The early screening, precise diagnosis, and effective treatment of invasive cervical cancer necessitate at-home molecular testing of human papillomaviruses (HPVs). However, current HPV DNA tests cannot meet the need for an affordable, rapid, and accurate diagnosis using a streamlined workflow. Here, we present a miniaturized single-step duplex CRISPR diagnostic platform, termed SCOPEv2 (Streamlined CRISPR On Pod Evaluation platform, version 2), for rapid and highly sensitive at-home molecular testing of high-risk HPV16 and HPV18 for population screening of cervical cancer. Dual-target recombinase polymerase amplification (RPA) was initially incorporated with Cas12a/Cas13a cleavage reactions in a single-step reaction system. A miniaturized and low-cost dual-color wireless analysis device was further developed to execute the analysis workflow. SCOPEv2 can detect HPV16 and HPV18 with limits of detection of 2.5 copies/μL (5 copies/reaction) and 5 copies/μL (10 copies/reaction) in 30 min, respectively. The analysis results for 128 clinical cervicovaginal swab samples revealed 94.7% sensitivity and 100% specificity. SCOPEv2 demonstrates an easy-to-use workflow, low cost, high analytical performance, and superior clinical feasibility, which enable accurate and simultaneous point-of-care testing of HPV16 and HPV18.

Background: Human papillomavirus (HPV) infection is the necessary cause of almost all cervical cancers. HPV vaccination programs have been implemented worldwide, yet real-world evidence on vaccine effectiveness against invasive cervical cancer remains limited. Methods: We conducted a retrospective cohort study using synthetically generated data from a large health provider in Israel, including women who underwent a first Papanicolaou (Pap) test during 2014–2015. Their HPV-vaccination status before an index Pap test was obtained from computerized records. Incident cervical cancer and high-grade cervical pathology (cervical cancer, cervical intraepithelial neoplasia [CIN] 1–3, and carcinoma in situ) occurrence were examined through 2022. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models and fitted with propensity score weighting. Results: The cohort included 98,102 women, of whom 9198 (9.4%) were vaccinated against HPV before an index Pap test. While HPV-vaccinated women had a higher risk of cervical pathology compared with unvaccinated women, among women vaccinated before age 18, HPV vaccination was associated with a substantially lower, though not statistically significant, risk of cervical cancer (HR 0.28, 95% CI: 0.07–1.20, p = 0.087). Conclusions: In this large cohort, HPV vaccination was correlated with a higher risk of cervical pathology, likely reflecting residual confounding factors from sexual behavior and differential baseline risks of HPV infection. In contrast, vaccination during adolescence showed a marked trend toward a reduced risk of cervical cancer, consistent with international evidence that early vaccination, prior to HPV exposure, is the most effective preventative treatment.

Cervical cancer remains a major public health concern globally. It is the fourth leading cause of cancer deaths among women worldwide. In 2020, the global incidence of cervical cancer was estimated to be 604 000 with a standardized mortality rate of 341 000. In Tanzania, cervical cancer is the most common female cancer and a leading cause of cancer-related deaths. The majority of data demonstrating the survival rate of cervical cancer originates from high- and middle-income countries with contributions from low-income countries such as Tanzania being relatively scarce. Determining the factors associated with survival is critical in an attempt to inform strategies to improve outcome of women with cervical cancer. The aim of the present study was to determine the 3-year overall survival rate and associated factors among women with invasive cervical cancer attended at Ocean Road Cancer Institute (ORCI) from 2018 to 2020. A retrospective cohort study was conducted at ORCI by using their cancer registry database. The study included 256 women diagnosed with cervical cancer from 2018 to 2020. Survival analysis was estimated by using Kaplan-Meir analysis, Cox regression hazard proportion and log-rank test and a P value of less than 0.05 was considered statistically significant. Stata version 17 was used for analysis. Among 256 women with cervical cancer, the survival rate across one-, two- and 3-years, respectively were 83.6%, 77.0%, and 72.7%. Survival rate was significantly associated with both FIGO stage during diagnosis and hemoglobin level. Those who received concurrent chemoradiotherapy had a higher survival rate compared to those who received radiotherapy or chemotherapy only, and it was statistically significant with P < 0.001. The study found an overall survival rate of 72.7% over 3 years. Factors associated with survival rate were early FIGO stage at diagnosis, normal hemoglobin level at diagnosis, and the use of concurrent chemoradiotherapy. Proper staging, good patient preparation and good choice of treatment improves survival. With availability of advance treatment options in the country the survival rate of women is promising.

