Obstet Gynecol Sci.  2025 Jan;68(1):30-42. 10.5468/ogs.24226.

Decoding impact of human papillomavirus in gynecological oncology: a narrative review

• Sarker MS
• Pervez MM

• KMID: 2563936
• DOI: http://doi.org/10.5468/ogs.24226

Abstract

Human papillomavirus (HPV) is a key factor in gynecological oncology. This narrative review investigates the complex connection between HPV and various gynecological cancers. For a comprehensive exploration, we examined the association between persistent HPV infection and cervical cancer and its global prevalence. Beyond the cervix, we navigated the linkages between HPV and other gynecological malignancies, shedding light on vulvar, vaginal, anal, and oropharyngeal cancers. The narrative extends to discuss the critical role of HPV vaccination in preventing these cancers and exploring challenges, controversies, and future perspectives in the field. As we have described the impact of HPV, this review underscores the significance of ongoing research and public health endeavors in shaping the trajectory of gynecological oncology.

Keyword

Human papillomavirus infections; Cervical cancer; Genital neoplasms

Reference

References

1. Nygård M, Hansen BT, Dillner J, Munk C, Oddsson K, Tryggvadottir L, et al. Targeting human papillomavirus to reduce the burden of cervical, vulvar and vaginal cancer and pre-invasive neoplasia: establishing the baseline for surveillance. PLoS One. 20145; 9:e88323.

2. Chaturvedi AK. Beyond cervical cancer: burden of other HPV-related cancers among men and women. J Adolesc Health. 2010; 46:S20–6.

3. Khan A, Abonyi S, Neudorf C. Barriers and facilitators in uptake of human papillomavirus vaccine across English Canada: a review. Hum Vaccin Immunother. 2023; 19:2176640.

4. Carmichael JA, Maskens PD. Cervical dysplasia and human papillomavirus. Am J Obstet Gynecol. 1989; 160:916–8.

5. Mrklas KJ, MacDonald S, Shea-Budgell MA, Bedingfield N, Ganshorn H, Glaze S, et al. Barriers, supports, and effective interventions for uptake of human papilloma-virus- and other vaccines within global and Canadian Indigenous peoples: a systematic review protocol. Syst Rev. 2018; 7:40.

6. Deak P. What I tell every patient about the HPV vaccine [Internet]. Washington (DC): American College of Obstetrics and Gynecology;c2024. [cited 2025 Jan 10]. Available from: https://www.acog.org/womens-health/experts-and-stories/the-latest/what-i-tell-every-patient-about-the-hpv-vaccine.

7. Shapiro GK. HPV vaccination: an underused strategy for the prevention of cancer. Curr Oncol. 2022; 29:3780–92.

8. World Health Organization. WHO guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention: use of dual-stain cytology to triage women after a positive test for human papillomavirus (HPV): web annex C: evidence-to-decision framework for dual-stain cytology to triage women after a positive test for human papillomavirus (HPV) [Internet]. Geneva: World Health Organization;c2024. [cited 2024 Aug 13]. Available from: http://dx.doi.org/10.2471/b09020.

9. Soheili M, Keyvani H, Soheili M, Nasseri S. Human papilloma virus: a review study of epidemiology, carcinogenesis, diagnostic methods, and treatment of all HPV-related cancers. Med J Islam Repub Iran. 2021; 35:65.

10. Liaw KL, Hildesheim A, Burk RD, Gravitt P, Wacholder S, Manos MM, et al. A prospective study of human papillomavirus (HPV) type 16 DNA detection by polymerase chain reaction and its association with acquisition and persistence of other HPV types. J Infect Dis. 2001; 183:8–15.

11. Centers for Disease Control and Prevention. Chapter 11: human papillomavirus [Internet]. Atlanta (GA): Centers for Disease Control and Prevention;c2024. [cited 2024 Oct 21]. Available from: https://www.cdc.gov/pinkbook/hcp/table-of-contents/chapter-11-human-papillomavirus.html.

12. Ardekani A, Taherifard E, Mollalo A, Hemadi E, Roshanshad A, Fereidooni R, et al. Human papillomavirus infection during pregnancy and childhood: a comprehensive review. Microorganisms. 2022; 10:1932.

13. Petca A, Borislavschi A, Zvanca ME, Petca RC, Sandru F, Dumitrascu MC. Non-sexual HPV transmission and role of vaccination for a better future (Review). Exp Ther Med. 2020; 20:186.

