Search Results (158)

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: Women living in riverine communities are affected by factors such as geographical and cultural distance that hinder access to and use of health services. In this context, access to the Pap smear is crucial for the early detection of cellular changes that may progress to cervical cancer, which underlines the importance of understanding riverine women’s subjective perceptions of this exam. Objectives: To analyze the perceptions of riverine women regarding cervical cancer screening through the lens of health literacy. Methods: Descriptive qualitative study conducted with 42 riverine women residents of the Brazilian Amazon who were registered at the Basic Health Unit on Cotijuba Island, Pará, Brazil. Data were collected through semi-structured individual interviews from January to May 2024 and analyzed using IRaMuTeQ software version 0.7 alpha 2. Results: Data were grouped into similar classes, yielding the following thematic axes: knowledge, feelings and perceptions about the Pap smear test; how health literacy and access to information affect self-care; access to health services. The study showed that limited participant knowledge about the Pap smear was reflected in low health literacy, which directly affected adherence to the exam. Conclusions: The study demonstrated that the riverine woman’s limited knowledge regarding the Pap smear was reflected in their poorly developed health literacy, which directly contributed to non-adherence to the exam. Full article

Background: Non-communicable diseases (NCDs) such as cardiovascular diseases, diabetes, obesity, and cancer are the leading cause of mortality globally and in Saudi Arabia, accounting for more than 70% of all deaths. Despite national initiatives offering free preventive services, screening uptake remains low. This study aimed to describe the demographic and clinical characteristics of individuals participating in community-based NCD screening campaigns in the Eastern Province of Saudi Arabia and to evaluate screening uptake, compliance, and diagnostic outcomes. Methods: A retrospective cross-sectional analysis was conducted among 3106 adults screened at volunteer-driven community campaigns held between January 2023 and December 2024. Screening included anthropometric measurements, blood pressure assessment, and glucose testing, followed by eligibility evaluation for osteoporosis and cancer screening. Uptake and compliance were verified using electronic health records. Descriptive and inferential statistical analyses were applied. Results: Participants were 64% male and 36% female, with a mean age of 41.4 ± SD years. Obesity, hypertension, and diabetes were identified in 32%, 31%, and 12% of participants overall. Gender-stratified prevalence showed higher obesity among females at 36% (95% CI 32.3 to 38.1) and higher hypertension and diabetes among males at 36% (95% CI 34.0 to 38.2) and 14% (95% CI 12.1 to 15.2), respectively. Uptake among eligible individuals was 51% for dual-energy X-ray absorptiometry (DEXA), 47% for fecal immunochemical testing (FIT), 43% for Pap smear, and 39% for mammography. Diagnostic findings demonstrated substantial undetected disease burden, including osteoporosis in 41% (95% CI 26.0 to 56.8) of DEXA scans, a FIT positivity rate of 5% (95% CI 1.5 to 10.3), abnormal Pap cytology in 3% (95% CI 1.1 to 7.5), and BI-RADS 0 mammograms in 19% (95% CI 11.9 to 29.5), reflecting incomplete assessments requiring further evaluation. Conclusions: Community-based campaigns can effectively resolve limited engagement in health promotional activities and detect substantial burdens of undiagnosed NCDs. However, improvements in referral tracking, follow-up systems, and culturally tailored health education are essential to enhance screening compliance and early detection outcomes. These results can be utilized to inform public policies by extending screening services to additional areas, increasing investment in preventive health campaigns, and enhancing the capacity of the health system. Full article

Background/Objective: Cervical cancer incidence is rising in Puerto Rico (PR) despite being preventable through HPV vaccination, Pap smear screening, and the timely treatment of dysplasia. This study evaluated the presence of single-nucleotide polymorphisms (SNPs) in Toll-like receptors (TLR4 and TLR9) among women with cervical dysplasia and HPV infection, as potential immune-related susceptibility factors. Methods: Cervicovaginal samples from 210 Hispanic women in PR were analyzed for dysplasia severity and HPV genotype. Demographic data were collected. Seven SNPs (four in TLR4, three in TLR9) were examined using PCR-RFLP and AS-PCR. Associations between SNP frequency, dysplasia severity, and high-risk HPV (HR-HPV) were assessed. Results: HR-HPV was found in 64% of severe dysplasia cases versus 46% of mild/negative cases (p < 0.025). The TLR4 AG (rs4986790) and CT (rs1927911) genotypes were more frequent in severe dysplasia. For TLR9, CT heterozygotes (rs187084) and the TC genotype (rs5743836) were also enriched in severe dysplasia. Conclusions: This first PR-based study shows that TLR4 and TLR9 SNPs significantly correlate with HR-HPV infection and dysplasia severity, supporting further research on their potential as biomarkers for cervical cancer prevention. Full article

