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All Journal The International Journal of Medical Science and Health Research The Indonesian Journal of General Medicine
Yahya Nurlianto
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Dentistry Health Professions Medicine & Pharmacology Nursing Public Health Veterinary

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How Does Fetal Surgery Impact Long-Term Neurological And Develop- Mental Outcomes In Children With Twin-Twin Transfusion Syndrome? Yunike Putri Nurfauzia; I Made Adi Saputra Wijaya; Mutia Juliana; Lina Haryani; Yahya Nurlianto
The Indonesian Journal of General Medicine Vol. 12 No. 2 (2025): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/zv7crn36

Abstract

Introduction: Twin-Twin Transfusion Syndrome (TTTS) is a serious complication in monochorionic twin pregnancies caused by unbalanced blood flow through placental vascular anastomoses. Fetoscopic laser surgery has become the primary intervention to improve survival and reduce neurological morbidity. Methods: This review synthesizes data from randomized controlled trials, prospective and retrospective cohort studies conducted over the last decade. Studies included patients undergoing fetoscopic laser surgery with follow-up periods ranging from weeks to years, assessing survival, neurological, and developmental outcomes. Results: Survival rates after fetal laser surgery range from mid-70% to mid-80%, with one trial reporting 67-68% survival without neurodevelopmental impairment at 2 years. Cerebral palsy incidence is low (1-2%), and cognitive or motor impairments occur in 2-8% of survivors. Comparisons between surgical techniques (Solomon vs. standard laser, sequential vs. selective coagulation) show similar survival and neurodevelopmental outcomes. Immediate surgery versus expectant management in early-stage TTTS showed no significant difference in 6-month survival without severe neurologic morbidity (78% vs. 77%). Laser surgery reduces severe cerebral injury compared to no treatment (5% vs. 18%). Discussion: While fetal surgery improves survival and neurological outcomes, challenges such as preterm birth and growth discordance remain. Adjunctive therapies and long-term neurodevelopmental monitoring are essential to optimize care. Conclusion: Fetoscopic laser surgery is effective in managing TTTS, offering improved survival and reduced neurological morbidity. Continued research is needed to refine techniques and adjunctive treatments
What Is The Association Between Long-Term Intrauterine Device (IUD) Use And The Risk Of Developing Uterine Cancer In Women Aged 35-65? Yunike Putri Nurfauzia; I Made Adi Saputra Wijaya; Mutia Juliana; Lina Haryani; Yahya Nurlianto
The Indonesian Journal of General Medicine Vol. 12 No. 2 (2025): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/faa30y69

Abstract

Introduction: Uterine cancer is a significant health concern, especially among women aged 35-65 years. Intrauterine devices (IUDs), including hormonal levonorgestrel-releasing intrauterine systems (LNG-IUS) and copper IUDs (Cu-IUD), are widely used for contraception and have been investigated for their potential role in reducing uterine cancer risk. Methods: A comprehensive review of studies published in the last decade was conducted, focusing on the association between long-term IUD use and uterine cancer risk in women aged 35-65. Studies included randomized controlled trials, prospective and retrospective cohorts, with follow-up durations ranging from six months to over ten years. Results: Evidence indicates that long-term use of both LNG-IUS and Cu-IUD is associated with a reduced risk of uterine cancer and its precursor lesions. LNG-IUS demonstrated superior efficacy compared to oral progestogens in treating atypical endometrial hyperplasia (AEH) and reducing cancer recurrence. Cu-IUD use was also linked to lower risks of endometrial and cervical cancers. Adverse events were generally mild, with weight gain being the most common side effect, and device-related complications such as expulsion and perforation were rare. Discussion: The protective effects of LNG-IUS are attributed to localized progestin release causing endometrial atrophy, while Cu-IUDs may exert effects through local inflammatory mechanisms. Despite promising findings, age-stratified data remain limited, and further long-term studies are needed. Conclusion: Long-term use of LNG-IUS and Cu-IUD offers effective contraception and a favorable reduction in uterine cancer risk with a good safety profile, supporting their role in preventive strategies for women aged 35-65.
What is the comparative effectiveness of cognitive behavioral therapy versus medical treatment in improving sexual function for women with sexual dysfunction? Yunike Putri Nurfauzia; I Made Adi Saputra Wijaya; Mutia Juliana; Yahya Nurlianto
The International Journal of Medical Science and Health Research Vol. 12 No. 3 (2025): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/sndsqr62