14. Dubel J, Dubel R, Ruszel K, Czekaj A, Namroży N. Vaccination against HPV (human papilloma virus) for women-why is it still recommended and not obligatory in Poland? J Educ Health Sport. 2023; 13:112–6.

15. Satanova AR, Kaidarova D, Kukubassov E, Bolatbekova R, Kaldybekov D, Bertleuov O. The global prevalence of human papillomavirus causing cervical cancer: a literature review. Oncol Radiol Kaz. 2022; 3:42–6.

16. López ED. Vaccination against human papillomavirus (HPV) in vulnerable populations - sexual minorities [Internet]. London: IntechOpen;c2022. [cited 2025 Jan 10]. Available from: https://www.intechopen.com/chapters/80380.

17. Kost BP, Hofmann J, Stoellnberger S, Bergauer F, Blankenstein T, Alba-Alejandre I, et al. Prevalence of human papillomavirus infection of the anal canal in women: a prospective analysis of high-risk populations. Oncol Lett. 2017; 13:2495–501.

18. Yu Y, Xu M, Sun J, Li R, Li M, Wang J, et al. Human papillomavirus infection and vaccination: awareness and knowledge of HPV and acceptability of HPV vaccine among mothers of teenage daughters in Weihai, Shandong, China. PLoS One. 2016; 11:e0146741.

19. Ai M. Relationship between human papillomavirus infection and cervical cancer progression. Infection International. 2015; 4:21–5.

20. Madhivanan P, Bokulich N, Coudray M, Colbert B, Ruiz-Perez D, Krupp K, et al. Composition of the vaginal microbiome associated with high risk HPV infection and increased risk for cervical cancer. Cancer Epidemiol Biomarkers Prev. 2020; 29:696.

21. Nagandla K, Lin KH, Chitra E, Jamli MFBM. Role of microRNAs as biomarkers of cervical carcinogenesis: a systematic review. Obstet Gynecol Sci. 2021; 64:419–36.

22. Frazer IH. Prevention of cervical cancer through papillomavirus vaccination. Nat Rev Immunol. 2004; 4:46–55.

23. Palefsky J. Biology of HPV in HIV infection. Adv Dent Res. 2006; 19:99–105.

24. Singh N, Hussain S, Sharma U, Suri V, Nijhawan R, Bharadwaj M, et al. The protective role of the -1306C>T functional polymorphism in matrix metalloproteinase-2 gene is associated with cervical cancer: implication of human papillomavirus infection. Tumour Biol. 2016; 37:5295–303.

25. Bowden SJ, Doulgeraki T, Bouras E, Markozannes G, Athanasiou A, Grout-Smith H, et al. Risk factors for human papillomavirus infection, cervical intraepithelial neoplasia and cervical cancer: an umbrella review and follow-up Mendelian randomisation studies. BMC Med. 2023; 21:274.

26. Franco EL, Harper DM. Vaccination against human papillomavirus infection: a new paradigm in cervical cancer control. Vaccine. 2005; 23:2388–94.

27. Barbosa MS, Vass WC, Lowy DR, Schiller JT. In vitro biological activities of the E6 and E7 genes vary among human papillomaviruses of different oncogenic potential. J Virol. 1991; 65:292–8.

28. Kovelman R, Bilter GK, Glezer E, Tsou AY, Barbosa MS. Enhanced transcriptional activation by E2 proteins from the oncogenic human papillomaviruses. J Virol. 1996; 70:7549–60.

29. Kraus I, Molden T, Holm R, Lie AK, Karlsen F, Kristensen GB, et al. Presence of E6 and E7 mRNA from human papillomavirus types 16, 18, 31, 33, and 45 in the majority of cervical carcinomas. J Clin Microbiol. 2006; 44:1310–7.

30. Kusanagi Y, Kojima A, Mikami Y, Kiyokawa T, Sudo T, Yamaguchi S, et al. Absence of high-risk human papillomavirus (HPV) detection in endocervical adenocarcinoma with gastric morphology and phenotype. Am J Pathol. 2010; 177:2169–75.

31. Kong TW, Kim M, Kim YH, Kim YB, Kim J, Kim JW, et al. High-risk human papillomavirus testing as a primary screening for cervical cancer: position statement by the Korean Society of Obstetrics and Gynecology and the Korean Society of Gynecologic Oncology. J Gynecol Oncol. 2020; 31:e31.