Cervical cancer is a major global public health challenge, with an alarmingly high burden in low- and middle-income countries (LMICs), where approximately 88% of deaths occur. The singular, well-established agent that causes invasive cervical cancer is an oncogenic type of human papillomavirus (HPV) infection. Cervical cancer is both highly preventable and highly treatable when detected at early and pre-invasive stages. Nearly all cases of cervical cancer can be avoided through vaccination against the HPV virus. In this perspective article, we track India's efforts in the HPV immunization program for primary prevention, supplementing early detection and screening programs. Also, we discuss the roadblocks that may interfere with this mission and highlight the assets that will pave the way for a better understanding of how to eliminate cervical cancer. This perspective article utilizes the World Health Organization's Building Blocks for Effective Health Systems framework to examine India's current HPV immunization efforts. This framework was contextualized with insights from peer-reviewed research and relevant grey literature to identify key facilitators and obstacles influencing the implementation of the HPV vaccination program. Globally available and approved HPV vaccines, although successful, are still expensive in LMICs. Therefore, India has been putting efforts into a locally produced HPV vaccine. The affordability of this vaccine makes the impact potentially transformative, but its future success depends on scaling up and utilizing effective strategies for nationwide implementation.

Self-sampling for human papillomavirus (HPV) is an established strategy to increase participation in cervical screening. We previously reported a randomized trial targeting women who had not attended screening after >10 invitations, where sending of self-sampling kits resulted in a 19% attendance and a positive predictive value (PPV) for high grade lesions (HSIL+) of 40%, despite no triaging after the HPV test. Because of the striking results, the intervention was extended to all women resident in Stockholm County, Sweden, in the years 2019/20, who had not attended screening >10 years (N = 42,409). Participation was 35.6% and 11.6% of the participating women were HPV-positive. Among these, there were 43 cases of invasive cervical cancer and 319 cases of high-grade lesions. The PPV was particularly high for HPV16/18 positive women (12% for invasive cancer and 59% for HSIL). In summary, participation with HPV self-sampling among long-term non-attenders in the real-life program was considerably higher than in the research setting and the high yield of HSIL+ implied high effectiveness.

To assess the accuracy of MRI in detecting residual disease after conization in patients with early-stage cervical cancer (CC) and to evaluate the impact of MRI on FIGO staging and surgical management. Between January 2018 and December 2023, a consecutive series of patients with early-stage invasive CC undergoing conization, pre-operative pelvic MRI, and surgery were included in this retrospective study. Two experienced radiologists reviewed the MRI scans for the presence of residual tumor, assessed on T2-weighted, diffusion-weighted, and contrast-enhanced sequences, if available. MRI findings were compared with surgical pathology to evaluate diagnostic performance and clinical impact. A total of 108 patients were included in the study. MRI detected residual disease with an accuracy of 78.7% (95% CI 71.0-86.4), sensitivity of 66%, specificity of 90.9%, positive predictive value of 87.5%, and negative predictive value of 73.5%. The use of contrast agent showed no significant difference in overall accuracy, with an accuracy of 74.5% for contrast-enhanced MRI (CE-MRI) and 83% for non-CE-MRI (p = 0.28), respectively. MRI correctly staged 73.8% of cases, suggested the correct extent of radicality in 79.7% of cases following the 2018 ESGO guidelines, and the appropriate type of hysterectomy (simple vs. radical) in 90.9% of cases following the SHAPE study. Non-CE MRI is a reliable and sufficient tool for detecting residual tumor after conization in early-stage CC, as contrast administration offers no additional diagnostic value. Accurate pre-operative identification of residual disease may refine FIGO staging and assist in tailoring surgical strategies. Question MRI evaluation of residual tumor after cervical conization in early-stage cervical cancer is critical to optimize surgical planning noninvasively and avoid overtreatment. Findings MRI correctly identified residual disease with high specificity (90.9%) and moderate sensitivity (66%); contrast enhancement did not significantly improve diagnostic accuracy. Clinical relevance MRI, particularly non-contrast protocols, reliably excludes post-conization residual disease and aids in selecting appropriate surgical treatment, reducing overtreatment in early-stage cervical cancer.