Abstract

Introduction: This review investigates the comparative effectiveness of Cognitive Behavioral Therapy (CBT) versus medical treatments in improving sexual function among adult women diagnosed with sexual dysfunction. Sexual dysfunctions studied include provoked vestibulodynia (PVD), hypoactive sexual desire disorder (HSDD), vaginismus, and related conditions. Methods: Fifteen studies, primarily randomized clinical trials, were analyzed. Interventions included various forms of CBT (couple-based, group-based, mindfulness-based) and medical treatments such as lidocaine, sildenafil, bupropion, and topical steroids. Outcomes measured were sexual function, pain, sexual satisfaction, psychological distress, and relational factors. Results: CBT consistently showed significant improvements in sexual function, psychological well-being, and relationship satisfaction. For example, one study reported a 66% improvement in sexual performance after 12 weeks of CBT, and another showed an 18-point increase in sexual function scores at six months follow-up. Medical treatments provided rapid relief of physiological symptoms like pain and lubrication deficits, with effect sizes sometimes comparable to CBT. However, CBT was more effective in addressing psychological and relational aspects. Discussion: CBT’s holistic approach addresses both physiological and psychological factors, offering longer-lasting benefits and skill development for patients. Medical treatments are advantageous for quick symptom relief and ease of administration. Combined approaches may optimize outcomes. Conclusion: Both CBT and medical treatments are effective, but CBT offers broader and potentially more durable improvements in sexual health. Treatment choice should be individualized based on patient needs and dysfunction type.
What is The Association Between Low Serum Vitamin A Levels and The Risk of Developing Gestational Trophoblastic Disease Yunike Putri Nurfauzia; I Made Adi Saputra Wijaya; Mutia Juliana; Yahya Nurlianto
The International Journal of Medical Science and Health Research Vol. 12 No. 3 (2025): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/cbg2nb15

Abstract

Introduction: Gestational Trophoblastic Disease (GTD) comprises a group of disorders characterized by abnormal trophoblastic proliferation, including hydatidiform mole and gestational trophoblastic neoplasia (GTN). Vitamin A, known for its role in cellular differentiation and immune modulation, has been studied for its potential association with GTD risk and treatment outcomes. Methods: A systematic review of recent studies was conducted, focusing on serum vitamin A levels in GTD patients and the effects of vitamin A supplementation on treatment response. Included studies ranged from cross-sectional analyses to randomized controlled trials involving human subjects diagnosed with various GTD subtypes. Results: Ferraz et al. (2020) reported normal serum vitamin A levels (0.3–0.7 mg/dL) in patients with complete hydatidiform mole, indicating no association between low vitamin A levels and GTD risk. Conversely, Hidayat et al. (2020) demonstrated that vitamin A supplementation (6,000 IU/day) combined with methotrexate chemotherapy in low-risk GTN patients led to a more rapid decline in beta-human chorionic gonadotropin (β-hCG) levels and reduced chemotherapy resistance compared to chemotherapy alone. Discussion: While low serum vitamin A does not appear to predispose to GTD, supplementation may enhance chemotherapy efficacy, possibly through antioxidant and immunomodulatory mechanisms. However, limited sample sizes and study heterogeneity warrant further research. Conclusion: Vitamin A supplementation shows promise as an adjunct therapy in GTD treatment, improving outcomes in select patients, though it is not linked to disease risk. Larger, controlled studies are needed to confirm these findings
What is The Role of Genetic Predisposition in Gestational Trophoblastic Disease ? : A Systematic Review Bangar Parlinggoman Tua; Yahya Nurlianto
The International Journal of Medical Science and Health Research Vol. 13 No. 7 (2025): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/egyyrs95