32. Hoang HT, Ishizaki A, Nguyen CH, Tran VT, Matsushita K, Saikawa K, et al. Infection with high-risk HPV types among female sex workers in northern Vietnam. J Med Virol. 2013; 85:288–94.

33. Castle PE, Cremer M. Human papillomavirus testing in cervical cancer screening. Obstet Gynecol Clin North Am. 2013; 40:377–90.

34. Bai A, Xue P, Li Q, Jiang Y, Qiao Y. Diagnostic value of high-risk HPV other than type 16/18 in high-grade cervical neoplasia among cytology-negative women: a multicenter retrospective study. Cancer Med. 2023; 12:14794–805.

35. Musa J, Maiga M, Green SJ, Magaji FA, Maryam AJ, Okolo M, et al. Vaginal microbiome community state types and high-risk human papillomaviruses in cervical precancer and cancer in North-central Nigeria. BMC Cancer. 2023; 23:683.

36. Condic M, Neidhöfer C, Ralser DJ, Wetzig N, Thiele R, Sieber M, et al. Analysis of the cervical microbiome in women from the German national cervical cancer screening program. J Cancer Res Clin Oncol. 2023; 149:6489–500.

37. Rad A, Sørbye SW, Brenn T, Tiwari S, Løchen ML, Skjeldestad FE. 13-type HPV DNA test versus 5-type HPV mRNA test in triage of women aged 25-33 years with minor cytological abnormalities-6 years of followup. Int J Environ Res Public Health. 2023; 20:4119.

38. Sudhakaran S, Bhatla N, Mathur SR, Mahey R, Vashist S, Natarajan J, et al. Evaluation of cervical cancer screening during pregnancy in India: human papillomavirus testing can change the paradigm. Natl Med J India. 2023; 36:17–21.

39. Lawson O, Ameyan L, Tukur Z, Dunu S, Kerry M, Okuyemi OO, et al. Cervical cancer screening outcomes in public health facilities in three states in Nigeria. BMC Public Health. 2023; 23:1688.

40. Grce M, Davies P. Human papillomavirus testing for primary cervical cancer screening. Expert Rev Mol Diagn. 2008; 8:599–605.

41. Martinelli M, Giubbi C, Di Meo ML, Perdoni F, Musumeci R, Leone BE, et al. Accuracy of human papillomavirus (HPV) testing on urine and vaginal self-samples compared to clinician-collected cervical sample in women referred to colposcopy. Viruses. 2023; 15:1889.

42. Nakowong P, Chatchawal P, Chaibun T, Boonapatcharoen N, Promptmas C, Buajeeb W, et al. Detection of high-risk HPV 16 genotypes in cervical cancers using isothermal DNA amplification with electrochemical genosensor. Talanta. 2024; 269:125495.

43. Barroeta JE. The future role of cytology in cervical cancer screening in the era of HPV vaccination. Acta Cytologica. 2023; 67:111–8.

44. Acevedo-Fontanez AI, Suarez E, Torres-Cintron CR, Ortiz AP. Abstract LB-166: risk of anal cancer in women with human papillomavirus-related gynecological neoplasm: puerto rico 1987-2013. Cancer Res. 2017; 77:LB–166.

45. Yamazaki T. Two cases of human papillomavirus-related oropharyngeal cancer after the treatment of cervical cancer. Cureus. 2020; 12:e8434. .

46. Riethmuller D, Jacquard AC, Lacau St Guily J, Aubin F, Carcopino X, Pradat P, et al. Potential impact of a non-avalent HPV vaccine on the occurrence of HPV-related diseases in France. BMC Public Health. 2015; 15:453.

47. Zahnd WE, Rodriguez C, Jenkins WD. Rural-urban differences in human papillomavirus-associated cancer trends and rates. J Rural Health. 2019; 35:208–15.

48. Bernabe-Dones RD, Gonzalez-Pons M, Villar-Prados A, Lacourt-Ventura M, Rodríguez-Arroyo H, Fonseca-Williams S, et al. High prevalence of human papillomavirus in colorectal cancer in hispanics: a case-control study. Gastroenterol Res Pract. 2016; 2016:7896716.