Background/Objective: High-risk human papillomavirus (hrHPV) is an established causative agent for the malignant transformation of cervical cells that can be detected using the Papanicolaou (Pap) smear test. A call by the World Health Organization (WHO) for global collective efforts towards eliminating cervical cancer has endorsed hrHPV DNA testing as an alternative screening test. The objective of this study was to determine the diagnostic utility of hrHPV DNA testing in detecting high-grade cervical intraepithelial lesions (HSILs) in unvaccinated women with abnormal Pap smears and histopathologically confirmed CIN3 and carcinoma. Methods: This study included 111 cervical tissues with a histopathological confirmation of the cervical intraepithelial neoplasia grade (CIN3) and malignancy. Tissues were sectioned, dewaxed, and digested, and DNA was extracted and tested for hrHPV using the Abbott RealTime HR HPV assay. Pap smear results associated with the tissue samples were extracted from corresponding clinical records, and data was analyzed using R-statistical software. Results: Extracted Pap smear records for the 111 cervical tissue samples indicated that 89 (80.2%) had a high-grade intraepithelial lesion (Pap-HSIL), 20 (18%) had squamous cell carcinoma (Pap-SCC), and two (1.8%) had Pap-adenocarcinoma. A total of 68/89 (76.4%) of Pap-HSIL, 15/20 (75%) of Pap-SCC, and ½ (50%) of Pap-adenocarcinoma cases had detectable hrHPV DNA. Conclusions: This study’s findings demonstrate that the Pap smear is still a valuable screening test especially for detecting both hrHPV-dependent and -independent cervical dysplasia in unvaccinated populations. While considerations are made to improve cervical cancer screening, including the introduction of hrHPV DNA testing in national cervical cancer screening programs, there is a need for the careful interpretation of molecular testing results for clinical intervention. This is especially important for hrHPV-independent cervical dysplasia screening, since this can have dire implications for clinically asymptomatic women. Full article

Background and Clinical Significance: Mesonephric adenocarcinoma (MA) of the uterine cervix is an exceptionally uncommon and aggressive cancer that arises from remnants of the mesonephric duct. It was first classified by the World Health Organization (WHO) in the 2020 WHO Classification of Female Genital Tumors as a type of cervical adenocarcinoma, also referred to as Gartner’s duct carcinoma. Due to its rarity, both detection and treatment pose significant challenges, and there is little information on its clinical manifestations and prognosis. Mesonephric hyperplasia (MH) in the uterine cervix is an uncommon condition that is often misdiagnosed as adenocarcinoma. Case Presentation: We present the case of a 49-year-old, asymptomatic, perimenopausal woman diagnosed with cervical mesonephric adenocarcinoma following a routine Pap smear, performed by Papanicolaou test, with a III A-B result; however, a cone biopsy revealed stage IB1 mesonephric adenocarcinoma. The patient underwent a radical hysterectomy type C (Querleu–Morrow 2017 classification). The final pathology confirmed stage IB2 of the cancer (2018 classification) according to The International Federation of Gynecology and Obstetrics (FIGO), with previous evidence of mesonephric hyperplasia from a trial abrasion performed three years earlier. Conclusions: This case highlights the challenges in recognizing and managing mesonephric hyperplasia and adenocarcinoma of the cervix. Given the uncommon nature of this cancer, clinicians should consider it when treating patients with ambiguous cervical pathology and mesonephric hyperplasia. Optimizing patient outcomes relies on early detection, accurate staging, and radical surgical treatment. Full article

This white paper, prepared by a consortium of Canadian national and provincial organizations and experts, outlines urgent strategies to curb the rising incidence of HPV-related cancers, of which, cervical cancer is currently the fastest-growing cancer in Canada. Despite school-based vaccination programs, the national HPV vaccine uptake remains suboptimal at about 64%, far below the 90% coverage target by 2025 necessary to eliminate cervical cancer by 2040. The report emphasizes a multi-pronged approach: support access to HPV vaccination with expanded funding policies and education around school-based programs while addressing inequities in underserved populations. HPV testing is highlighted as the preferred method for cervical cancer screening, offering higher sensitivity than Pap smears. Self-collection is presented as an innovative strategy to reduce barriers, particularly for marginalized groups, with promising evidence from Canadian pilots and international models. Crucially, we call for investment in comprehensive, population-based databases to track vaccination, screening participation, and follow-up care. Robust registries would allow targeted outreach to under- or never-screened individuals, ensure timely follow-up of abnormal results, and measure the impact of prevention programs across Canada. With vaccination, equitable access to HPV testing, integration of self-collection, and strong data systems, Canada can achieve its goal of eliminating cervical cancer within two decades. Full article

