e18565 Background: Persistent infection with high-risk human papillomavirus (HR-HPV) is an important cause of malignancy, and patients receiving allogeneic hematopoietic stem cell transplant (SCT) for hematologic malignancies are at heightened risk of HPV-related secondary malignancies due to immunosuppressive therapies and graft versus host disease. However, the prevalence of HR-HPV among SCT recipients has not been well established. We aimed to describe the prevalence of HR-HPV in this population. Methods: This prospective observational study enrolled patients at MD Anderson Cancer Center planning to undergo allogeneic SCT for hematologic malignancies from March 2017 to January 2019. Patients completed a self-administered survey providing demographic information and HPV-related risk factors. Specimens were collected at 3 anatomical sites (oral, anal, and either cervical [female] or penile [male]) before and at 6-12 months after SCT. Cervical specimens were tested with Cervista. Oral, anal, and penile specimens underwent HPV PCR-based testing. Specimens that had a positive HPV result were then genotyped using the Roche Linear Array HPV test, which detects 37 HPV types including 14 HR-HPV types (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68). Results: A total of 48 eligible patients were identified, and of these, 40 (27 males, 13 females) were enrolled in the study. Median age at enrollment was 54 years (range 22-69). All 40 patients received baseline HPV testing, and 12 patients received 6-12-month follow-up testing. At baseline 9 patients had positive HR-HPV test results (22.5%, 95% CI 10.8-38.5%). In females, prevalence of HR-HPV was highest in the cervical (2/13, 15%) and anal (2/13, 15%) specimens; none tested positive for HR-HPV in oral specimens. In males, prevalence of HR-HPV was highest in the penile (4/27, 15%) and oral (3/27, 11%) specimens; none tested positive for HR-HPV in anal specimens. Of the 12 patients who had baseline and follow up testing, 2 tested positive for HR-HPV before SCT. Among these, 1 patient's testing remained positive for HR-HPV after SCT. Conclusions: The prevalence of HR-HPV infection was high in our population of SCT recipients. In females, HR-HPV positivity was most frequently seen in cervical and anal specimens, while in males HR-HPV positivity was most frequently seen in penile and oral specimens. Larger studies with longer follow up are warranted to evaluate the long-term effects of HR-HPV positivity on development of HPV-related secondary malignancies in this population.

Abstract Cervical cancer is one of the leading causes of cancer and cancer-related deaths among women worldwide. More than 85% of cases and deaths occur in the developing world where the availability of effective screening is limited. In this issue of the journal, Pierce and colleagues (beginning on page 1273) describe a novel technique using a high-resolution microendoscope (HRME) to diagnose cervical dysplasia. This perspective reviews the limitations of existing cervical cancer screening methods currently in use in low-resource settings and the potential for HRME imaging to contribute to cervical cancer prevention in the developing world. Cancer Prev Res; 5(11); 1257–9. ©2012 AACR.

OBJECTIVE:Mailed self-collection for human papillomavirus (HPV) testing can increase cervical cancer screening among underscreened women, though barriers differ by subgroup. Hispanic/Latina women, especially foreign-born, have lower screening rates than non-Hispanic white women. This study compared barriers to Papanicolaou (Pap) screening and experiences with mailed HPV self-collection among underscreened foreign-born Hispanic, US-born Hispanic, and US-born non-Hispanic women in a safety-net health system. METHODS:We analyzed survey data from a randomized trial of mailed HPV self-collection among women aged 30-65 years who were overdue for screening. Participants received an at-home kit and completed a telephone survey in English/Spanish. Barriers and experiences were compared using chi-squared tests. RESULTS:Of 256 participants, 64.1% were foreign-born Hispanic, 12.1% US-born Hispanic, and 23.8% US-born non-Hispanic. Foreign-born Hispanic women had increased prevalence of self-reported barriers to Pap screening-including discomfort with male providers, embarrassment, pain, appointment and transportation difficulties, uncertainty about screening intervals, and fear of cancer or HPV. Experiences with self-collection were similar across all groups: most participants reported a good experience, a willingness to use it again, and a willingness to recommend it. However, foreign-born Hispanic women were more likely to express concerns about proper sample collection, safety, and confidentiality. CONCLUSIONS:Barriers to traditional cervical cancer screening across several categories, including discomfort and embarrassment, lack of knowledge or healthcare access, and fear of cancer, were more prevalent among foreign-born Hispanic women than among the other groups. While experiences with self-collection were generally positive across the three groups, the prevalence of barriers was higher among foreign-born Hispanic women.