49. Smith EM, Swarnavel S, Ritchie JM, Wang D, Haugen TH, Turek LP. Prevalence of human papillomavirus in the oral cavity/oropharynx in a large population of children and adolescents. Pediatr Infect Dis J. 2007; 26:836–40.

50. Nielsen A, Kjaer SK, Munk C, Iftner T. Type-specific HPV infection and multiple HPV types: prevalence and risk factor profile in nearly 12,000 younger and older Danish women. Sex Transm Dis. 2008; 35:276–82.

51. Pytynia KB, Dahlstrom KR, Sturgis EM. Epidemiology of HPV-associated oropharyngeal cancer. Oral Oncol. 2014; 50:380–6.

52. Scheel A, Lin GC, McHugh JB, Komarck CM, Walline HM, Prince ME, et al. Human papillomavirus infection and biomarkers in sinonasal inverted papillomas: clinical significance and molecular mechanisms. Int Forum Allergy Rhinol. 2015; 5:701–7.

53. Teixeira MF, Sabidó M, Leturiondo AL, de Oliveira Ferreira C, Torres KL, Benzaken AS. High risk human papillomavirus prevalence and genotype distribution among women infected with HIV in Manaus, Amazonas. Virol J. 2018; 15:36.

54. Sehnal B, Podlešák T, Kmoníčková E, Nipčová M, Driák D, Sláma J, et al. Anogenital HPV infection as the potential risk factor for oropharyngeal carcinoma. Klin Onkol. 2018; 31:103–9.

55. Nang DW, Tukirinawe H, Okello M, Tayebwa B, Theophilus P, Sikakulya FK, et al. Prevalence of high-risk human papillomavirus infection and associated factors among women of reproductive age attending a rural teaching hospital in western Uganda. BMC Womens Health. 2023; 23:209.

56. Martínez-Gómez X, Curran A, Campins M, Alemany L, Rodrigo-Pendás JÁ, Borruel N, et al. Multidisciplinary, evidence-based consensus guidelines for human papillomavirus (HPV) vaccination in high-risk populations, Spain, 2016. Euro Surveill. 2019; 24:1700857.

57. Gerend MA, Stephens YP, Kazmer MM, Slate EH, Reyes E. Predictors of human papillomavirus vaccine completion among low-income Latina/o adolescents. J Adolesc Health. 2019; 64:753–62.

58. Leung SOA, Akinwunmi B, Elias KM, Feldman S. Educating healthcare providers to increase human papillomavirus (HPV) vaccination rates: a qualitative systematic review. Vaccine X. 2019; 3:100037.

59. Abi Jaoude J, Saad H, Farha L, Dagher H, Khair D, Kaafarani MA, et al. Barriers, attitudes and clinical approach of lebanese physicians towards HPV vaccination; a cross- sectional study. Asian Pac J Cancer Prev. 2019; 20:3181–7.

60. Whitworth HS, Gallagher KE, Howard N, Mounier-Jack S, Mbwanji G, Kreimer AR, et al. Efficacy and immunogenicity of a single dose of human papillomavirus vaccine compared to no vaccination or standard three and two-dose vaccination regimens: a systematic review of evidence from clinical trials. Vaccine. 2020; 38:1302–14.

61. Sonawane K, Zhu Y, Montealegre JR, Lairson DR, Bauer C, McGee LU, et al. Parental intent to initiate and complete the human papillomavirus vaccine series in the USA: a nationwide, cross-sectional survey. Lancet Public Health. 2020; 5:e484–92.

62. Lin C, Mullen J, Smith D, Kotarba M, Kaplan SJ, Tu P. Healthcare providers’ vaccine perceptions, hesitancy, and recommendation to patients: a systematic review. Vaccines (Basel). 2021; 9:713.

63. Galvin AM, Garg A, Griner SB, Moore JD, Thompson EL. Health literacy correlates to HPV vaccination among US adults ages 27-45. J Cancer Educ. 2023; 38:349–56.

64. Patrick L, Bakeera-Kitaka S, Rujumba J, Malande OO. Encouraging improvement in HPV vaccination coverage among adolescent girls in Kampala, Uganda. PLoS One. 2022; 17:e0269655.

65. McNamara M, Batur P, Walsh JME, Johnson KM. HPV update: vaccination, screening, and associated disease. J Gen Intern Med. 2016; 31:1360–6.