Background/Objectives: Cervical Pap smears are routinely used to detect cellular abnormalities as a cervical cancer screening tool and to assess the presence of HPV for risk stratification of the disease. Here, we aimed to extend the applications of this sampling procedure by combining it with multicolor flow cytometry to characterize cell populations across cervical cancer disease stages. Methods: Cervical Pap smears from 30 patients with various disease stages ranging from normal to intraepithelial neoplasia up to treated cancers were analyzed as biofluids using multicolor flow cytometry. Individual samples were evaluated, and statistical analyses were performed over all sample stages. Cancer cell lines (CaSki, SiHa, HeLa, A549, U2OS) were examined as tumor cell controls. Results: Cervical biofluids were subdivided into cell populations according to their scattering properties and the expression of specific biomarkers: EpCAM and cytokeratin 8 for epithelial cells from tumors as well as healthy ectocervical and endocervical regions, and CD45 for immune cells. Discrimination of tumor cells was facilitated with cancer cell lines. Statistical analysis revealed that the composition of cell populations differs among disease stages, whereas treated cancer samples were consistently associated with a reduction in squamous epithelial cells and an increase in immune cells compared to normal samples. Conclusions: Herein, we identified the major cell populations in cervical biofluid samples and demonstrated that this method can detect changes in the cellular composition across different disease stages. This approach could be further exploited in cancer research and potentially serve as a companion diagnostic tool in tumor development, progression and during treatment. Full article

Objective: This study aimed to identify risk factors associated with high-grade cervical intraepithelial neoplasia (CIN3+) in young adults with abnormal Pap smears. Methods: We performed a retrospective chart review of women ≤30 years who underwent loop electrosurgical excision procedure (LEEP) for abnormal Pap results (atypical squamous cells of undetermined significance [ASCUS] or higher), between 2012 and 2022 at Dongtan Sacred Heart Hospital. Clinical characteristics, including age, HPV infection, prior gynecologic surgery, pelvic inflammatory disease (PID), complete blood count, and Pap smear screening history were collected. Women with CIN3+ based on punch biopsy or LEEP were designated as CIN3+. Results: A total of 158 women underwent LEEP. Of these, 61.4% were diagnosed with CIN3+ and 8.2% with invasive cervical cancer. Independent predictors of CIN3+ included age >28 years, smoking, lack of regular Pap screening, and high-risk HPV infection. Subgroup analysis suggested age ≥28 years and neutrophil-to-lymphocyte ratio >2.12 were risk factors for invasive cervical cancer. Conclusions: Young Korean women with abnormal Pap smears and risk factors such as older age, smoking, high-risk HPV infection, and irregular screening histories are at increased risk for CIN3+. These findings highlight the importance of timely intervention; however, because our cohort included only women who underwent LEEP, it may represent a higher-risk subset and thus introduce selection bias. Validation in larger multicenter, prospective studies incorporating fertility and recurrence outcomes are needed before definitive recommendations can be made. Full article

Background and Objective: Cervical cancer remains one of the leading causes of death among women worldwide, particularly in regions with limited access to early screening. Pap smear screening is the primary tool for early detection, but manual interpretation is labor-intensive, subjective, and prone to inconsistency and misdiagnosis. Accurate segmentation of cervical cell nuclei is essential for automated analysis but is often hampered by overlapping cells, poor contrast, and staining variability. This research aims to develop an improved algorithm for accurate cervical nucleus segmentation to support automated Pap smear analysis. Method: The proposed method involves a combination of adaptive gamma correction for contrast enhancement, followed by Otsu thresholding for segmentation. Post-processing is performed using adaptive morphological operations to refine the results. The system is evaluated using standard image quality assessment metrics and validated against ground truth annotations. Result: The results show a significant improvement in segmentation performance over conventional methods. The proposed algorithm achieved a Precision of 0.9965, an F-measure of 97.29%, and an Accuracy of 98.39%. The PSNR value of 16.62 indicates enhanced image clarity after preprocessing. The method also improved sensitivity, leading to better identification of nuclei boundaries. Advanced preprocessing techniques, including edge-preserving filters and multi-Otsu thresholding, contributed to more accurate cell separation. The segmentation method proved effective across varying cell overlaps and staining conditions. Comparative evaluations with traditional clustering methods confirmed its superior performance. Conclusions: The proposed algorithm delivers robust and accurate segmentation of cervical cell nuclei, addressing common challenges in Pap smear image analysis. It provides a consistent framework for automated screening tools. This work enhances diagnostic reliability in cervical cancer screening and offers a foundation for broader applications in medical image analysis. Full article