Related Article from Preventing Cervical Cancer Globally

In vivo microscopy (IVM) has shown great promise to improve early detection of epithelial precancer, but it suffers from fundamental trade-offs that limit the resolution, field-of-view (FOV) and depth-of-field (DOF). Here, we present PrecisionView, a compact, deep learning-enabled endomicroscope that breaks these constraints and achieves 20 mm 2 FOV and 500 µm DOF with 4 µm resolution, representing approximately 5× increase in FOV and 8× larger DOF compared to conventional IVM with similar resolution. PrecisionView integrates a deep learning-optimized phase mask and real-time reconstruction, enabling rapid in vivo assessment of two key hallmarks of cancer: epithelial cell nuclear morphology and subsurface microvasculature through fluorescence and reflectance imaging. By imaging the oral cavity of healthy volunteers and cervical specimens with precancerous lesions, PrecisionView generates large-scale (1 to 3 cm 2 ) coregistered maps of cellular and vascular structures, revealing distinct microscopic patterns associated with anatomic structures and precancerous lesions. Our results suggest the potential of this computational endomicroscope to address the unmet need for early cancer detection at the point of care.

In this phase II trial, patients with endometrial cancer (EC) were randomized to everolimus/letrozole with (experimental arm) or without ribociclib (control arm) (ClinicalTrials.gov Identifier: NCT03008408). The primary endpoint was progression-free survival (PFS). Secondary endpoints included toxicity, overall survival (OS), objective response rate (ORR), and clinical benefit rate (CBR). For all-comers, there was no difference in PFS (HR 0.78, 95% CI 0.4-1.4, p = 0.38), OS (HR 0.8, 95% CI 0.4-1.5, p = 0.46), ORR (44.1% vs 25.7%, p = 0.11), or toxicity-related treatment discontinuation (4 [8.6%] vs 3 [11.4%], p = 0.22). Among those with prior endocrine therapy, ORR was higher in the experimental arm (61.5% vs 0.0%, p < 0.001). Within the experimental arm, CTNNB1mut tumors were associated with improved PFS (HR 0.27, 95% CI 0.1-0.7, p = 0.006) and OS (HR 0.24, 95% CI 0.1-0.7, p = 0.004) compared to those with non-CTNNB1mut tumors. Despite no survival improvement in all-comers, addition of ribociclib to everolimus/letrozole may improve efficacy in patients with prior endocrine therapy and cases with CTNNB1mut tumors may have prolonged response. Therapeutic options for recurrent endometrial cancer (rEC) are limited. Here, the authors present a randomized phase 2 clinical trial comparing the combination of mTOR and aromatase inhibitors (everolimus and letrozole) with or without the CDK4/6 inhibitor, ribociclib, in patients with rEC.