Abstract

Introduction : Gestational Trophoblastic Disease (GTD) encompasses a spectrum of proliferative placental disorders. While genetic alterations are integral to its pathogenesis, the role of inherited genetic predisposition remains poorly quantified. A significant gap exists between the established use of genetic markers for diagnostics and a comprehensive understanding of heritable risk. This systematic review aims to synthesize the current evidence on the role of genetic predisposition in GTD. Methods : Adhering to PRISMA 2020 guidelines, a systematic literature search was conducted across PubMed, Semantic Scholar, Springer, and Google Scholar. Eligibility criteria focused on studies investigating genetic variants, hereditary factors, or familial clustering in human subjects with any form of GTD. Data on genetic analysis types, specific markers, predisposition findings, and clinical implications were systematically extracted and synthesized. Results : From 11 included studies, the evidence for inherited predisposition was limited and heterogeneous. Strong evidence was confined to recurrent hydatidiform moles, with one systematic review identifying monogenic causes involving genes such as NLRP7, CHRNA1, DYNC2H1, and RYR1. Other studies documented molecular dysregulation in genes like p53 and BCL-2 without quantifying inherited risk. A prominent theme was the diagnostic utility of genetics, with SNP arrays, STR analysis, and cell-free DNA being used for diagnosis and differentiation rather than risk prediction. No high-level evidence for predisposition was identified. Discussion : The evidence confirms a clear heritable, monogenic cause for a subset of patients with recurrent molar pregnancies. However, for sporadic GTD, research has pivoted towards diagnostic applications that improve disease detection and management, rather than establishing quantifiable predisposition risk. While genetic tools for diagnostics are advancing, their application for risk assessment remains limited. Conclusion : The clinical role of genetics in GTD is currently centered on diagnosis rather than risk prediction. While heritable factors are definitive in rare recurrent cases, quantifiable genetic risk for the broader population remains largely unknown. Future research requires large-scale association studies to identify risk alleles and translate molecular insights into prognostic and therapeutic strategies for all forms of GTD.
The Association Between Early Menarche and Increased Risk of Cervical Cancer: A Systematic Review Bangar Parlinggoman Tua; Yahya Nurlianto; Mutia Juliana; Lina Haryani; Nanik Cahyati
The Indonesian Journal of General Medicine Vol. 19 No. 2 (2025): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/gpe4zr59

Abstract

Introduction: Cervical cancer (CC) remains a significant global health burden, primarily driven by persistent high-risk human papillomavirus (HPV) infection. While HPV is the necessary cause, the role of host reproductive cofactors, such as early menarche, in promoting carcinogenesis remains controversial. This systematic review synthesizes the epidemiological evidence on the association between early menarcheal age and the risk of cervical cancer and its precursors. Methods: This review was conducted adhering to the PRISMA 2020 guidelines. A systematic search of PubMed, EMBASE, and Web of Science was performed to identify observational (cohort and case-control) studies published to date. Studies assessing the risk of invasive cervical cancer (ICC), cervical intraepithelial neoplasia (CIN/HSIL), or high-risk HPV (HR-HPV) infection in relation to menarcheal age were included. The methodological quality and risk of bias for included non-randomized studies were rigorously assessed using the Risk Of Bias In Non-randomized Studies - of Interventions (ROBINS-I) tool. Results: Seventeen studies met the inclusion criteria. A subset of case-control and cross-sectional studies reported a statistically significant positive association between early menarche and cervical disease. Notably, one meta-analysis of Chinese studies reported a pooled Odds Ratio (OR) of 3.242 for ICC. Another study found a strong association between early menarche (<13 years) and HPV 16/18 infection (OR = 6.2). A 2023 study also identified early menarche as a significant risk factor for high-grade squamous intraepithelial lesions (HSIL). However, these findings are contradicted by larger, more methodologically robust prospective cohort and pooled case-control analyses. These high-quality studies, which included comprehensive adjustment for key confounders, found no significant independent association between menarcheal age and risk of ICC. The evidence demonstrates that the observed association is strongly mediated by age at first sexual intercourse (AFSI), which is significantly predicted by early menarche (e.g., OR = 6.4). Discussion: The data highlights a critical epidemiological challenge in distinguishing between behavioral mediation and biological causation. The findings are evaluated through two primary pathways: 1) The behavioral-mediation pathway, where early menarche serves as a robust proxy for early AFSI and subsequent HPV exposure; and 2) The biological-plausibility pathway, which posits that early endogenous estrogen exposure creates a "window of vulnerability" in the cervical transformation zone, increasing susceptibility to HPV. The robust null findings in studies that control for AFSI, alongside recent data distinguishing risk for uterine (significant) versus cervical (null) cancer, strongly support the behavioral-mediation pathway. Conclusion: While several studies report a significant positive association, the weight of the highest-quality epidemiological evidence suggests that early menarche is not a direct, independent causal factor for cervical cancer. Instead, it functions as a significant indirect risk marker. The association is robustly and almost entirely mediated by the strong correlation between early menarche and early sexual debut. Public health interventions should therefore focus on this behavioral link, targeting education and HPV vaccination to adolescents, particularly those undergoing early pubertal maturation.
The Relationship Between Nutritional Status and Chemotherapy Toxicity in Patients with Cervical Cancer: A Systematic Review Bangar Parlinggoman Tua; Yahya Nurlianto; Mutia Juliana
The International Journal of Medical Science and Health Research Vol. 20 No. 2 (2025): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/tcw7d817

