-related disease. In recent years, increasing attention has focused on molecular biomarkers and the vaginal microbiome as complementary approaches for improving cervical cancer prevention strategies. This systematic review aimed to evaluate recent evidence regarding HPV genotype distribution, molecular biomarkers, vaginal microbiome composition, and their implications for cervical cancer prevention in Eastern Europe. A systematic literature search was conducted in PubMed/MEDLINE, Scopus, Web of Science, Embase, and the Cochrane Library for studies published between January 2020 and May 2026. This systematic review was conducted in accordance with the PRISMA 2020 guidelines and prospectively registered in PROSPERO (CRD420261391136). Studies from Eastern European populations reporting data on HPV genotype distribution, screening strategies, vaccination, molecular biomarkers, or vaginal microbiome composition were included. HPV prevalence in screening populations ranged from approximately 12% to over 20%, with HPV16 consistently identified as the predominant genotype across all included studies. However, non-16/18 high-risk genotypes, particularly HPV31, HPV51, HPV52, HPV66, and HPV68, represented a substantial proportion of infections in several Eastern European cohorts. Studies evaluating CINtec PLUS cytology and HPV E6/E7 mRNA testing demonstrated improved specificity for identifying clinically significant cervical lesions compared with HPV DNA testing alone. Emerging evidence also suggested associations between vaginal dysbiosis, increased microbial diversity, persistent high-risk HPV infection, and progression to cervical intraepithelial neoplasia. Although the 9-valent HPV vaccine provides coverage for most circulating high-risk genotypes identified in the region, vaccination uptake remains inconsistent throughout Eastern Europe. The findings of this systematic review support the growing importance of extended HPV genotyping, molecular biomarkers, and microbiome-related approaches in cervical cancer prevention strategies in Eastern Europe. Strengthening organized screening programs, expanding vaccination coverage, and improving access to molecular diagnostic technologies remain essential priorities for reducing the regional burden of HPV-related disease. Full article

Patient embarrassment represents a significant yet often underrecognized barrier to effective gynecological care. This review integrates multidisciplinary evidence from Embase, PubMed, PsycINFO, and the Cochrane Library (2000–2025) to examine the relationship between embarrassment, shame, and modesty and their impact on care-seeking behaviors, clinical outcomes, and healthcare utilization. Available data indicate that embarrassment is consistently associated with reduced participation in preventive screening, with up to one-third of non-attenders citing modesty-related concerns. In symptomatic patients, these emotional barriers contribute to clinically meaningful diagnostic delays, particularly in conditions such as cervical cancer, vulvar cancer, and endometriosis. Embarrassment also affects in-consultation behavior, with a substantial proportion of patients reporting withheld concerns or incomplete disclosure of medically relevant information. The consequences extend beyond delayed diagnosis to include reduced treatment adherence, increased disease severity at presentation, and higher healthcare costs due to more complex and resource-intensive interventions. Contributing factors include cultural stigma, prior negative clinical experiences, fear of judgment, and aspects of the clinical environment that may heighten patient vulnerability. Full article

Human papillomavirus (HPV) infection is a major driver of anogenital disease and virus-related carcinogenesis. Although most infections resolve spontaneously, persistent infection with high-risk genotypes may progress to high-grade squamous intraepithelial lesions (HSILs) and cancer, particularly in the setting of impaired immune surveillance. Unlike previous HPV-related reviews focused primarily on cervical disease, vaccination, or isolated immunosuppressed populations, this narrative review comparatively examines the clinical expression, colposcopic findings, screening strategies, and therapeutic implications of HPV-related disease across the immunological spectrum. This narrative review provides an integrative synthesis of HPV-related disease in the female lower genital tract across the immunological spectrum. A structured, non-systematic search of PubMed/MEDLINE, Scopus, and Web of Science was conducted using terms related to “human papillomavirus”, “HPV”, “cervical intraepithelial neoplasia”, “colposcopy”, “immunosuppression”, “HIV”, and “vaccination”. Immunosuppressed populations, including individuals living with HIV, transplant recipients, and patients receiving immunosuppressive therapy, exhibit higher rates of persistent infection, multifocal disease, recurrence, and progression to HSIL and invasive malignancy. These patients also present greater diagnostic complexity, broader anatomical involvement, and reduced response to conventional treatment. Rather than representing a uniform condition, HPV-related disease reflects a biologically dynamic spectrum shaped by host immune competence. This review highlights the distinct clinical, colposcopic, and therapeutic challenges observed in immunosuppressed populations and reinforces the need for individualized, risk-adapted strategies integrating contemporary advances in screening, vaccination, and HPV-related disease management. Full article

