Open research questions in Cervical Cancer and HPV Research

What the literature leaves open

• The strength of our study is that it is one of few studies on the prevalence of cervical HPV infections and cytological changes in asymptomatic WLWH in Ethiopia.

  Prevalence of cervical human papillomavirus infections and cytological abnormalities in asymptomatic women living with HIV in Addis Ababa, Ethiopia · 2026 · DOI

• 4 HPV burden in the head and neck The last evaluation of the International Agency for Research in Cancer (IARC) on the carcinogenicity of HPV in humans concluded that (a) there is enough evidence for the carcinogenicity of HPV type 16 in the oral cavity, oropharynx (including tonsil cancer, base of tongue cancer and other oropharyngeal can- cer sites), and (b) limited evidence for laryngeal cancer (IARC Monograph Vol 100B).

  Risk behaviours and level of knowledge as contributing factors to cervical screening among tertiary institutions in North Central Nigeria · 2026 · DOI

• Another limitation of this study is that it did not examine men's awareness of the role of HPV infection in the development of cervical cancer, their potential to carry HPV during transmission, and their awareness of HPV vaccination. Another limitation of this study is that the spousal support behavior was evaluated as a binary variable.

  Determining the relationship between men’s eHealth literacy levels, their beliefs about cervical cancer, and their spousal support for screening · 2026 · DOI

• Another limitation of this study is that it did not examine men's awareness of the role of HPV infection in the development of cervical cancer, their potential to carry HPV during transmission, and their awareness of HPV vaccination. Another limitation of this study is that the spousal support behavior was evaluated as a binary variable.

  Determining the relationship between men’s eHealth literacy levels, their beliefs about cervical cancer, and their spousal support for screening · 2026 · DOI

• an scale-up. Second, follow HPVimplementation-effectiveness study should positive women—especially the triage-negative group— through to documented treatment and, ideally, to incidentcancer outcomes, converting the present diagnostic evidence into the effectiveness evidence a program requires. Third, a cost-effectiveness analysis, formal budget-impact and parameterized with local colposcopy and ablation costs, should quantify the economic value of the conserved referral capacity demonstrated here. Together these studies would establish whether a decentralized, AI-assisted, telemedicine pathway can move from a promising single-province result to a dependable instrument of cervical-cancer elimination in archipelagic and other geographically isolated settings.

  Deep learning-assisted digital VIA via telemedicine and HPV self-sampling for CIN2+ detection in remote archipelago women: a prospective diagnostic accuracy study · 2026 · DOI

• Future research should focus on integrating HPV vaccination records with cervical cancer screening data to provide a more comprehensive understanding of prevention strate- gies and their combined effectiveness in reducing disease burden.

  Effect of Organized Cervical Cancer Screening Programs on Incidence and Mortality: A Systematic Review and Meta-analysis · 2026 · DOI

• Whether these differences reflect distinct modes of action of the respective virus proteins remains to be investigated. We chose PA2G4 (EBP1) for functional validation of our findings, in view of conflicting reports in the litera- ture concerning its significance in cancer.

  Quantitative assessment of STAT3 and HPV16 E6 transcripts using Flow-FISH approach for early detection of progressive cervical lesions · 2026 · DOI

• Although recent changes to the classification of VSCC categorized the disease into: HPVa, HPVi p53 abnormal (abn), HPVi p53 wild-type (wt), the molecular underpinnings of each subtype and its corresponding VIN remains unknown.

  Abstract B020: Evaluating copy number changes of chromosomally unstable vulvar squamous cell carcinoma and vulvar intraepithelial neoplasia lesions · 2026 · DOI

• (1) Note. X2 = Pearson chi-square statistic; df = degrees of freedom; V = Cramer’s V. * p < 0.10. ** p < 0.05. *** p < 0.001 Knowledge Levels Regarding HPV and Cervical Cancer by College of Enrollment The distribution of knowledge levels varied significantly across academic colleges, as illustrated in Figure 2. Students in the College of Agriculture and Natural Sciences reported the highest knowledge score (58.8%), followed closely by those in the College of Health and Allied Sciences (54.5%). Conversely, students in the Humanities and Legal Studies college exhibited the lowest proportion of good knowledge (44.4%). These descriptive findings support the bivariate analysis, which confirmed that college enrollment is a significant factor in determining students' awareness of HPV and cervical cancer, (X2 (3) = 7.86, p =.049). Figure 2.