Abstract

Introduction: Cervical cancer imposes a significant global health burden, disproportionately affecting low- and middle-income countries where malnutrition is also endemic. Antineoplastic therapy, particularly concurrent chemoradiotherapy (CCRT) with platinum-based agents, is the standard of care but is associated with severe toxicities. This systematic review investigates the central hypothesis that poor nutritional status—defined by a range of anthropometric, serological, and body composition metrics—is an independent and significant predictor of increased chemotherapy-related toxicity in cervical cancer patients. Methods: This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A systematic search of PubMed, Scopus, and the Cochrane Library was performed to identify studies evaluating the relationship between nutritional status and chemotherapy toxicity in cervical cancer patients. Eligibility criteria were based on the Population (cervical cancer patients), Exposure (malnutrition), Comparison (well-nourished), and Outcome (toxicity) framework. Methodological quality was appraised using the Cochrane Risk-of-Bias 2 (RoB 2) tool for randomized controlled trials (RCTs) and the Newcastle-Ottawa Scale (NOS) for observational studies. Results: A total of 16 studies (2 RCTs and 14 observational cohorts) met the inclusion criteria. The results demonstrate a consistent and statistically significant association between malnutrition and increased treatment toxicity. Specifically, poor nutritional status assessed by the Patient-Generated Subjective Global Assessment (PG-SGA) was an independent predictor of both Grade 3+ toxicity and Toxicity-Induced Modification of Treatment (TIMT). Sarcopenia (low Skeletal Muscle Index, SMI) was significantly associated with higher rates of treatment interruption due to toxicity (p=0.024) and was a determining factor for Grade 3+ adverse events. Low Body Mass Index (BMI < 18.5 kg/m²) was linked to severe Grade 3/4 gastrointestinal complications, including bowel obstruction (p<0.001). A low Prognostic Nutritional Index (PNI) correlated with increased severity of fatigue, nausea, and diarrhea (p<0.05). Nutritional interventions, such as omega-3 supplementation, were shown in an RCT to significantly reduce the incidence of chemotherapy toxicity. Discussion: The evidence converges to confirm that malnutrition is a critical determinant of chemotherapy tolerance. The mechanisms are multifactorial. Pharmacokinetic alterations, such as hypoalbuminemia, increase the free, active fraction of protein-bound drugs, leading to toxicity. Pharmacodynamic failures, particularly in sarcopenic patients, result in a relative overdose from standard Body Surface Area (BSA)-based dosing due to a smaller volume of distribution. Malnutrition also impairs the host's ability to repair healthy tissue (e.g., gut mucosa, bone marrow) damaged by chemotherapy. Conclusion: Nutritional status is a powerful, modifiable predictor of severe chemotherapy-related toxicity in cervical cancer patients. These findings mandate the integration of nutritional screening (e.g., PG-SGA) and objective assessment (e.g., CT-based SMI) into routine oncological practice. Such screening can risk-stratify patients and trigger pre-emptive nutritional interventions to improve treatment tolerance, reduce toxicity-related interruptions, and optimize clinical outcomes
The Association Between Parity and Cervical Cancer Risk: A Systematic Review Bangar Parlinggoman Tua; Yahya Nurlianto; Mutia Juliana
The International Journal of Medical Science and Health Research Vol. 20 No. 2 (2025): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/s0harx65