Cervical cancer remains a major public health challenge, particularly in low- and middle-income countries. The primary cause of cervical cancer is high-risk human papillomavirus (HPV), and screening using physician-collected samples is complicated by stigma, inconvenience, and access. There are non-invasive alternatives to the physician-collected samples, including self-sampling methods such as first-void urine and vaginal swabs. This systematic review and meta-analysis evaluated and compared the diagnostic accuracy of vaginal and urine self-sample methods for detecting high-risk HPV. PubMed, Scopus, Web of Science, and the Cochrane Library were searched for studies published between January 2015 and October 2025. Bivariate random-effects models and HSROC models were used to estimate pooled sensitivity and specificity results compared with clinician-collected samples for CIN2+. Meta-regression assessed sources of heterogeneity. Twenty-two studies involving over 9000 participants were included. Vaginal self-sampling showed a pooled sensitivity of 91.3% and a specificity of 86.9%, while urine self-sampling showed 86.9% sensitivity and 79.5% specificity. Vaginal swabs demonstrated higher sensitivity in head-to-head comparisons. DNA-based PCR assays showed higher sensitivity than mRNA-based tests, and room-temperature storage decreased urine sample sensitivity. Both methods are effective for high-risk HPV detection. Vaginal self-sampling showed superior performance, while urine self-sampling remains a valuable non-invasive option for under-screened populations. Full article

Background/Objectives: Cervical self-sampling is increasingly used for high-risk human papillomavirus (hrHPV) testing, but evidence for integrated liquid-based cytology (LBC) and sexually transmitted infection (STI) testing is limited. This study evaluated the feasibility and diagnostic agreement of an integrated single-step self-sampling approach for LBC, hrHPV, and STI testing. Methods: In this prospective paired study, 520 Korean women for cervical cancer screening between December 2024 and February 2025 were enrolled. Each participant first underwent cervical self-sampling using Earlypap^®, followed by clinician-collected sampling. Paired specimens were analyzed for LBC, hrHPV, and STI detection. Percentage agreement and Cohen’s kappa coefficients (κ) were calculated. Results: Self-sampling was successful on the first attempt in 98.5% of participants, with 92.1% preferring it over clinician-collection. LSIL was detected in 2.3% of self-collected and 1.2% of clinician-collected specimens, and HSIL was detected in 0.4% of both specimen types. hrHPV positivity was 14.8% in self- and 12.9% in clinician-collected specimens. Ureaplasma spp. were frequently detected, and Candida albicans was identified in approximately 5% of specimens. Overall agreement was 91.7% (κ = 0.67) for LBC, 95.4% (κ = 0.79) for hrHPV, and 97.0% (κ = 0.72) for STI. Conclusions: Integrated cervical self-sampling using a single-step device demonstrated high feasibility and substantial agreement with clinician-based sampling, supporting its potential to improve screening efficiency and reduce participation barriers. Full article