Human papillomaviruses (HPVs) are well-established etiological causes of invasive cervical cancer (ICC), with type 16 being the main contributor. This virus is often found to be integrated into the host genome in precancerous lesions and advanced cervical cancers. It is suggested that distinct lineages of HPV-16 differ in their persistence, carcinogenic potential, and geographic distribution. Given that genomic integration is one of the most critical steps in the development of cervical cancer, and lineage D has a higher propensity to integrate the viral genome into the host genome, it is necessary to conduct a study to investigate a possible relationship between HPV-16 lineages and physical status in Iran. In this study, a total of 125 laboratory-confirmed HPV-16-positive cervical samples (comprising 30 normal, 39 precancerous, and 56 cancerous specimens) were analyzed. The DNA level of E2 and E6 viral genes was measured using the quantitative Real-Time PCR method, and the E2/E6 ratio was used to calculate the physical status of the HPV-16 DNA in the studied samples. The full sequence of the E6 gene was also sequenced to determine HPV-16 lineages. Three lineages, A (32.8%), C (0.8%), and D (66.4%) of HPV-16, were found in this study. HPV-16 exhibits different integration profiles, with viral DNA detected in three forms: episomal, mixed, and integrated. The physical status of the genome was statistically different based on histology and age. The integrated form was more prevalent in ICC patients than in CIN I-III and normal groups (P=0.000048). Also, the integrated form of the genome was found in higher amounts in the age group >40 years in comparison to <40 years (P= 0.00117). Regarding lineages, no statistically significant differences were identified between HPV-16 lineages and the integration status. However, when the samples were stratified by histology status, an association between lineage D and integrated form was observed, while no association was found for lineage A. In conclusion, lineages A and D were found to be dominant in the Iranian population. Moreover, an association was found between lineage and integration status, as lineage D has a higher propensity to integrate than lineage A. However, it is recommended that further studies with larger sample sizes from different regions of Iran be conducted to estimate whether a specific lineage or sublineage has a higher chance of integrating into the host genome, persisting, and causing cancer.

Bacground/Objectives: Cervical intraepithelial neoplasia (CIN) comprises a range of precancerous cervical lesions, and timely detection and intervention are essential to avert the development to invasive cervical cancer. Our previous study showed specific elemental alterations in the serum of patients with diagnosed CIN. In this study, we aimed to determine the levels of trace elements (Be, Cr, Mn, Co, Ni, Cu, Zn, Se, Cd, Tl, Pb, Rb, Sr, Mo, Th, and U) in more valuable materials, cervical tissue samples collected from patients diagnosed with CIN 2 and 3 (n = 60). Methods: The control group consisted of healthy, pathologically unaltered samples from the same patients (n = 60). The concentrations of all trace elements were determined using inductively coupled plasma–mass spectrometry (ICP-MS). Key demographic and clinical data were statistically analyzed in the context of trace element levels in cervical tissues. Results: We discovered that CIN 2 and CIN 3 tissues had significantly higher concentrations of essential trace elements Cr, Co, Se, and Mo, and toxic trace elements Be, Ni, and Cd compared to controls. The findings of this study highlight the differences in trace element concentrations in CIN tissue samples compared to controls. Conclusions: The presented results suggest the possible role of trace elements in the pathophysiological processes that lead to neoplasms in cervical tissues. The results provide initial and pivotal insight into the trace element concentrations in CIN tissues, which could aid further studies regarding cervical neoplasms and their pathogenesis.

Introduction: Cervical cancer (CC) remains a significant global health burden, primarily driven by persistent high-risk human papillomavirus (HPV) infection. While HPV is the necessary cause, the role of host reproductive cofactors, such as early menarche, in promoting carcinogenesis remains controversial. This systematic review synthesizes the epidemiological evidence on the association between early menarcheal age and the risk of cervical cancer and its precursors. Methods: This review was conducted adhering to the PRISMA 2020 guidelines. A systematic search of PubMed, EMBASE, and Web of Science was performed to identify observational (cohort and case-control) studies published to date. Studies assessing the risk of invasive cervical cancer (ICC), cervical intraepithelial neoplasia (CIN/HSIL), or high-risk HPV (HR-HPV) infection in relation to menarcheal age were included. The methodological quality and risk of bias for included non-randomized studies were rigorously assessed using the Risk Of Bias In Non-randomized Studies - of Interventions (ROBINS-I) tool. Results: Seventeen studies met the inclusion criteria. A subset of case-control and cross-sectional studies reported a statistically significant positive association between early menarche and cervical disease. Notably, one meta-analysis of Chinese studies reported a pooled Odds Ratio (OR) of 3.242 for ICC. Another study found a strong association between early menarche (&lt;13 years) and HPV 16/18 infection (OR = 6.2). A 2023 study also identified early menarche as a significant risk factor for high-grade squamous intraepithelial lesions (HSIL). However, these findings are contradicted by larger, more methodologically robust prospective cohort and pooled case-control analyses. These high-quality studies, which included comprehensive adjustment for key confounders, found no significant independent association between menarcheal age and risk of ICC. The evidence demonstrates that the observed association is strongly mediated by age at first sexual intercourse (AFSI), which is significantly predicted by early menarche (e.g., OR = 6.4). Discussion: The data highlights a critical epidemiological challenge in distinguishing between behavioral mediation and biological causation. The findings are evaluated through two primary pathways: 1) The behavioral-mediation pathway, where early menarche serves as a robust proxy for early AFSI and subsequent HPV exposure; and 2) The biological-plausibility pathway, which posits that early endogenous estrogen exposure creates a "window of vulnerability" in the cervical transformation zone, increasing susceptibility to HPV. The robust null findings in studies that control for AFSI, alongside recent data distinguishing risk for uterine (significant) versus cervical (null) cancer, strongly support the behavioral-mediation pathway. Conclusion: While several studies report a significant positive association, the weight of the highest-quality epidemiological evidence suggests that early menarche is not a direct, independent causal factor for cervical cancer. Instead, it functions as a significant indirect risk marker. The association is robustly and almost entirely mediated by the strong correlation between early menarche and early sexual debut. Public health interventions should therefore focus on this behavioral link, targeting education and HPV vaccination to adolescents, particularly those undergoing early pubertal maturation.