66. Arevalo M, Brownstein NC, Whiting J, Vadaparampil ST, Head KJ, Meade CD, et al. Factors related to human papillomavirus vaccine uptake and intentions among adults aged 18-26 and 27-45 years in the United States: a cross-sectional study. Cancer. 2023; 129:1237–52.

67. Konishi I. Precision medicine in gynecology and obstetrics. In : Ino K, editor. Prevention of cervical cancer: era of HPV testing and vaccination. 1st ed. Singapore: Springer Singapore;2017. p. 87–99.

68. Elfström KM, Herweijer E, Sundström K, Arnheim-Dahlström L. Current cervical cancer prevention strategies including cervical screening and prophylactic human papillomavirus vaccination: a review. Curr Opin Oncol. 2014; 26:120–9.

69. Snyman LC, Dreyer G, Botha MH, van der Merwe FH, Becker PJ. The vaccine and cervical cancer screen (VACCS) project: linking cervical cancer screening to HPV vaccination in the south-west district of Tshwane, Gauteng, South Africa. S Afr Med J. 2015; 105:115–20.

70. del Carmen MG. Cervical cancer: will interventions to HPV vaccination reduce disparities? Curr Women’s Health Rev. 2018; 14:235–41.

71. Silver MI, Kobrin S. Exacerbating disparities?: cervical cancer screening and HPV vaccination. Prev Med. 2020; 130:105902.

72. Ong SK, Abe SK, Thilagaratnam S, Haruyama R, Pathak R, Jayasekara H, et al. Towards elimination of cervical cancer - human papillomavirus (HPV) vaccination and cervical cancer screening in Asian National Cancer Centers Alliance (ANCCA) member countries. Lancet Reg Health West Pac. 2023; 39:100860. .

73. Murillo R, Ordóñez-Reyes C. Human papillomavirus (HPV) vaccination: from clinical studies to immunization programs. Int J Gynecol Cancer. 2019; 29:1317–26.

74. Diaz M, de Sanjose S, Ortendahl J, O’Shea M, Goldie SJ, Bosch FX, et al. Cost-effectiveness of human papillomavirus vaccination and screening in Spain. Eur J Cancer. 2010; 46:2973–85.

75. Schiffman M. Integration of human papillomavirus vaccination, cytology, and human papillomavirus testing. Cancer. 2007; 111:145–53.

76. Muñoz N, Castellsagué X, Berrington de González A, Gissmann L. Chapter 1: HPV in the etiology of human cancer. Vaccine. 2006; 24 Suppl 3:1–10.

77. Walboomers JM, Jacobs MV, Manos MM, Bosch FX, Kummer JA, Shah KV, et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol. 1999; 189:12–9.

78. Harper DM, Franco EL, Wheeler C, Ferris DG, Jenkins D, Schuind A, et al. Efficacy of a bivalent L1 virus-like particle vaccine in prevention of infection with human papillomavirus types 16 and 18 in young women: a randomised controlled trial. Lancet. 2004; 364:1757–65.

79. Kjaer SK, Sigurdsson K, Iversen OE, Hernandez-Avila M, Wheeler CM, Perez G, et al. A pooled analysis of continued prophylactic efficacy of quadrivalent human papillomavirus (types 6/11/16/18) vaccine against high-grade cervical and external genital lesions. Cancer Prev Res (Phila). 2009; 2:868–78.

80. Wright TC Jr, Denny L, Kuhn L, Pollack A, Lorincz A. HPV DNA testing of self-collected vaginal samples compared with cytologic screening to detect cervical cancer. JAMA. 2000; 283:81–6.

81. Dalal NH, Chino F, Williamson H, Beasley GM, Salama AKS, Palta M. Mind the gap: gendered publication trends in oncology. Cancer. 2020; 126:2859–65.

82. Abdou Y, Goudarzi A, Yu JX, Upadhaya S, Vincent B, Carey LA. Immunotherapy in triple negative breast cancer: beyond checkpoint inhibitors. NPJ Breast Cancer. 2022; 8:121.

83. Levin G, Kogan L, Matan L, Brandt B, Meyer R, Perri T. Positive results bias in randomized controlled trials in gynecologic oncology. Arch Gynecol Obstet. 2024; 309:1681–3.