Background: Cervical cancer is among the most common cancers affecting women worldwide, with high morbidity and mortality in low- and middle-income countries. In Saudi Arabia, most cases are diagnosed at a late stage despite the availability of free HPV vaccination and screening. Objectives: To identify Saudi women’s perceptions of the HPV vaccine using the Health Belief Model, estimate willingness to receive the HPV vaccine and the factors influencing it, assess uptake of Pap smear and HPV vaccine, and define barriers to both practices. Methodology: A cross-sectional study of a convenience sample of 1334 Saudi women aged 16 to 65 years, from all regions of Saudi Arabia, was conducted. Data were collected via an online questionnaire that included sociodemographic characteristics, beliefs about the HPV vaccine based on the Health Belief Model, vaccine hesitancy, and HPV vaccine and Pap smear uptake. Data were analyzed using SPSS version 29. Results: Only 6% completed their vaccination series or received at least one dose; 37.3% planned to get vaccinated; and 56.7% stated they do not intend to get vaccinated. The main reasons for vaccine refusal were lack of trust (41.8%) and fear of side effects (32.3%). Only 21% had undergone Pap smear testing, with barriers including embarrassment and fear. Among the HBM constructs, perceived susceptibility, benefits, and barriers remained statistically significant predictors of HPV vaccination. Increased perceived susceptibility and benefits raise the likelihood of accepting the HPV vaccine, while higher perceived barriers lessen it. Vaccine hesitancy had a significant negative effect on willingness to receive the HPV vaccine (OR = 0.78, 95% CI 0.69–0.90, p < 0.01). Additionally, Pap smear uptake was an independent predictor of the intent to get the HPV vaccine (OR = 1.78, 95% CI 1.25–2.54, p < 0.01). The independent factors influencing HPV vaccine uptake were largely similar to those affecting the willingness to receive the vaccine, except for age, perceived benefits, and Pap smear uptake. Conclusions: There is a gap between Saudi women’s intention to get HPV vaccinated and actual vaccination. Women who saw a high risk of HPV-related cancer, believed in vaccine efficacy, had a Pap smear, and were open to vaccination were more likely to vaccinate. Hesitant women and those perceiving barriers were less likely to vaccinate or consider it. The main gaps for future campaigns are perceptions of HPV severity and cultural factors influencing decision-making. Emphasizing HPV as a cancer-related virus rather than a sexually transmitted infection can reduce barriers and highlight its severity. Full article

Human cervical cancer and pre-cancer research relies on datasets scattered across modality-specific archives, imaging repositories, benchmark platforms, trial registries, and controlled-access catalogs. This fragmentation—combined with heterogeneous metadata, ambiguous use of “cervical” terminology, and inconsistent indexing of pre-cancer and screening/triage resources—limits reproducible discovery, access planning, and cross-modal benchmarking. We present the Cervical Cancer Dataset Catalog (CCDCAT), a machine-readable, versioned dataset of datasets that enumerates host-specific dataset-instance records anchored to stable identifiers and resolvable landing records within an explicitly declared discoverable source universe (U_v1.0) and a frozen discovery/labeling lexicon (Q_v1.0). The CCDCAT spans invasive cervical cancer, pre-cancer/dysplasia, and cervix-focused screening and triage phenotypes, and it covers molecular omics, imaging and microscopy (including cervix photography, cytology, and digital pathology), trial registry records, benchmark resources, and controlled-access catalogs represented as metadata with explicit access pathways. Eligibility and labels are assigned conservatively from source-provided metadata; when evidence is insufficient, the CCDCAT abstains rather than infers. In the initial release (CCDCAT-U_v1.0; v0.1), we enumerate 14 eligible dataset instances across 11 host systems within a declared universe of 21 sources. Releases include manuscript-ready tables and interoperable artifacts (schema, controlled vocabularies, provenance logs, abstention ledgers, and a queryable database), enabling reproducible filtering, linkage, and auditable reuse planning. Full article

The clinical translation of automated HPV detection in Whole Slide Images (WSIs) is challenged by staining variability, sparse viral effects, and the biological continuum between cytology and histology. This work presents a fully automated pipeline for binary patch-level classification of HPV-induced lesions on H&E-stained tissue. The core contribution is a domain-adaptive transfer learning strategy: a ResNet50 backbone is pretrained on the SIPaKMeD cervical cytology dataset rather than ImageNet, then fine-tuned on a target histological cohort. Preprocessing includes adaptive tissue segmentation, blur rejection, and Macenko stain normalization to ensure vendor-agnostic inputs. Evaluated using a strict Leave-One-Patient-Out cross-validation on 42 diagnostic specimens, the SIPaKMeD-based initialization significantly outperforms the ImageNet baseline. This approach achieves higher AUC-ROC scores and superior stability across folds, demonstrating that domain-specific pretraining effectively mitigates data scarcity and class imbalance in digital cervical cancer screening. Under a complementary 5-fold patient-level cross-validation covering all 19 patients of the cohort ($\mathrm{133,704}$ patches, 7181 HPV-positive, prevalence $5.37\%$), the SIPaKMeD-pretrained model attains a mean test AUC-ROC of $0.694$ with a $95\%$ patient-aware bootstrap confidence interval of $[0.681, 0.705]$, consistently above the ImageNet baseline mean of $0.656$ obtained on the controlled three-fold ablation. Full article