Cervical cancer is a leading cause of morbidity and mortality among women, particularly in low- and middle-income countries. Early detection through routine Pap smear screening is essential to prevent disease progression. The COVID-19 pandemic severely disrupted healthcare services worldwide, including cancer screening programs. This study aimed to evaluate the impact of the COVID-19 pandemic on cervical cancer screening in Brazil. A nationwide retrospective population-based study was conducted using data from the Cancer Information System (SISCAN) of Brazil’s public health system (SUS). Data from 2018–2019 (pre-pandemic) were compared to 2020–2021 (pandemic period) regarding the number of Pap smear tests performed, regional distribution, and diagnostic outcomes. Furthermore, data from 2022–2023 were incorporated to evaluate the volume of cytopathological exams performed in the post-pandemic context. Statistical analyses included paired t-tests, Wilcoxon signed-rank tests, and repeated measures ANOVA with Bonferroni correction. A significant reduction in Pap smear testing was observed nationwide during the pandemic (p < 0.01), with variations across regions. Despite fewer screenings, there was an increase in unsatisfactory exams and a rise in adenocarcinoma and atypical findings in some regions. In contrast, the post-pandemic period showed a significant recovery in the number of exams, reaching volumes comparable to those observed before the pandemic (p < 0.05). The COVID-19 pandemic substantially reduced cervical cancer screening coverage in Brazil, highlighting structural vulnerabilities in the healthcare system. Strengthening organized screening programs is essential to mitigate the long-term impact of these disruptions. Full article

Background/Objectives: Routine preventive care, including physical examinations, mammography, and cervical cancer screening, is critical for long-term health maintenance and recurrence surveillance among breast cancer survivors. Community-based organizations (CBOs) may play a key role in supporting adherence to these services through education, navigation, and survivorship care planning. Methods: A secondary analysis was conducted using data from N = 777 breast cancer survivors who contacted a national cancer-focused CBO for resources, including no-cost patient navigation. Preventive care adherence was measured via a composite index based on self-reported receipt of physical exams, mammograms, and Pap smears at guideline-recommended intervals. Patient-reported outcomes were assessed 30 days post-contact, including Survivorship Care Planning (SCP) receipt and quality of life (QoL). Results: Adherence to all three guideline-based screenings was reported by 66% of BCS, 29% adhered to two, and 6% to one or fewer. Physical exams had the highest adherence rate (97%), followed by mammograms (88%) and Pap smears (73%). Bivariate analyses showed higher adherence among younger survivors (t = 4.59, df = 711, p < 0.001), non-white survivors (t = −3.27, df = 267, p < 0.001), those in partnered relationships (t = 1.76, df = 54, p < 0.05), and individuals with better QoL (r = −0.09, p < 0.01). Receipt of SCP components was associated with a trend toward improved adherence: 56% received a care summary, 64% received follow-up instructions, and 45% received written materials (r = 0.05, p < 0.10). In multivariable regression adjusting for partnership status and SCP receipt, younger age (B = 1.13, p < 0.001), non-white race/ethnicity (B = 1.00, p < 0.01), and higher QoL scores (B = 0.09, p < 0.05) were significantly associated with greater adherence. Conclusions: Engagement with a CBO was associated with high levels of adherence to preventive care among breast cancer survivors—especially those who were younger, non-white, and with better QoL. SCP, particularly when delivered in written form with follow-up instructions, may support improved adherence. These findings highlight the value of CBO-led survivorship support in promoting long-term health maintenance for breast cancer survivors. Full article

