Cervical Cancer Prophylaxis—State-of-the-Art and Perspectives

Abstract

Background: Each year 604,127 new cases of cervical cancer (CC) are diagnosed, and 341,831 individuals die from the disease. It is the fourth most common cancer among women and the fourth most common cause of death from female cancers worldwide. The pathogenesis of CC is associated with human papillomavirus (HPV) infections and consists of several steps involving cell proliferation outside the human body’s control mechanisms. Strategies to prevent CC are based on screening and vaccination. Scope of the Review: The aim of this paper was to collect and analyze the available literature on the issue of CC prevention and the impact of the COVID-19 pandemic on its implementation. For this purpose, PubMed and Google Scholar databases were searched using keywords, such as “cervical cancer”; “HPV”; “prevention”; “prophylaxis”; “vaccination”; “screening” and “COVID-19” in different variations. Only articles published since 2018 were included in the study. Conclusions: Selected European countries have different CC prevention programs funded by national budgets. This translates into observed differences in the risk of death from CC (age-standardized rate Malta = 1.1, Poland = 5.9). COVID-19 pandemic due to disruption of CC screening may exacerbate these differences in the future. To improve the situation, new screening methods, such as p16/Ki67, HPV self-testing, and the use of artificial intelligence in colposcopic assessment, should be disseminated, as well as free HPV vaccination programs implemented in all countries. The search for new solutions is not without significance and entails ultra-sensitive screening tests for risk groups (mRNA E6/E7, SOX1/SOX14), HPV vaccines with shorter dosing schedules, and new therapeutic pathways using nanotheranostics.

Cervical Cancer Prevention and Treatment Needs among Hispanic Women Living on the US-Mexico Border

“…In order to increase the number of people who get screened and the number of timely cervical cancer diagnoses, researchers suggest the expansion of surveillance systems; using reminder mechanisms; and developing community-based, culturally tailored intervention programs including health education campaigns and home visits (Bruni et al, 2022; Desai et al, 2022; Makadzange et al, 2022; Silvera et al, 2022; Suk et al, 2022; Zeno et al, 2022). They also recommend transitioning to using HPV-research-based screening (specifically DNA detection) rather than the Pap test because it is more cost-effective, can be self-collected, and allows high-grade persistent lesions to be identified earlier (ACS, 2023; Cascardi et al, 2022; Desai et al, 2022; Makadzange et al, 2022; Poniewierza & Panek, 2022; Ramos-Pibernus et al, 2021; Wood et al, 2018). Researchers encourage national/government funding of cervical cancer prevention programs (Poniewierza & Panek, 2022).…”

“…They also recommend transitioning to using HPV-research-based screening (specifically DNA detection) rather than the Pap test because it is more cost-effective, can be self-collected, and allows high-grade persistent lesions to be identified earlier (ACS, 2023; Cascardi et al, 2022; Desai et al, 2022; Makadzange et al, 2022; Poniewierza & Panek, 2022; Ramos-Pibernus et al, 2021; Wood et al, 2018). Researchers encourage national/government funding of cervical cancer prevention programs (Poniewierza & Panek, 2022). Overall, the importance of making the elimination of cervical cancer an agenda is stressed (Bruni et al, 2022; Desai et al, 2022; Giuliano, 2023).…”

Advances on Prevention and Screening of Gynecologic Tumors: Are We Stepping Forward?

“…There are three approaches used to manage cancers, based on the concept of primary, secondary, and tertiary prevention. The primary prevention approach focuses on preventing disease before it develops (i.e., prophylactic treatment); secondary prevention attempts to detect the disease as early as possible (i.e., early detection); and tertiary prevention is directed at managing a present disease (i.e., treatment) [ 6 , 7 , 8 , 9 ].…”

“…Cross protection against other HPV types, not included in the vaccine, is shown only in vaccines that have the adjuvant substance 04 (AS04) [ 6 , 7 ]. Accumulating evidence suggests that the adoption of the vaccines resulted in a significant decrease in HPV infection, HPV lesions, and cervical cancer [ 6 , 7 , 8 , 9 ]. In particular, the most recent Cochrane systematic review about the topic clarified that both nonavalent and quadrivalent vaccines offer similar protection against a combined outcome of cervical, vaginal, and vulval precancer lesions or cancer [ 10 ].…”

“…Moreover, mobile health interventions effectively improve cancer screening rates in the general population, but they are necessary for the poorest countries. New screening methods, such as p16/Ki67 [ 11 ], HPV self-testing, and the use of artificial intelligence in colposcopic assessment, should be disseminated [ 7 , 8 ]. It is useful to focus on precancerous lesions in order to create tools for women regarding their risk of persistence/recurrence after primary conization and identify categories at higher risk compared with the other ones [ 9 ].…”