84. Thomas C. HPV vaccines: bring me your daughters! S Afr Med J. 2008; 98:259–61.

85. Khorasanizadeh F, Hassanloo J, Khaksar N, Mohammad Taheri S, Marzaban M, Rashidi BH, et al. Epidemiology of cervical cancer and human papilloma virus infection among Iranian women - analyses of national data and systematic review of the literature. Gynecol Oncol. 2013; 128:277–81.

86. Cole K, Al-Kadhimi Z, Talmadge JE. Highlights into historical and current immune interventions for cancer. Int Immunopharmacol. 2023; 117:109882.

87. Zhang L, Zhou F, Zhao KN. Molecular approaches target to immunotherapy for HPV-associated cancers. Curr Cancer Drug Targets. 2017; 17:512–21.

88. Zoa Assoumou S, Ndjoyi Mbiguino A, Mabika Mabika B, Nguizi Ogoula S, El Mzibri M, Khattabi A, et al. Human papillomavirus genotypes distribution among Gabonese women with normal cytology and cervical abnormalities. Infect Agent Cancer. 2016; 11:2.

89. Lima SF Júnior, Tavares MM, Macedo JL, Oliveira RS, Heráclio SA, Maia MM, et al. Influence of IL-6, IL-8, and TGF-β1 gene polymorphisms on the risk of human papillomavirus-infection in women from Pernambuco, Brazil. Mem Inst Oswaldo Cruz. 2016; 111:663–9.

90. Arora S, Ramachandra SS, Squier C. Knowledge about human papillomavirus (HPV) related oral cancers among oral health professionals in university setting-a cross sectional study. J Oral Biol Craniofac Res. 2018; 8:35–9.

91. Rubey KM, Brenner JS. Nanomedicine to fight infectious disease. Adv Drug Deliv Rev. 2021; 179:113996.

92. Mukherjee AG, Wanjari UR, Gopalakrishnan AV, Kannampuzha S, Murali R, Namachivayam A, et al. Exploring the molecular pathogenesis, pathogen association, and therapeutic strategies against HPV infection. Pathogens. 2022; 12:25.

93. Lin YY, Alphs H, Hung CF, Roden RB, Wu TC. Vaccines against human papillomavirus. Front Biosci. 2007; 12:246–64.

94. Gohar A, Ali AA, Elkhatib WF, El-Sayyad GS, Elfadil D, Noreddin AM. Combination therapy between prophylactic and therapeutic human papillomavirus (HPV) vaccines with special emphasis on implementation of nanotechnology. Microb Pathog. 2022; 171:105747.

95. Bosch FX, Broker TR, Forman D, Moscicki AB, Gillison ML, Doorbar J, et al. Comprehensive control of human papillomavirus infections and related diseases. Vaccine. 2013; 31 Suppl 5:F1–31.

96. Ino K. Prevention of cervical cancer: era of HPV testing and vaccination. In: Ino K, editor. Precision medicine in gynecology and obstetrics. Singapore: Springer; 2017. p.87-99.

97. Eun TJ, Perkins RB. Screening for cervical cancer. Med Clin North Am. 2020; 104:1063–78.

98. Bosch FX, Tsu V, Vorsters A, Van Damme P, Kane MA. Reframing cervical cancer prevention. Expanding the field towards prevention of human papillomavirus infections and related diseases. Vaccine. 2012; 30Suppl 5:F1–11.

99. Stanley M. Prevention strategies against the human papillomavirus: the effectiveness of vaccination. Gynecol Oncol. 2007; 107:S19–23.

100. Jiménez W, Paszat L, Kupets R, Wilton A, Tinmouth J. Presumed previous human papillomavirus (HPV) related gynecological cancer in women diagnosed with anal cancer in the province of Ontario. Gynecol Oncol. 2009; 114:395–8.

101. Phoolcharoen N, Baker ES, Salcedo MP. Cervical cancer screening. 2nd ed. Cham: Springer International Publishing;2021.

102. Chan CK, Aimagambetova G, Ukybassova T, Kongrtay K, Azizan A. Human papillomavirus infection and cervical cancer: epidemiology, screening, and vaccination-review of current perspectives. J Oncol. 2019; 2019:3257939.

103. Saraiya M, Steben M, Watson M, Markowitz L. Evolution of cervical cancer screening and prevention in United States and Canada: implications for public health practitioners and clinicians. Prev Med. 2013; 57:426–33.