[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-359528-105":3,"detail-sidebar-cat-0-en-105":85,"doc-detail-359528-en":134},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":78,"head_meta":80,"extra_data":82,"updated_unix":84},105,"en","risk-of-cervical-cancer-and-high-grade-lesions-in-vulnerable-women-a-systematic-review-and-meta-analysis","Risk of Cervical Cancer and High-Grade Lesions in Vulnerable Women - A Systematic Review and Meta-Analysis","","Cervical cancer is largely preventable yet causes substantial mortality, disproportionately affecting vulnerable women. This systematic review and meta-analysis estimates the risk of high-grade cervical lesions and cervical cancer in vulnerable populations across high- and upper-middle-income countries using studies published up to February 2024. Based on 127 studies and bias assessment via the Newcastle–Ottawa Scale, the pooled relative risks show elevated cervical cancer risk (RR 2.78) and high-grade lesions (RR 2.5), with high heterogeneity supporting equity-focused prevention strategies.",{"@graph":14,"@context":77},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/risk-of-cervical-cancer-and-high-grade-lesions-in-vulnerable-women-a-systematic-review-and-meta-analysis/359528/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/risk-of-cervical-cancer-and-high-grade-lesions-in-vulnerable-women-a-systematic-review-and-meta-analysis/359528.png","ImageObject",300,407,{"name":42,"@type":43},"WPS_1786070896","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-29","2026-09-23",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",10,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69,73],{"name":60,"@type":61,"acceptedAnswer":62},"What populations does the review consider as vulnerable women?","Question",{"text":63,"@type":64},"The review includes women with low socioeconomic status, migrants, prisoners, sex workers, women with substance use disorders, mental illness, and women living with HIV.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How are the outcomes defined in this study?",{"text":68,"@type":64},"The primary outcome is the pooled risk of cervical cancer and high-grade lesions, while secondary outcomes include subgroup-specific risk. High-grade lesions are biologically defined (e.g., CIN2+, CIN3+).",{"name":70,"@type":61,"acceptedAnswer":71},"What key risk estimates did the meta-analysis find?",{"text":72,"@type":64},"Vulnerable women face higher risks of cervical cancer (RR 2.78, 95% CI 2.32–3.32) and high-grade lesions (RR 2.5, 95% CI 2.05–3.04).",{"name":74,"@type":61,"acceptedAnswer":75},"How many studies were included and how was study selection handled?",{"text":76,"@type":64},"The search yielded 11,540 citations, with 138 fully published studies meeting eligibility; data were extractable from 127 studies, summarized using PRISMA flow and supplementary materials.","https://schema.org",{"og:url":32,"og:type":79,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":81,"canonical":32},"index,follow",{"doc_id":83,"site_id":7},359528,1790473037,{"code":4,"msg":86,"data":87},"success",[88,92,96,100,105,110,114,119,124,127,130],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":97,"show_sort_weight":98,"slug":99},"Exam",70,"exam",{"id":101,"doc_module":4,"doc_module_name":25,"category_name":102,"show_sort_weight":103,"slug":104},5,"Comic",60,"comic",{"id":106,"doc_module":4,"doc_module_name":25,"category_name":107,"show_sort_weight":108,"slug":109},6,"Technology",50,"technology",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":112,"slug":113},7,40,"healthcare",{"id":115,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},8,"Research & Report",30,"research-report",{"id":120,"doc_module":4,"doc_module_name":25,"category_name":121,"show_sort_weight":122,"slug":123},9,"Religion & Spirituality",20,"religion-spirituality",{"id":122,"doc_module":4,"doc_module_name":25,"category_name":125,"show_sort_weight":122,"slug":126},"World Cup","world-cup",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":55,"slug":129},"Lifestyle","lifestyle",{"id":131,"doc_module":4,"doc_module_name":25,"category_name":132,"show_sort_weight":101,"slug":133},19,"General","general",{"code":4,"msg":86,"data":135},{"doc_id":83,"user_id":136,"nickname":42,"user_avatar":137,"doc_module":4,"category_id":111,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":138,"file_id":139,"file_url":140,"file_type":141,"file_size":142,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":55,"language":143,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":144,"faqs":145,"seo_title":146,"seo_description":12,"update_tm":147,"read_time":148},549768072016,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Article [https://doi.org/10.1038/s41467-026-70050-w](https://doi.org/10.1038/s41467-026-70050-w)  \nRisk ofcervical cancer and high-grade lesions invulnerable women a systematic review and meta-analysis  \nReceived: 7 March 2025  \n\n| Accepted: 6 February 2026 |\n| --- |\n| |\n| Check