Nearly all cervical cancer cases are caused by high-risk human papillomavirus (hrHPV) infections. The World Health Organization recommends screening for hrHPV using nucleic acid amplification tests (NAATs) that detect hrHPV DNA or mRNA. Lack of access to affordable, point-of-care screening tests in resource-limited settings leads to women presenting with advanced-stage cervical cancer, with many dying of the disease. There is a significant need to develop point-of-care NAATs to improve screening and early detection. Because access to real clinical samples is limited, initial evaluation of NAATs is often performed using contrived samples created using some combination of extracted hrHPV DNA and/or cultured hrHPV-positive cells. When mock samples do not adequately recapitulate the contents of clinical cervicovaginal samples, it can delay clinical translation of potentially promising assays. To improve the value of contrived samples, we characterized the composition of 32 hrHPV DNA-positive cervicovaginal clinical samples. We also describe a simple method to generate contrived samples that mimic the diversity of clinical cervicovaginal samples, and test them using the methods used to characterize the clinical samples. Results show that the hrHPV DNA content of cervicovaginal samples varies by approximately eight orders of magnitude and spans from 100% linear integrated DNA to 100% circular non-integrated DNA, that the concentration of hrHPV mRNA also varies by nearly nine orders of magnitude between patient samples, and that the concentration of potential inhibitors such as hemoglobin varies by more than three orders of magnitude. hrHPV DNA and mRNA extracted from contrived samples exhibited expected patterns of DNA quantity, DNA conformation, and mRNA quantity. Altogether, the protocols described here to generate mock samples can help NAAT developers optimize test performance prior to clinical evaluation, potentially improving test performance and reducing time to deployment.

Cervical cancer is the most common cancer in women in Mozambique, where limited screening infrastructure contributes to high disease burden. While testing for high-risk human papillomavirus (hrHPV) DNA can identify women at risk for cervical cancer, its limited specificity may lead to overtreatment in screen-and-treat programs, straining resources. We performed a pilot study to evaluate preliminary feasibility of a novel, accessible test to detect hrHPV mRNA, a more specific biomarker for cervical cancer risk, from 22 women who previously screened positive for visual inspection with acetic acid at Maputo Central Hospital in Mozambique. Cervicovaginal samples were analyzed for hrHPV DNA using the Xpert HPV test. RNA was extracted from samples using a benchtop spinner instead of a centrifuge. Isothermal reverse transcription recombinase polymerase amplification (RT-RPA) assays targeting HPV 16, 18, and 45 mRNA, plus a cellular control were performed on a portable fluorimeter with results compared to the gold standard portable reverse transcription quantitative polymerase chain reaction (RT-qPCR). Cervical biopsies were obtained and submitted for histopathologic analysis. RT-RPA and RT-qPCR results were in 100

Background Cervical cancer is a public health problem in Latin America and the Caribbean (LAC). The Cervical Cancer Elimination strategy sets three targets (90% HPV vaccination, 70% screening, 90% treatment) for countries to be in the path towards elimination. This study provides an overview of the current status of cervical cancer control in LAC, highlighting opportunities and challenges for cervical cancer elimination. Methods We conducted a descriptive analysis of the cervical cancer control status in LAC, using an online questionnaire completed by delegates from health authorities of 35 countries/territories. Findings We found marked advances in the development of national plans and cervical cancer elimination strategies, particularly in Latin America. Caribbean countries and territories face barriers in program organization and human resource provision. While HPV vaccination is systematically monitored, surveillance systems for screening and treatment are limited, reducing the ability to track program performance and progress. Transition to HPV testing is ongoing, but ensuring adequate funding and management of screen-positive females remain challenging. Gaps in histopathology and treatment —especially radiotherapy— are most pronounced in the Caribbean. Interpretation Regional collaboration, resource mobilization, and investment in information systems and workforce capacity are essential to achieve equitable access to cervical cancer prevention and care. This analysis provides a baseline to guide future studies to support LAC countries in achieving the 90-70-90 targets. Funding Work funded by the Spanish Agency for International Development Cooperation (AECID) and Gavi, the Vaccine Alliance.