Persistent challenges in cervical cancer (CC) control highlight the need for stage-specific cost estimates to refine prevention strategies. Structural integration of National Health Insurance (NHI) administrative claims, the Taiwan Cancer Registry (TCR), and the National Cause of Death Registry (NCDR) provided the empirical basis for this population-based research. The final analytical sample encompassed 6055 women with cervical intraepithelial neoplasia (CIN) identified in 2016 as well as 9318 patients diagnosed with stage I to IV invasive CC during the 2008 to 2015 period. Reimbursed direct medical costs were estimated for CIN within 6 months after diagnosis and for CC over 5 years after diagnosis. Across CIN grades, no consistent cost gradient was observed, although inpatient utilization was highest in CIN3. Among women with CC, healthcare utilization and expenditures were concentrated in the first year after diagnosis, accounting for 52–65% of the total 5-year costs. After age adjustment, the mean first-year costs increased from NT$256,095 (US$8413) in stage I to NT$474,724 (US$15,595) in stage IV, while 5-year survival declined from 85.3% to 19.5%. These findings show that cervical disease imposes substantial direct medical costs on Taiwan’s healthcare system and provide updated evidence to inform human papillomavirus (HPV) vaccination and CC screening policy. Full article

Background and Objectives: Despite the widespread adoption of HPV-based cervical cancer screening, the optimal triage strategy for women with low-grade cytological abnormalities and non-16/18 high-risk HPV (hrHPV) types remains debated. This study evaluated the impact of ASCCP risk-based triage strategies on colposcopy referral and biopsy outcomes in a large tertiary care center. Methods: This retrospective cross-sectional study included 2748 sexually active women aged 30–65 years who underwent colposcopy at Ankara Etlik City Hospital (January 2023–June 2025). Of these, 1932 met ASCCP criteria for cervical biopsy. Cytology results, HPV genotypes (16, 18, and other hrHPV types), and histopathological findings were analyzed. CIN3+ (CIN3, adenocarcinoma in situ, or invasive carcinoma) was the primary outcome. Multivariable logistic regression identified independent predictors, with model fit assessed by Nagelkerke R² and the Hosmer–Lemeshow test. Results: The mean age was 42.8 ± 8.1 years. The overall CIN3+ prevalence was 15.9% (308/1932). HSIL cytology was the strongest independent predictor of CIN3+ (adjusted OR 22.41, 95% CI: 11.28–44.52). HPV16/18 combined with HSIL or ASC-H cytology conferred the highest risk (adjusted OR 17.88–21.67). Women with ASC-US or LSIL cytology and non-16/18 hrHPV types had CIN3+ rates below 10%. Irregular screening history was also an independent predictor (adjusted OR 1.38). A risk-based triage approach suggested a potential reduction of approximately 29.7% in colposcopy utilization. However, this estimate applies exclusively to the biopsied subgroup and does not account for potentially undetected lesions in the 816 non-biopsied women enrolled in surveillance follow-up. Conclusions: HSIL cytology and HPV16/18 positivity represent the highest-risk profile for CIN3+ and should remain primary indications for colposcopy. Conversely, women with ASC-US or LSIL cytology and non-16/18 hrHPV types may be candidates for surveillance-based co-testing rather than immediate colposcopy, potentially enabling a resource-efficient reduction in unnecessary procedures within the biopsied cohort studied. Prospective validation in broader colposcopy-referred populations is needed before generalizing these findings to primary screening settings. Full article