Cervical cancer is the second most commonly diagnosed cancer and one of the leading causes of death in women. The objective of the current review was to synthesize the available evidence on the association between male circumcision and risk of cervical cancer in females. We searched PubMed, Cochrane, CancerLit, Google Scholar, medRxiv, bioRxiv, UpToDate, TRIP database, and the ProQuest Dissertations and Theses Global databases to identify relevant articles. We considered research studies that assessed male circumcision status and cervical cancer in females for inclusion. The risk-of-bias assessment was performed using the Newcastle-Ottawa scales. We estimated summary measures of effect and 95% CIs for the odds of developing cervical dysplasia, carcinoma in situ, or invasive cervical cancer in females based on the circumcision status of their male partners. We identified 380 potentially eligible records through systematic database searches. After excluding 278 records on the basis of title and abstract screening, 102 full-text records were assessed for eligibility. We included 19 studies in the final analysis. The risk-of-bias assessment revealed a low risk across 10 records. Male circumcision was associated with decreased odds of cervical cancer (odds ratio [OR], 0.65 [95% CI, 0.53 to 0.79]). Circumcision was also associated with decreased odds of developing Invasive cervical cancer (OR, 0.71 [95% CI, 0.51 to 0.99]), cervical dysplasia (OR, 0.65 [95% CI, 0.45 to 0.92]), and carcinoma in situ cervix (OR, 0.67 [95% CI, 0.50 to 0.90]). Male circumcision has been found to be associated with lower odds of developing various cervical lesions, suggesting its prophylactic potential. Understanding the effects of male circumcision on human papillomavirus (HPV) infection would have important implications for studies of HPV transmission, leading to a better understanding of the pathogenesis of cervical cancer.

Precancerous and suspicious cervical cancer lesions refer to abnormal changes in cervical cells that may develop into malignancy if left untreated. Women living with Human Immunodeficiency Virus (HIV) face a significantly higher burden of AIDS-defining malignancies, particularly invasive cervical cancer. Their risk of developing cervical cancer is approximately six times greater than that of HIV-negative women. Despite the elevated risk, there is limited evidence in understanding the prevalence of cervical lesions among women living with HIV (WLHIV) who undergo cervical cancer screening in Ethiopia. This gap underscores the need for further research to inform targeted interventions and improve health outcomes for these high-risk populations. A facility-based cross-sectional study was conducted among 583 adult WLHIV in the Awi Zone, Northwest Ethiopia. Both primary and secondary data were collected between January and May 2023 to address the study objectives. Data were entered into Epidata version 4.6 and exported to SPSS version 26 for analysis. A bivariable and multivariable binary logistic regression model was fitted to identify factors associated with the outcome variable. Statistical significance was determined at a p-value of less than 0.05 and a 95% confidence interval (CI). The magnitude of precancerous and/or suspicious cervical cancer lesions (PCCLs) among women living with HIV was 24.9% (95% CI: 21.3-28.1%). The likelihood of developing precancerous and suspicious cervical cancer lesions was higher among individuals with a baseline CD4 + cell count of < 200 cells/mm³ (AOR = 3.82, 95% CI: 2.44-5.39), a history of sexually transmitted infections other than HIV (AOR = 3.97; 95% CI: 1.97-5.70), use of oral contraceptives (AOR = 2.18; 95% CI: 1.40-3.40), having two or more sexual partners (AOR = 2.86; 95% CI: 1.79-4.55), fair adherence to antiretroviral therapy (ART) (AOR = 2.81; 95% CI: 1.39-5.64), and poor ART adherence (AOR = 3.25; 95% CI: 1.87-7.43). In this study, a relatively high prevalence of precancerous lesions was found among WLHIV compared to previous studies in Ethiopia. Behavioral, clinical, and reproductive health-related factors were linked to the occurrence of the disease. These findings underscore the importance of giving special attention to high-risk women through targeted screening and preventive interventions.