Cervical cancer remains a significant public health concern, ranking as the 10th most common cancer among women in Greece. Current screening programs primarily rely on cytology and HPV DNA testing; however, their positive predictive value (PPV) for detecting high-grade cervical intraepithelial neoplasia (CIN2+) remains limited. This study aimed to compare the clinical performance of the HPV mRNA test with that of the HPV DNA test, focusing on their PPV for detecting CIN1+ lesions in a cohort of Greek women. A total of 114 women undergoing routine cervical cancer screening were tested using an HPV DNA assay (detecting 41 HPV types), Pap smear, and were referred for colposcopy and biopsy when indicated. Among them, 29 women aged 18 to 65 years (mean age: 35.1 ± 10.8 years) who tested positive for one or more of the five high-risk HPV types (16, 18, 31, 33, 45) were further assessed using the PreTect HPV-Proofer^® mRNA assay. Of these 29 women, 11 (37.9%) had negative biopsy findings, 16 (55.2%) were diagnosed with CIN1, and 2 (6.9%) with CIN2, corresponding to a positive predictive value (PPV) of 55.2% for CIN1 and 6.9% for CIN2 with the HPV DNA test. Among the 17 women who tested positive for HPV mRNA, 13 were diagnosed with CIN1 and 2 with CIN2. Among the 12 women who tested negative for HPV mRNA, 3 had CIN1 and 9 had negative biopsy results. Based on these findings, the PPV of the HPV mRNA test for CIN1 was 76.5%, the negative predictive value (NPV) was 75.0%, and the clinical sensitivity for CIN1 was 81.3%. For CIN2, the PPV was 11.8%, while the clinical sensitivity and NPV were 100%. These findings highlight the potential of HPV mRNA testing to improve specificity in cervical cancer screening by more accurately identifying clinically significant lesions and reducing unnecessary colposcopies. Full article

Background/Objectives: Cervical cancer (CC), caused mainly by high-risk human papillomavirus (hrHPV), remains a global health challenge despite being preventable. The disease’s incidence and mortality rates significantly vary across regions, highlighting the need for effective screening programs. The World Health Organization prioritizes CC screening to monitor and eliminate the disease. The Screening for Cervical Cancer and Early Treatment (SCCET) project aligns with this goal by adhering to the 2012 National Program for Cervical Cancer Screening and implementing the European Guidelines of Quality Assurance. Methods: The SCCET initiative facilitates access to equitable and high-quality preventive medical services for Romanian women, incorporating the Babeș–Papanicolaou smear (Pap test) and/or hrHPV DNA screening. Focused on the Muntenia Region of South Romania, the project leverages a methodical approach to gather substantial medical data on hrHPV infection rates and cervical lesions, thereby improving health management for women in the screening program. Results: Through public information and educational campaigns about HPV and its link to CC, the SCCET project has significantly enhanced participation in the screening program. In the study conducted between September 2022 and March 2023, 14,385 women aged 30 to 64 years voluntarily participated; of these, 11,996 (83.4%) underwent primary hrHPV DNA screening and were tested using the PowerGene 9600 Plus Real-Time polymerase chain reaction (PCR) system and the commercial Atila BioSystems AmpFire^® HPV Screening 16/18/HR test, version 4.1. This substantial participation indicates a positive shift in public attitudes towards CC prevention and highlights the success of the project’s outreach efforts. The study revealed an overall prevalence of hrHPV infection of 12.24%; of these, the most common genotype was other hrHPV types (9.84%), followed by HPV 16 (2.3%) and HPV 18 (0.71%). Conclusions: The SCCET project’s recent data on primary hrHPV DNA screening showcases its pivotal role in advancing the management and prevention of CC in Romania. By providing accessible, high-quality screening services and fostering public education on HPV, the initiative has made significant strides toward reducing the burden of CC. This effort aligns with global public health goals, and providing updated information on the prevalence of hrHPV types will allow the development of personalized national screening and vaccination programs to eradicate CC. Full article

Background: Cervical cancer ranks among the most prevalent tumors in low-income countries, with the Pap test as one of the primary screening tools. The Pap smear detects abnormal cells, the CLART test identifies specific HPV genotypes, and HPV self-sampling allows for self-collected HPV testing. This study aimed to evaluate the feasibility of the first smartphone-based health device for home-collection HPV testing. Methods: Enrolled patients during the gynecological examination underwent three different samplings: Pap smear, HPV DNA genotyping test CLART, and vaginal HPV-Selfy swab. Each patient received a kit including an activation code, vaginal swab, and instructions. After performing the self-sample, patients returned the kit to our laboratory. Both the samples collected by the gynecologist and those collected by the patients themselves were analyzed. Results: A total of 277 patients were enrolled, with 226 self-collected swabs received for analysis. The assay yielded valid results for both self-collected and clinician-collected swabs in 190 patients. When comparing these results with paired clinician-taken vaginal swabs, we observed an agreement of 95.2% (Cohen’s Kappa: 0.845). We report an agreement of 93.7% (Cohen’s Kappa: 0.798). Conclusions: The study demonstrated the feasibility of HPV-Selfy as a complementary tool in cervical cancer screening, especially where adherence to traditional surveillance is low. Full article