  Assessment of Knowledge and Attitudes Toward HPV, Cervical Cancer, and Vaccination Barriers among Undergraduates in Ghana: A Cross-Sectional Study · 2026 · DOI

• ARTICLE IN PRESS ARTICLE IN PRESS ACCEPTED MANUSCRIPT Strengthen vaccine supply chain management and cold-chain systems to ensure uninterrupted vaccine availability. ￿ Address healthcare workforce shortages through recruitment, capacity building, supportive supervision, and staff motivation strategies. ￿ Expand outreach and school-community vaccination strategies to reach out-of-school girls and underserved populations. ￿ Enhance community awareness through targeted health education involving local leaders, teachers, religious leaders, and community- based organizations to address misconceptions and improve vaccine acceptance. ￿ Strengthen monitoring and evaluation systems to improve tracking of HPV vaccine uptake and completion rates.

  Bridging the service gap: health facility challenges in HPV vaccine uptake in rural Uganda · 2026 · DOI

• A major strength of this study is the mixed-methods design, which allowed triangulation of quantitative and qualitative findings and provided a comprehensive understanding of HPV vaccine completion barriers. Inclusion of caregivers, healthcare workers, and Village Health Team members enhanced the depth and credibility of findings. However, the cross-sectional design limits causal inference between identified factors and HPV vaccine completion. Additionally, reliance on caregiver self-report may introduce recall bias. The study was conducted in a single rural district, which may limit generalisability to other settings. Despite these limitations, the findings provide important evidence to guide HPV vaccination programme strengthening in similar rural contexts.

  Bridging the service gap: health facility challenges in HPV vaccine uptake in rural Uganda · 2026 · DOI

• Based on these results, it is imperative to incorporate health education for cervical cancer into the wellness programs at the university. Patients should also be advised about pap tests and HPV vaccines in their routine care with the health care provider, rather than when they have symptoms. Public health interventions to eradicate cervical cancer will require more than awareness about literacy, but rather targeted and actionable health messages in Pakistan.

  Assessing Knowledge, Awareness, and Attitudes Toward Cervical Cancer and Screening Among Women: A Descriptive Study · 2026 · DOI

• One benefit of this study was the use of an urban, educated population as a ‘best-case scenario' for the country in terms of health literacy. The use of the simple random sampling method reduced the selection bias and gave a fair selection of the subjects. But the fact is that the awareness among the general and less educated populace of Lahore can be even lower than what is seen here, because the study was conducted based on English literacy. RECOMMENDATIONS Based on these results, it is imperative to incorporate health education for cervical cancer into the wellness programs at the university. Patients should also be advised about pap tests and HPV vaccines in their routine care with the health care provider, rather than when they have symptoms. Public health interventions to eradicate cervical cancer will require more than awareness about literacy, but rather targeted and actionable health messages in Pakistan.

  Assessing Knowledge, Awareness, and Attitudes Toward Cervical Cancer and Screening Among Women: A Descriptive Study · 2026 · DOI

• Most published evidence focuses on female adolescents and on cervical cancer; the perception of the HPV vaccine in university-age populations of both sexes--and across the broader spectrum of HPV-attributable disease--remains comparatively understudied.

  Biopsychosocial determinants of HPV vaccine perception in university students of both sexes in Cucuta, Colombia, 2024: a cross-sectional study · 2026 · DOI