INTRODUCTION: Cervical cancer remains a leading cause of cancer-related mortality for women globally, with a disproportionate burden concentrated in low- and middle-income countries (LMICs) (World Health Organization, 2024). This significant disparity is largely attributable to inadequate implementation of, and adherence to, preventive screening programs (Bray et al., 2024). This systematic review synthetically evaluates the quantitative association between adherence to Papanicolaou (Pap) smear screening and cervical cancer mortality. METHODS: A systematic review of the literature was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Page et al., 2021). Major electronic databases (including PubMed, MEDLINE, Embase, and Web of Science) were searched for observational studies (cohort and case-control) that assessed cervical cancer mortality or the incidence of invasive cervical cancer as an outcome of cytology screening history (Peirson et al., 2013). Study quality and risk of bias were assessed using the Newcastle-Ottawa Scale (NOS), the standard, validated tool for non-randomized studies (Wells et al., 2000). RESULTS: A total of 16 high-impact observational studies met the inclusion criteria. The findings are overwhelmingly consistent and statistically significant in demonstrating a profound protective effect. Large-scale cohort studies demonstrate that women adhering to screening have a substantially lower risk of mortality; one major study found a 70% reduction in cervical cancer mortality (Hazard Ratio: 0.30; 95% Confidence Interval [CI]: 0.12–0.74) (Makino et al., 2006). Case-control studies report exceptionally strong protective effects, with odds ratios (OR) for mortality as low as 0.08 (95% CI: 0.07–0.09) (Landy et al., 2016) and 0.34 (95% CI: 0.14–0.49) (Lönnberg et al., 2013). Furthermore, a meta-analysis of case-control studies on invasive cancer (the precursor to mortality) found a pooled protective effect (OR: 0.35; 95% CI: 0.30–0.41), signifying an approximate 65% reduction in risk (Peirson et al., 2013). DISCUSSION: The evidence irrefutably confirms a significant inverse relationship between screening adherence and mortality. The epidemiological findings demonstrate that the public health failure is not one of diagnostic efficacy but of implementation. This discussion synthesizes the quantitative efficacy of screening with the major documented barriers—economic, psychosocial, cultural, and provider-level—that suppress adherence rates and perpetuate this preventable mortality (Akin-Odanye et al., 2024). CONCLUSION: Adherence to Pap smear screening is a critical, primary determinant in the prevention of cervical cancer mortality. Public health strategies must shift from proving efficacy to aggressively dismantling the known structural and psychosocial barriers to adherence to achieve global elimination targets.