Abstract

Introduction: Cervical cancer remains the fourth most common cancer in women globally (Sung et al., 2021; World Health Organization, 2024). While persistent infection with high-risk human papillomavirus (HPV) is established as the necessary cause, it is insufficient for carcinogenesis (Walboomers et al., 1999). Parity (the number of live births) has long been suspected as a critical cofactor, but evidence has been inconsistent (Tekalegn et al., 2022). This review synthesizes the epidemiological evidence on this association. Methods: This systematic review was conducted adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines (Page et al., 2021). A systematic search of MEDLINE/PubMed, Scopus, HINARI, Google Scholar, and Science Direct was performed (Tekalegn et al., 2022). Inclusion criteria were case-control or cohort studies quantifying the association between parity and cervical cancer risk. The methodological quality of included studies was assessed using the Newcastle-Ottawa Scale (NOS) (Wells et al., 2000). Results: A total of 18 observational studies, comprising 17 case-control studies and one prospective cohort study, were included in the final synthesis. A recent, high-quality meta-analysis incorporating many of these studies (Tekalegn et al., 2022) reported a significant pooled odds ratio (OR) from 6,685 participants. The analysis showed that women with high parity had 2.65 times higher odds of developing cervical cancer compared to their low-parity counterparts (OR = 2.65, 95% CI: 2.08–3.38). This review confirms this finding and further highlights a significant dose-response relationship, with risk increasing progressively with each additional birth (Muñoz et al., 2002; Sharma and Pattanshetty, 2018). Discussion: The evidence confirms that high parity is a major, independent cofactor that promotes carcinogenesis, particularly in HPV-positive women (Muñoz et al., 2002). This association is not an artifact of confounding by sexual behavior. Proposed biological mechanisms include: (1) supraphysiological hormonal changes during pregnancy promoting HPV oncogene expression; (2) persistent eversion (ectropion) of the cervical transformation zone, increasing epithelial vulnerability (Jensen et al., 2013); (3) cervical trauma during childbirth facilitating viral persistence; and (4) localized, pregnancy-related immunomodulation that impairs viral clearance. Conclusion: High parity is a robust and significant risk factor for cervical cancer. This finding has direct implications for public health, identifying women with high parity as a high-risk group that should be prioritized for cervical screening and HPV vaccination programs, especially in resource-limited settings where both high parity and cervical cancer incidence are prevalent.
The Impact of Prophylactic HPV Vaccination on the Incidence of High-Grade Cervical Intraepithelial Neoplasia (CIN2/CIN3): A Systematic Review Bangar Parlinggoman Tua; Yahya Nurlianto; Mutia Juliana
The International Journal of Medical Science and Health Research Vol. 20 No. 2 (2025): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/kjmnzx32

Abstract

Introduction: Cervical cancer is the fourth most common cancer in women globally, etiologically linked to persistent high-risk human papillomavirus (HPV) infection (World Health Organization, 2024a; World Health Organization, 2024b). High-grade cervical intraepithelial neoplasia (CIN), specifically CIN2 and CIN3, are the direct, histologically confirmed precursor lesions (Cleveland Clinic, 2023). This systematic review synthesizes the evidence from randomized controlled trials (RCTs) and real-world observational studies on the effectiveness of prophylactic HPV vaccination in reducing the incidence of CIN2 and CIN3 (CIN2+). Methods: Following PRISMA guidelines, a systematic search of PubMed, Embase, and the Cochrane Library was conducted (Ghebrekidan et al., 2024; Khalil et al., 2023). Studies were included if they were RCTs or observational (cohort, case-control) studies assessing the efficacy or effectiveness of prophylactic HPV vaccination (bivalent, quadrivalent, or nonavalent) on histologically confirmed CIN2+ outcomes in females. Methodological quality was appraised using the Cochrane Risk of Bias 2 (RoB 2) tool for RCTs (Sterne et al., 2019; Cochrane, 2024) and the Newcastle-Ottawa Scale (NOS) for observational studies (Wells et al., 2024; Ohri, 2024). Results: This synthesis includes 17 high-quality studies. Foundational RCTs (e.g., FUTURE, PATRICIA) demonstrated near-perfect efficacy (98-100%) against vaccine-type HPV 16/18-related CIN2+ in per-protocol (HPV-naïve) populations (FUTURE II Study Group, 2007; Paavonen et al., 2009; Kjaer et al., 2018). A high-certainty Cochrane review confirmed a 63% reduction in any CIN2+ (irrespective of HPV type) in hrHPV-negative young women (Risk Ratio 0.37, 95% CI 0.25-0.55) (Arbyn et al., 2018). Recent, large-scale real-world effectiveness (RWE) studies from national registries report profound, significant reductions in high-grade lesions. In England, cohorts vaccinated at age 12-13 showed an 87% reduction in invasive cervical cancer and a 97% reduction in CIN3 (Falcaro et al., 2021). In Sweden, vaccination before age 17 was associated with an 88% reduction in invasive cervical cancer (Lei et al., 2020), and in Scotland, an 86% reduction in CIN3+ was observed in the 12-13 age cohort (Palmer et al., 2019). Effectiveness is strongly dependent on vaccination age (Hariri et al., 2023; Herweijer et al., 2016). Furthermore, significant evidence demonstrates high effectiveness (74-87% reduction) in preventing the recurrence of high-grade lesions when used as an adjuvant to surgical conization (Dvořák et al., 2024; Ghelardi et al., 2021). Discussion: The evidence is overwhelming and consistent. The near-100% efficacy observed in controlled trial settings has translated directly into profound population-level effectiveness in countries with high, sustained vaccine uptake (Ghebrekidan et al., 2024; Drolet et al., 2019). The dependency of effectiveness on age confirms the vaccine's prophylactic mechanism, underscoring the criticality of pre-adolescent vaccination. Conclusion: Prophylactic HPV vaccination provides a significant, robust, and long-lasting reduction in the incidence of high-grade cervical precancer (CIN2/3). High-coverage national programs are demonstrating the potential to "almost eliminate" (Falcaro et al., 2021) cervical cancer in vaccinated generations, representing a major public health triumph.
The Relationship Between Pap Smear Screening Adherence and Cervical Cancer Mortality: A Systematic Review Bangar Parlinggoman Tua; Yahya Nurlianto; Mutia Juliana
The International Journal of Medical Science and Health Research Vol. 20 No. 3 (2025): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/xnj3se72