• To our best knowledge, this is the first time a non-targeted nationwide cervical screening intervention in Ghana has been systematically evaluated and documented. This study has several notable strengths. Its large-scale and nationwide reach, encompassing all 16 regions of Ghana, provides valuable data on the implementation of cervical screening across diverse settings within the country. The use of hr-HPV DNA testing aligns with current international best practices and WHO rec- ommendations, and relying on HWs trained through the standardized, comprehensive CCPTC curriculum likely enhanced the consistency of screening procedures compared to programs with less structured training. Although the model required central laboratory HPV testing and thermal-ablation equipment, it leveraged existing CCPTC alumni infrastructure and ubiquitous mobile technology for telementoring, rendering it more feasible for scale-up than parallel vertical programmes. Ghana’s current opportunistic VIA/Pap strategy can be incrementally strengthened by embedding this alumni-driven concurrent-testing approach within routine services, thereby addressing the critical human-resource and equipment gaps identified in the 2014 policy [4]. PLOS One | https://doi.org/10.1371/journal.pone.0350573 June 26, 2026 14 / 18 Together with prior small-scale studies, our findings support a shift toward HPV screening complemented by VIA triage in resource-limited settings. The high prevalence of diverse hr-HPV types highlights the need for broad-coverage HPV tests and eventual adoption of vaccines covering non-16/18 genotypes. The demonstrated feasibility of leveraging existing postal networks for specimen transport and mobile telementoring for quality assurance provides a pragmatic blueprint for national programs aiming to meet WHO cervical cancer elimination targets. Policymakers should consider integrating this hub-and- spoke approach into routine health services, investing in decentralized laboratory capacity or sustained postal partnerships, and scaling up workforce training and digital mentorship to close the cervical cancer equity gap across sub-Saharan Africa. However, the study also has several limitations. A major limitation is the lack of histological confirmation for the vast majority of participants; VIA ‘positivity’ was used as a subjective surrogate endpoint together with HPV DNA testing. Second, there is the potential for selection bias, as the participants were women who voluntarily presented for screening, who may differ from the general eligible population in Ghana, potentially being more health-conscious or educated, which could affect the generalizability of findings like hr-HPV prevalence. Third, we relied on self-reported data for variables such as HIV status, smoking history, and prior clinical history (which introduces potential recall or social desirability bias) and a high proportion of women had unknown HIV status. Fourth, despite standardized training, the inherent subjectivity of VIA interpretation and TZ classification could lead to inter-observer variability among HWs across the 29 sites [37], although telementoring aimed to mitigate this. Finally, the acknowledged absence of an a priori sample size calculation means that the statistical power for certain secondary analyses, such as subgroup comparisons or multivariable modeling, might be limited, although the overall sample size is substantial for a descriptive report of the screening program.

  A collaborative cervical precancer screening strategy with concurrent HPV genotyping and visual inspection using alumni of a training centre across Ghana: The Rotary ‘Protect Your Pearl’ initiative · 2026 · DOI

• Moreover, societal attention regarding the risk of HPV infection in men is scarce, leading to com- placency among them, as they may perceive themselves as unlikely to contract the virus (32, 34).

  HPV vaccine hesitancy among Chinese adults and its influencing factors in the context of improved vaccine accessibility · 2026 · DOI

• Although coinfections with multiple HPV types are common, it remains unclear whether certain genotypes tend to associate preferentially or whether these associations occur randomly.

  Associations between high-risk human papillomavirus genotypes: evidence of HPV16 predominance as a monoinfection and its no stronger link with high-grade lesions · 2026 · DOI

• Conclusions: Selected imaging features may help distinguish HPV(+) from HPV(−) OPSCC, but current evidence remains insufficient for reliable standalone clinical application.

  Radiological Features of Human Papillomavirus (HPV)-Positive and HPV-Negative Oropharyngeal Squamous Cell Carcinoma (OPSCC)—Considerations for Multimodal Analysis · 2026 · DOI

• We reviewed the literature on radiological differences between HPV-positive and HPV-negative OPSCC across ultrasound, CT, MRI, and PET-CT as this appears to be a critical gap in the literature.

  Radiological Features of Human Papillomavirus (HPV)-Positive and HPV-Negative Oropharyngeal Squamous Cell Carcinoma (OPSCC)—Considerations for Multimodal Analysis · 2026 · DOI

• Abstract The MYB-related transcription factor and partner of profilin (MYPOP or p42POP) is a ubiquitously expressed yet understudied protein recently identified as a restriction factor of oncogenic human papillomaviruses (HPV) and proposed tumor suppressor.

  The MYB-related transcription factor MYPOP acts as a selective regulator of cancer cell growth · 2026 · DOI

• Future research should focus on prospective multicenter validation with stan- dardized protocols and explore multi-biomarker approaches to improve 181 sensitivity while maintaining specificity.