Breast cancer (BC) is the most common cancer diagnosed in women worldwide, and a leading cause of cancer-related death in low-and-middle income countries. Lack of organized screening programs contribute to late-stage diagnosis and worse outcomes. Integrating breast and cervical cancer screening may offer a feasible approach to improving early BC detection in resource-limited settings. We developed an integrated breast and cervical cancer early detection workshop for healthcare providers already engaged in cervical cancer screening. This study aims to evaluate the impact of these workshops on participants’ confidence in performing clinical breast exams (CBEs) and recommending appropriate BC screening. A 1-day workshop was delivered to healthcare providers from Zambia and Indonesia. Didactics were focused on recognizing BC symptoms and basic clinical management. The hands-on session included CBEs using a low-cost breast model. Participants completed a survey after the course which assessed current BC screening practices, feasibility of integrated screening, and confidence in performing and recommending CBEs. Fisher’s exact test was used to compare differences between Indonesia and Zambia survey responses. There were 77 Zambian and 38 Indonesian participants; 44.1% of Zambian and 50% of Indonesian participants completed the survey. 54.7% of participants had never attended an integrated screening workshop and 43.4% did not consistently discuss BC screening with patients. After the workshop, most participants reported increased confidence in recommending appropriate BC screening (66.0%) and performing CBEs (84.9%). Zambian participants were significantly more likely than Indonesian participants to report increased confidence in recommending BC screening (79.4% vs. 42.1%, p=0.01). There were no significant differences in barriers faced in recommending BC screening to patients, which included lack of time, patient’s lack of awareness or fear about screening, provider’s lack of knowledge about screening, and insurance issues. The integrated workshop was effective in improving participants’ confidence in recommending appropriate BC screening and performing CBEs. This highlights the value of training programs to strengthen provider capacity for cancer detection in low-resource settings. Future directions may include wider dissemination of the workshop and refresher courses for providers who have already participated. Srivarshini C. Mohan, Min Yi, Melissa Varon, Reina Guerrero, Toma S. Omofoye, Bayu Brahma, Kabisa Mwala, Kathleen Schmeler, Ana Paula Correa Refinetti. Impact of Breast Cancer Screening Workshops in Indonesia and Zambia [abstract]. In: Proceedings of the 13th Annual Symposium on Global Cancer Research; 2025 Sep 16. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(12_Suppl):Abstract nr 76.

Background Cervical cancer is preventable by following guidelines for vaccination, screening, diagnosis and treatment of preinvasive cervical lesions. We implemented a multicomponent intervention to increase rates of colposcopy after abnormal screening results in three clinic systems in the Rio Grande Valley, along the Texas-Mexico border. The goal of this study was to assess the outcomes of this program including participation in colposcopy within 90 days of screening for women with abnormal screening results, and the time between screening and colposcopy appointments during the first year (Year 1/baseline) and subsequent years (Years 2 through 4) of program implementation. Methods We performed a retrospective cohort analysis of medical records of clinics participating in the program. We utilized multiple logistic regression and linear regression to assess the colposcopic outcomes of women with indication for colposcopy. Results A total of 1556 of the 14,846 (10.5 %) women who had undergone cervical cancer screening had abnormal results and met the criteria to be referred for colposcopy. There was a significant increase in the proportion of women who underwent colposcopy (within 90 days of screening) from Year 1/baseline (82.7 %) to Year 2 (90.6 %), OR= 1.65, p-value< 0.05. Similarly, the mean interval from screening to colposcopy decreased significantly from baseline (79 days) to Year 2 (49 days), to Years 3 and 4 (40 and 41 days, respectively), p < 0.001. Conclusions Our results suggest that multicomponent interventions can improve and sustain appropriate and timely colposcopy among women in medically underserved regions, improving cervical cancer prevention efforts in resource-limited settings.