Introduction: Cervical cancer is the fourth most common cancer in women globally, etiologically linked to persistent high-risk human papillomavirus (HPV) infection (World Health Organization, 2024a; World Health Organization, 2024b). High-grade cervical intraepithelial neoplasia (CIN), specifically CIN2 and CIN3, are the direct, histologically confirmed precursor lesions (Cleveland Clinic, 2023). This systematic review synthesizes the evidence from randomized controlled trials (RCTs) and real-world observational studies on the effectiveness of prophylactic HPV vaccination in reducing the incidence of CIN2 and CIN3 (CIN2+). Methods: Following PRISMA guidelines, a systematic search of PubMed, Embase, and the Cochrane Library was conducted (Ghebrekidan et al., 2024; Khalil et al., 2023). Studies were included if they were RCTs or observational (cohort, case-control) studies assessing the efficacy or effectiveness of prophylactic HPV vaccination (bivalent, quadrivalent, or nonavalent) on histologically confirmed CIN2+ outcomes in females. Methodological quality was appraised using the Cochrane Risk of Bias 2 (RoB 2) tool for RCTs (Sterne et al., 2019; Cochrane, 2024) and the Newcastle-Ottawa Scale (NOS) for observational studies (Wells et al., 2024; Ohri, 2024). Results: This synthesis includes 17 high-quality studies. Foundational RCTs (e.g., FUTURE, PATRICIA) demonstrated near-perfect efficacy (98-100%) against vaccine-type HPV 16/18-related CIN2+ in per-protocol (HPV-naïve) populations (FUTURE II Study Group, 2007; Paavonen et al., 2009; Kjaer et al., 2018). A high-certainty Cochrane review confirmed a 63% reduction in any CIN2+ (irrespective of HPV type) in hrHPV-negative young women (Risk Ratio 0.37, 95% CI 0.25-0.55) (Arbyn et al., 2018). Recent, large-scale real-world effectiveness (RWE) studies from national registries report profound, significant reductions in high-grade lesions. In England, cohorts vaccinated at age 12-13 showed an 87% reduction in invasive cervical cancer and a 97% reduction in CIN3 (Falcaro et al., 2021). In Sweden, vaccination before age 17 was associated with an 88% reduction in invasive cervical cancer (Lei et al., 2020), and in Scotland, an 86% reduction in CIN3+ was observed in the 12-13 age cohort (Palmer et al., 2019). Effectiveness is strongly dependent on vaccination age (Hariri et al., 2023; Herweijer et al., 2016). Furthermore, significant evidence demonstrates high effectiveness (74-87% reduction) in preventing the recurrence of high-grade lesions when used as an adjuvant to surgical conization (Dvořák et al., 2024; Ghelardi et al., 2021). Discussion: The evidence is overwhelming and consistent. The near-100% efficacy observed in controlled trial settings has translated directly into profound population-level effectiveness in countries with high, sustained vaccine uptake (Ghebrekidan et al., 2024; Drolet et al., 2019). The dependency of effectiveness on age confirms the vaccine's prophylactic mechanism, underscoring the criticality of pre-adolescent vaccination. Conclusion: Prophylactic HPV vaccination provides a significant, robust, and long-lasting reduction in the incidence of high-grade cervical precancer (CIN2/3). High-coverage national programs are demonstrating the potential to "almost eliminate" (Falcaro et al., 2021) cervical cancer in vaccinated generations, representing a major public health triumph.

Cervical intraepithelial neoplasia (CIN) represents a spectrum of premalignant lesions requiring accurate early detection to prevent progression to invasive cervical cancer. Colposcopy with visual inspection using acetic acid (VIA) is the gold standard for CIN assessment but suffers from substantial interobserver variability, limiting diagnostic consistency. We evaluated hyperspectral imaging (HSI) as an objective, non-invasive method for characterizing CIN-related tissue changes. This prospective proof-of-principle clinical study enrolled women with histologically confirmed CIN3 indicated for large-loop excision of the transformation zone (LLETZ). Standardized colposcopic images following VIA were obtained and annotated independently by five certified colposcopists according to IFCPC Rio 2011 classification. These annotations served as pathological tissue region references and were quantitatively assessed using intersection over union metrics to evaluate interobserver agreement. HSI was performed immediately prior to LLETZ using the TIVITA Tissue System, capturing spectral reflectance data across 500–995 nm in 100 wavelength bands. Spatial correspondence between colposcopic and hyperspectral images was achieved through homography transformation based on landmark alignment, allowing expert annotations to be projected into the HSI domain. Reflectance spectra from annotated areas were averaged to calculate four proprietary HSI-derived tissue indices, which revealed significantly higher values in CIN-affected regions compared to healthy tissue (p <0.01, Wilcoxon signed-rank test), suggesting increased vascularization and water content. Our findings highlight conventional colposcopy limitations due to examiner subjectivity and support HSI’s potential to provide reproducible, quantitative biomarkers for CIN. HSI integration into clinical workflows may enhance cervical cancer screening objectivity and enable reliable diagnostics in resource-limited settings. Clinical and Translational Impact Statement— Hyperspectral imaging enables objective detection of cervical intraepithelial neoplasia and could improve diagnostic accuracy while reducing unnecessary biopsies

We demonstrated that cervical cancer risk following any screening result is lower if there is a known prior negative screening history versus an unknown screening history. We extended these findings to look at how screening performs following repeatedly screening negative. Approximately 1.7 million women aged 30-64 years underwent triennial human papillomavirus (HPV) and cytology co-testing from 2003 to 2021. We modeled 5-year risks of cervical intraepithelial neoplasia grade 3 or more severe diagnoses (CIN3+) and invasive cervical cancer for the initial co-test and then successive rounds following negative co-testing. A logistic-Weibull prevalence-incidence model was used to model risks. HPV test positivity was greater than cytology positivity for only the first co-test and both decreased with each screening round. Diagnostic yields of CIN3+ and cancer declined with each round of screening so that the first screen yielded 8-fold more CIN3+ and invasive cancer than the 5th screen following 4 consecutive negative co-tests. Five-year risks of CIN3+ for positive and negative HPV and cytology results, individually or combined, decreased considerably after the first screen with smaller decreases in each subsequent round. For cancer, we noticed a considerable decrease with the first screen only. Five-year CIN3+ risks were greater for positive HPV or cytology results with a longer antecedent screening interval and younger age at screening (ptrend<0.001). Triennial screening that includes HPV testing becomes inefficient after a single, and more so after multiple, negative screens. These data support the use of longer screening intervals, especially following negative screen(s).