  Diagnostic accuracy of HPV DNA in oral gargle and rinse samples for Head and neck squamous cell carcinoma: A systematic review and meta-analysis · 2026 · DOI

• inherently precludes warrant acknowledgement in the interpretation of these findings. The relatively modest sample size (n = 50) and the purposive, single-site sampling methodology limit the generalisability of these results to the broader Bangladeshi adolescent population and preclude multivariable regression modelling, which would have permitted more granular exploration of independent predictors of knowledge. The cross- sectional design causal inference. Social desirability bias cannot be entirely excluded given the self-reported nature of the data. The absence of previously validated, population- specific instruments for this setting necessitated adaptation of existing tools, introducing potential measurement variability. Notwithstanding these limitations, this investigation offers several notable methodological and contextual strengths. The study addresses a well-defined evidence gap: government secondary semi-urban Bangladesh represent an underserved research context in the HPV vaccine literature. The 100% response rate minimises non-response bias. The application of alongside three-tier knowledge granular, domain-specific categorisation provides analysis schools in Asia Pacific Journal of Cancer Research 10 Parvin et al.; Asia Pac J Cancer Res; Jan-Mar 2026; 3(1): 1-13 actionable data. The inclusion of sensitivity analyses enhances the robustness of the primary chi-square findings. Finally, the study's grounding in the Health Belief Model provides a theoretically coherent framework for interpreting behavioural correlates of knowledge.

  Knowledge Regarding Cervical Cancer Vaccination Among Adolescent Girls · 2026 · DOI

• This study conducted a structured, multi-dimensional bibliometric survey using the WoSCC and Scopus databases. While the dual-source complementary strategy enhanced the robustness of the results, reliance solely on commercial indexing databases inevitably excluded certain grey literature and non-English local journals. Given that high- burden regions for HIV and cervical cancer are primarily located in sub-Saharan Africa and Latin America, restricting the language to English may have led to the omission of regionally significant studies. In addition to data coverage concerns, the country-level collab- oration analysis in this study was based on the national affiliations TABLE 8 Antiretroviral therapy and chemotherapy drug interactions and toxicities.

  Global research trends and hotspots in human immunodeficiency virus-associated cervical cancer (1990–2025): a multi-database bibliometric analysis · 2026 · DOI

• While this pilot study offers meaningful insights into the health beliefs influencing cervical cancer screening intention among the lower socioeconomic group women in Malaysia, the limitations should be acknowledged. As a pilot study, aimed to examine and explore the preliminary relevance of Health Belief Model and instru- ment validity, the sample size was small and participants were recruited using convenience sampling. Importantly, as recruitment was conducted within the Klang Valley, the sample may be more reflective of the urban B40 population from which it was drawn for the pilot study and may not fully represent the broader B40 population across different settings. Therefore, the findings may not be fully rep- resentative of all B40 women in Malaysia and may be subject to selec- tion bias. These factors limit the generalizability of the results and the findings observed should be interpreted as preliminary rather than definitive. Nevertheless, the aim of this pilot was to gain preliminary insights into predictors of screening intention rather than to achieve generalizability. Despite this limitation, the study has its strength. It provides an early application of the Health Belief Model in assessing cervical cancer screening intention among Malaysian women, offering practical insights into how theoretical constructs translate in a local context. This contributes valuable groundwork for refining the instru- ment and informing the design of a larger, adequately powered study.

  Health belief model and cervical cancer screening intention among lower socioeconomic women in Malaysia: a pilot study · 2026 · DOI

• The interpretation of our findings should be considered in light of several limitations. First, the retrospective and crosssectional design, combined with data collection from a single tertiary referral center, introduces a selection bias. Our results reflect the profile of a high-risk cohort attending a specific institution, and causal inferences cannot be established. Second, due to the retrospective nature of the analysis, data on confounding variables (such as HPV vaccination status, smoking, and detailed sexual history) were not consistently available and could not be included in the statistical models. Specifically, the lack of vaccination status information prevents us from accurately assessing the impact of the 2008 national program on current HPV prevalence and genotype distribution, particularly among the younger cohorts. This absence likely leads to an overestimation of the HPV prevalence in vaccinated populations and should be taken into account during interpretation. This lack of control may influence the observed associations. Third, while our sample size (n = 7,601) is large, its retrospective derivation means that we did not perform a priori sample size calculation. However, the size is considered highly adequate to detect meaningful differences in prevalence and associations, ensuring high statistical power. Fourth, the exclusion of nondiagnostic records, such as those labeled with “inflammation” or “cervical atrophy” [Figure 1], while necessary to maintain the analytic focus on squamous intraepithelial lesions, may have introduced a small selection bias by excluding data potentially related to specific HPV types or age-related immunological status. Stamoulis et al.: HPV prevalence and correlates in Greek women SUMMARY This retrospective study successfully met its objective of defining the prevalence, genotype distribution, and clinical correlates of HPV infection burden within this specific Greek tertiary care cohort. Our findings confirmed a high overall HPV prevalence of 31% and established a clear burden– response relationship, as multiple infections were significantly associated with the highest Odds for low-grade lesions, particularly among younger women. While the highest risks for HSIL were concentrated among the established oncogenic types (HPV-16, -18, and -33), our analysis also demonstrated significant associations of the low-risk HPV-42 with LSIL and of the non-vaccine-covered HPV-51 genotype with both ASC-US and LSIL. These comprehensive results reinforce the clinical necessity of genotype and infection burden profiling for accurate risk stratification and underscore the critical need for continued age-stratified screening and localized genotype surveillance to inform future prophylactic strategies in Greece. AVAILABILITY OF DATA AND MATERIALS An anonymized version of the dataset analyzed during the current study is available from the corresponding author upon reasonable request.