There are limited data on the effectiveness of mailed self-collection to increase cervical cancer screening (CCS) participation in underresourced health care settings. To compare the effectiveness of mailed self-collection kits, with and without patient navigation, to telephone reminders to increase CCS in a safety-net health system. This pragmatic, parallel, single-blinded, randomized clinical trial within a publicly funded safety-net health system in Houston, Texas, compared (1) telephone reminder (TR) for clinic-based screening, (2) TR with mailed self-collection (SC), and (3) TR with mailed SC and patient navigation among a random sample of CCS-eligible patients not up to date with CCS, including those with no CCS on record. The trial was conducted from February 20, 2020, to August 31, 2023. All groups received a TR by a patient navigator to attend clinic-based CCS. In the SC and SC with patient navigation groups, participants were additionally mailed a self-collection kit to their home as an alternative to clinic-based CCS. In the SC with patient navigation group, the mailed kit was followed by a patient navigation telephone call. CCS participation was defined as attendance for clinic-based screening or return of a mailed self-collection kit within 6 months of randomization and determined through electronic health record review. Of the 2474 participants in the intent-to-screen analyses (median [IQR] age, 49 [39-57] years), 2325 (94.0%) were from racial or ethnic minoritized populations (1655 [66.9%] identifying as Hispanic or Latino, 82 [3.3%] as non-Hispanic Asian, 535 [21.6%] as non-Hispanic Black or African American, and 53 [2.1%] as other or unknown race, including American Indian or Alaska Native and Native Hawaiian or Other Pacific Islander), and 1388 (56.1%) were covered by the county’s publicly funded financial assistance program. At 6 months, 144 of 828 participants (17.4%) in the TR group, 340 of 828 (41.1%) in the SC group, and 381 of 818 (46.6%) in the SC with patient navigation group had participated in CCS. Compared to TR, relative participation was 2.36 (95% CI, 1.99-2.80) times higher for SC and 2.68 (95% CI, 2.27-3.16) times higher for SC with patient navigation; screening difference was 23.7% (95% CI, 19.4%-27.9%) for SC and 29.2% (95% CI, 24.9%-33.5%) for SC with patient navigation. In this randomized clinical trial in a safety-net health system, SC was effective for increasing CCS participation among underscreened patients; there were modest additional gains from SC with patient navigation. The large increase in CCS participation using SC compared to TR suggest that SC should be considered in safety-net settings with suboptimal CCS coverage. ClinicalTrials.gov Identifier: NCT03898167

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.

Background:Zambia faces the double burden of rising cancer incidence and a disproportionate volume of mortality from delayed presentations. The Ministry of Health Zambia acknowledged cancer research as a key pillar of cancer control in the National Cancer Control Strategic Plan 2022-2026, but there remains a paucity of country-specific evidence to inform strategies, implementation, monitoring and evaluation of research activities. Our study aimed to map and critically analyse the existing cancer research landscape to inform national planning. Methods:We adopted a two-stage mixed-method research. First, we conducted a systematic review, including 76 Zambian cancer studies published between 2012 and 2022, adhering to PRISMA guidance. Second, we conducted an in-person modified consensus meeting in Ndola, Zambia attended by 31 domestic and international stakeholders, to co-develop priorities and strategies based on gaps and facilitators identified through the systematic review. Results:The year-on-year cancer research output in Zambia had risen and diversified beyond cervical cancer but prevention, palliative care and health economic studies were lacking. Delay in deciding to seek care was most studied (n = 17, 63.0%), especially in cervical cancer. Research activities were mostly retrospective (n = 47/76, 61.8%) with only one randomised controlled trial identified. Greater than 90% (n = 10/11, 90.9%) of the most prolific research funders were international, predominantly from the United States and the United Kingdom, and Zambian researchers were under-represented as first and last authors at 43% (n = 33/76) and 45% (n = 34/76), respectively. The existing national cervical cancer registry, active global collaboration and adoption of technology were facilitators to be leveraged to build research capacity through multi-level, stakeholder-specific strategies. Conclusion:To strengthen research capacity, sustained commitment to priorities through the implementation of co-developed strategies is required at individual, organisational and institutional levels. This paradigm shift is necessary to deliver evidence-based cancer care tailored to the needs of Zambians with emphasis on value and quality.