Human papillomavirus (HPV) is one of the most common groups of sexually transmitted viruses in the world, mostly asymptomatic and causes HPV-associated diseases: from benign to malignant neoplasms. Prevalence, lack of specific symptoms in the early stages, complicated diagnosis and early detection of HPV infection, which is critical given the oncogenicity of some virus variants, delayed start of treatment, some unavailability of timely prophylaxis – determine the relevance of studying HPV infection.HPV itself does not cause cancer, and the neoplastic process is launched if there are triggers. The most significant triggers are the following: sexual activity (early age of first sexual intercourse and number of partners), smoking, long-term use of oral contraceptives for more than 5 years, folic acid deficiency, exposure to ultraviolet rays and radiation, immunosuppression, betel nut consumption, pregnancy, as well as concomitant infection with sexually transmitted infections, chronic pelvic inflammatory di-seases, endometriosis, qualitative and quantitative disorders of the vaginal microflora. Against the background of HPV infection, several epigenetic changes were found in both the viral and host cell genomes, including hypomethylation or hypermethylation of viral deoxyribonucleic acid and hypermethylation of host cell tumor suppressor genes, as well as histone modifications and changes in the expression of non-coding ribonucleic acids. Viral oncoproteins E6 and E7 interact and alter the expression of several cellular proteins involved in epigenetic regulation, altering the transcriptional competence of infected cells, which is caused by changes in gene expression, increased activity of histone-modifying enzymes, and chromatin remode-ling. To date, the most effective method of prevention is vaccination.Currently, there are three main types of vaccines in the world and in Ukraine: bivalent, tetravalent, and nine-valent. The effectiveness of the vaccine has been demonstrated by numerous studies, for example, in a study of women who were vaccinated at the age of 12–13 with a bivalent HPV vaccine, there were no cases of invasive cervical cancer, indicating 100% vaccine effectiveness. Among women aged 14–22 who received three doses of the vaccine, 3.2 per 100,000 had cervical cancer, compared with 8.4 per 100,000 among unvaccinated women. Several studies also show that vaccination prevents oropharyngeal and anal infections.

&amp;lt;i&amp;gt;Introduction:&amp;lt;/i&amp;gt; Precancerous cervical lesion is the potential risk factors of invasive cervical cancer. However, factors associated with premalignant cervical lesions remain poorly documented in general population in Adama town. The previous studies had their own methodological gaps which lead to generalizability limitations. Therefore, it is critical to identify the associated factors with precancerous cervical lesions for comprehensive and integrated screening services. &amp;lt;i&amp;gt;Objective:&amp;lt;/i&amp;gt; To identify the determinants of precancerous cervical lesions among women screened for cervical cancer at Adama town public health facilities Adama, Oromia, Ethiopia, 2024. &amp;lt;i&amp;gt;Method:&amp;lt;/i&amp;gt; Health facility based unmatched case control study design was carried out in selected public health facilities in Adama town. The public health facility participants were selected through simple random sampling techniques. The sample size of cases 84 and control 252 were collected by systematic random sampling. The data were entered and analyzed with Epi info 7.2.6 and SPSS 27. Variables with P-value &amp;lt; 0.25 in the binary logistic analysis were included in the multivariate logistic regression model. An odds ratio with its 95% CI and P value less than 0.05 was used to decide about the presence of association. &amp;lt;i&amp;gt;Result: &amp;lt;/i&amp;gt;The median age of the participants was 36 years ± 8 IQR years. This study revealed that the odds of being positive for precancerous cervical lesion were higher among women who were widowed (AOR =10.679, 95% confidence interval CI: 3.049-37.405), with lower family income (AOR =4.662: 95% CI: 1.767-12.302), youngest first marriage age (AOR =5.005: 95% CI: 1.847-13.563), practicing sexual intercourse before age 16 (AOR =11.190: 95% CI: 1.280- 97.867), history of STIs (AOR =5.188: 95% CI: 1.689-15.934), partner history of STIs (AOR=5.324: 95% CI (1.521-18.630) and lifetime multiple sexual partners history (AOR=3.389: 95% CI: 1.438-7.987). &amp;lt;i&amp;gt;Conclusion:&amp;lt;/i&amp;gt; Most of the determinants of precancerous cervical lesions were modifiable and mainly related to women’s socio-demographic related factors, reproductive, clinical and sexual behavior related. Therefore, strengthening awareness on safe sexual practices and healthy life styles through behavioral change communication would decrease the incidence of precancerous cervical lesions.