  Prevalence and clinical correlates of human papillomavirus infection: A study of 7,601 women attending a tertiary referral center in Greece · 2026 · DOI

Most-cited papers in Cervical Cancer and HPV Research

• Epidemiologic Classification of Human Papillomavirus Types Associated with Cervical Cancer · New England Journal of Medicine · 2003 · 4,746 citations
• Natural History of Cervicovaginal Papillomavirus Infection in Young Women · New England Journal of Medicine · 1998 · 1,815 citations
• HPV vaccination introduction worldwide and WHO and UNICEF estimates of national HPV immunization coverage 2010–2019 · Preventive Medicine · 2020 · 646 citations
• Low etiologic fraction for high-risk human papillomavirus in oral cavity squamous cell carcinomas · Oral Oncology · 2012 · 290 citations
• Worldwide use of HPV self-sampling for cervical cancer screening · Preventive Medicine · 2021 · 264 citations
• Determinants of Clearance of Human Papillomavirus Infections in Colombian Women with Normal Cytology: A Population-based, 5-Year Follow-up Study · American Journal of Epidemiology · 2003 · 226 citations
• Human Papillomavirus Infections in Children: the Potential Role of Maternal Transmission · Critical Reviews in Oral Biology & Medicine · 2000 · 178 citations
• Cervical cancer screening in the United States: Challenges and potential solutions for underscreened groups · Preventive Medicine · 2020 · 174 citations
• Cervical cancer screening uptake in Sub-Saharan Africa: a systematic review and meta-analysis · Public Health · 2021 · 168 citations
• Impact of COVID-19 on Cervical Cancer Screening Rates Among Women Aged 21–65 Years in a Large Integrated Health Care System — Southern California, January 1–September 30, 2019, and January 1–September 30, 2020 · MMWR Morbidity and Mortality Weekly Report · 2021 · 138 citations

Most recent work

• Comparative effectiveness and safety of pharmacological treatments for rapid tranquilisation in emergency settings: a systematic review and individual participant data network meta-analysis · The Lancet Psychiatry · 2026
• Diagnostic accuracy of HPV DNA in oral gargle and rinse samples for Head and neck squamous cell carcinoma: A systematic review and meta-analysis · Japanese Dental Science Review · 2026
• Integrating active surveillance and HPV vaccination for high-risk CIN2: a strategy to reduce disease progression · Frontiers in Medicine · 2026
• Effectiveness analysis and clinical application potential exploration of combined detection of PAX1/JAM3 gene methylation in early diagnosis of cervical precancerous lesions · Clinical Epigenetics · 2026
• Parental knowledge, attitudes, and hesitancy toward human papillomavirus vaccination in Saudi Arabia: an online cross-sectional study · Frontiers in Medicine · 2026
• Facilitators and Barriers to The Access and Utilization of Cervical Cancer Health Services Among Child-Bearing Women in Lusaka District, Zambia · Journal of Global Health and Social Medicine · 2026
• Escape room-based learning for HPV vaccine education in Japanese female university students: a controlled, three-group study · Scientific Reports · 2026
• Modelling the epidemic dynamics of HPV among women in China and optimization of ongoing cervical cancer elimination strategies · BMC Medicine · 2026
• REBACIN® can remove high-risk Human Papillomavirus (HPV) persistent infection efficiently as an effective non-invasive treatment: a multicenter prospective study · World Journal of Surgical Oncology · 2026
• Human papillomavirus vaccination status among the urban and rural married women of Bangladesh: An analytical cross-sectional study · Preventive Medicine Reports · 2026

Related topics in Medicine