Abstract

INTRODUCTION: Cervical cancer remains a leading cause of cancer-related mortality for women globally, with a disproportionate burden concentrated in low- and middle-income countries (LMICs) (World Health Organization, 2024). This significant disparity is largely attributable to inadequate implementation of, and adherence to, preventive screening programs (Bray et al., 2024). This systematic review synthetically evaluates the quantitative association between adherence to Papanicolaou (Pap) smear screening and cervical cancer mortality. METHODS: A systematic review of the literature was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Page et al., 2021). Major electronic databases (including PubMed, MEDLINE, Embase, and Web of Science) were searched for observational studies (cohort and case-control) that assessed cervical cancer mortality or the incidence of invasive cervical cancer as an outcome of cytology screening history (Peirson et al., 2013). Study quality and risk of bias were assessed using the Newcastle-Ottawa Scale (NOS), the standard, validated tool for non-randomized studies (Wells et al., 2000). RESULTS: A total of 16 high-impact observational studies met the inclusion criteria. The findings are overwhelmingly consistent and statistically significant in demonstrating a profound protective effect. Large-scale cohort studies demonstrate that women adhering to screening have a substantially lower risk of mortality; one major study found a 70% reduction in cervical cancer mortality (Hazard Ratio: 0.30; 95% Confidence Interval [CI]: 0.12–0.74) (Makino et al., 2006). Case-control studies report exceptionally strong protective effects, with odds ratios (OR) for mortality as low as 0.08 (95% CI: 0.07–0.09) (Landy et al., 2016) and 0.34 (95% CI: 0.14–0.49) (Lönnberg et al., 2013). Furthermore, a meta-analysis of case-control studies on invasive cancer (the precursor to mortality) found a pooled protective effect (OR: 0.35; 95% CI: 0.30–0.41), signifying an approximate 65% reduction in risk (Peirson et al., 2013). DISCUSSION: The evidence irrefutably confirms a significant inverse relationship between screening adherence and mortality. The epidemiological findings demonstrate that the public health failure is not one of diagnostic efficacy but of implementation. This discussion synthesizes the quantitative efficacy of screening with the major documented barriers—economic, psychosocial, cultural, and provider-level—that suppress adherence rates and perpetuate this preventable mortality (Akin-Odanye et al., 2024). CONCLUSION: Adherence to Pap smear screening is a critical, primary determinant in the prevention of cervical cancer mortality. Public health strategies must shift from proving efficacy to aggressively dismantling the known structural and psychosocial barriers to adherence to achieve global elimination targets.
Co-Authors Bangar Parlinggoman Tua I Made Adi Saputra Wijaya Lina Haryani Mutia Juliana Nanik Cahyati Yunike Putri Nurfauzia