Objective: This study aims to evaluate the diagnostic value of high-risk human papillomavirus (HR-HPV) positivity—particularly HPV type 16—together with cytological findings and colposcopic assessment in detecting cervical intraepithelial neoplasia (CIN) and cervical cancer. Materials and Methods: We retrospectively analyzed 781 women who underwent colposcopic examination at a tertiary healthcare center between January 2020 and April 2024. HPV DNA results and cytological evaluations prior to colposcopy were reviewed. Histopathological outcomes from cervical biopsy, endocervical curettage (ECC), and probe curettage (P/C) were examined. Multivariate logistic regression was used to determine the predictors of CIN 2 or more severe lesions. Results: HPV type 16 was found to be a significant independent predictor of CIN2+ lesions, with an odds ratio of 22.36 (p=0.002) compared to HPV-negative individuals. The model demonstrated statistical significance, and the area under the curve (AUC) was calculated as 0.679, indicating moderate diagnostic performance. Other HPV genotypes and unknown HPV status also showed a significant association with higher-grade lesions. Conclusion: HR-HPV, and particularly HPV 16, is strongly associated with the presence of advanced cervical lesions. Women testing positive for HPV 16 should undergo close surveillance and timely colposcopic evaluation by specialists to enable early diagnosis and prevent progression to invasive cervical cancer.

PURPOSECervical cancer remains a leading cause of cancer mortality in low- and middle-income countries (LMICs). The International Gynecologic Cancer Society (IGCS) Global Gynecologic Oncology Fellowship aims to build human capacity to address the burden of cervical cancer in LMICs. This study assesses resource constraints experienced at fellowship sites with regard to management of cervical cancer.METHODSFrom September to December 2020, one fellow from each of the 12 existing IGCS fellowship programs participated in a survey that assessed capacity for cervical cancer management, including access to care, diagnostics and treatment, cancer surveillance, and palliative care. Descriptive statistics were used for analysis.RESULTSPatients at IGCS sites experienced significant delays to care, especially for chemotherapy and radiation therapy. Less than half of the sites had a gynecology-trained pathologist, and only 58% of sites had access to a magnetic resonance imaging machine, though with many delays in obtaining imaging reads. For treatment, neoadjuvant chemotherapy is not commonly used. Access to radiation therapy is poor, with 58% of sites reporting wait times of 5-8 weeks or more. The radiation machine downtime ranges from 1 to 3 months per year, creating gaps where no patients can access this treatment. Palliative care is practiced by variable members of the health care team although hospice services are rare.CONCLUSIONThis study demonstrates significant resource constraints experienced by gynecologic oncology providers in various LMICs when managing cervical cancer. This includes delays to diagnosis, poor access to chemoradiation services, and need for palliative care. Despite these limitations, the IGCS Global Gynecologic Oncology Fellowships have built workforce capacity to manage cervical cancer, serving as local champions to address this disease.

BackgroundSince 2020, co-testing for women over the age of 35 has been a new strategy for cervical cancer screening in Germany. In this study, we investigated the added value of co-testing in organized cervical screening for the German screening population.MethodsA total of 1956 women were referred to our large dysplasia consultation institution due to abnormal screening results in the first round of screening between 2020 and 2022. The endpoint of this retrospective study was the posttest probability of a CIN 2+/CIN 3 + lesion on the cervix uteri. In addition, the influence of HPV subtypes on the endpoints was investigated.ResultsCIN 2 + or CIN 3 + lesions were diagnosed in 21.6% and 13.0%, respectively, of the patients. The probability of severe dysplasia increases with the grade of cytological abnormality and is dependent on the HPV subtype. The probability for detecting invasive cervical cancer (16 patients in total) was significantly higher for women with HPV16 infection than for women with HPV infection of other high-risk types (odds ratio 11.18; 95% confidence interval 3.01, 40.81). CIN 2 + lesions were diagnosed in 10.1% of patients with normal cytology.ConclusionsCIN 2 + lesions could be detected in more than every 5th woman with an abnormal screening result. The proportion of CIN 3 + patients was significantly higher in the presence of HPV 16.