for updates |\n\nAmir Hassine 1,4, Anna Tisler 2,4, Myriam Martel3,5 & Marc Bardou 1,5   \nCervical cancer is largely preventable, yet causes around 300,000 deaths annually, disproportionately affecting vulnerable women. In here, we aim to estimate the risk of high-grade cervical lesions and cervical cancer among vulnerable populations in high-and upper-middle-income countries. We conduct a systematic review and meta-analysis of studies published up to February 2024 (from 2004 for HIV) across four databases. Risk of bias is assessed using the Newcastle–Ottawa Scale. We include women with low socioeconomic status, migrants, prisoners, sex workers, women with substance use disorders, mental illness, and living with HIV. The primary outcome is the pooled risk of cervical cancer and high-grade lesions; the secondary outcome is subgroup-specific risk. The analysis focuses on biologically defined females, with sex determined by author reporting. In this work, based on 127 studies, we show that vulnerable women face higher risks of cervical cancer (RR2.78; 95%CI 2.32–3.32) and high-grade lesions (RR 2.5; 95%CI 2.05–3.04), with high heterogeneity supporting equity-focused prevention strategies.  \nCervical cancer (CC) remains a major global public health concern, with over 600,000 new cases diagnosed annually1. Even in high- and upper-middle-income countries (HICs and UMICs), where screening and HPV vaccination have significantly reduced CC incidence and mortality, these benefits are not equitably distributed2–4. Evidence shows a persistent social gradient in CC outcomes5–8, with certain subgroups—such as women living with HIV (WLWH), socioeconomically disadvantaged individuals, women with disabilities, and migrants—facing significantly higher risks of high-grade cervical lesions (HGL) and CC6,9–11.  \nThese disparities result from a complex interplay of factors, including lower cervical screening uptake, delayed diagnoses, and a higher burden of persistent HPV infection in affected groups12–14. Limited awareness of HPV, negative attitudes toward screening, and various cultural and systemic barriers further restrict access to care15–17. Together, these challenges hinder progress toward the equity-focused targets set by the World Health Organisation (WHO) in its global strategy for cervical cancer elimination18.  \nHowever, the concept of “vulnerability” is still not clearly defined in the literature, and there are no standardised criteria for identifying at-risk populations in different settings. While individual studies have reported increased cervical disease burden in various subgroups6,9–11, few have applied rigorous meta-analytic methods to quantify risk across diverse vulnerable populations in high-income (HICs) and upper-middle-income (UMICs) countries. This limits the generalisability of findings and the development of evidence-based policies.  \nFilling this gap is essential. In most high-resource settings, cervical cancer prevention strategies tailored to vulnerable women are underdeveloped or lacking19. Policymakers lack a comprehensive synthesis of the burden of high-grade lesions and cervical cancer in these populations. A robust systematic review and meta-analysis could generate the evidence needed to guide targeted interventions and public health priorities. Adopting an inclusive definition of vulnerability and conducting subgroup analyses would help identify the most  \n1Université Bourgogne Europe, CHU Dijon Bourgogne, Centre d’investigation clinique INSERM 1432, Dijon, France. 2Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia. 3Research Institute of the McGill University Health Center, Montreal, Quebec, Canada. 4These autho","cbCaiea0ao0tfGEH","https://ap.wps.com/l/cbCaiea0ao0tfGEH","pdf",1583373,"English","# Results\n## Study selection","[{\"question\":\"What populations does the review consider as vulnerable women?\",\"answer\":\"The review includes women with low socioeconomic status, migrants, prisoners, sex workers, women with substance use disorders, mental illness, and women living with HIV.\"},{\"question\":\"How are the outcomes defined in this study?\",\"answer\":\"The primary outcome is the pooled risk of cervical cancer and high-grade lesions, while secondary outcomes include subgroup-specific risk. High-grade lesions are biologically defined (e.g., CIN2+, CIN3+).\"},{\"question\":\"What key risk estimates did the meta-analysis find?\",\"answer\":\"Vulnerable women face higher risks of cervical cancer (RR 2.78, 95% CI 2.32–3.32) and high-grade lesions (RR 2.5, 95% CI 2.05–3.04).\"},{\"question\":\"How many studies were included and how was study selection handled?\",\"answer\":\"The search yielded 11,540 citations, with 138 fully published studies meeting eligibility; data were extractable from 127 studies, summarized using PRISMA flow and supplementary materials.\"}]","Risk of Cervical Cancer and High-Grade Lesions in Vulnerable Women - A Systematic Review and Meta-Analysis | PDF",1790137117,25]