Factores protectores para reducir lesiones premalignas de cérvix en mujeres: revisión sistemática para gestión pública
DOI:
https://doi.org/10.5281/zenodo.17729350Palabras clave:
educación sanitaria, salud de la mujer, cáncerResumen
El objetivo de esta revisión sistemática fue identificar factores protectores para la gestión pública de lesiones premalignas de cérvix en mujeres. Se aplicó la metodología PRISMA en bases de datos como Scielo, Scopus, ProQuest y ScienceDirect, incluyendo 53 estudios publicados entre 2018 y 2025, con diseños cuantitativos, cualitativos o mixtos. Los hallazgos se organizan en tres categorías. En primer lugar, la prevención biológica incluye la vacunación contra el VPH (tetravalente y nonavalente), efectiva incluso después de procedimientos quirúrgicos, así como la presencia de un microbioma cervicovaginal dominado por Lactobacillus. En segundo lugar, en el ámbito conductual, la prevención se relaciona con la postergación del inicio de la actividad sexual, la reducción del número de parejas, el uso del condón, evitar el tabaquismo y la adherencia a programas educativos sanitarios. Finalmente, respecto al sistema de salud, las estrategias deben contemplar el tamizaje organizado, la prueba de VPH, los modelos comunitarios de acompañamiento y la capacitación de proveedores, lo cual favorece la detección temprana y reduce recurrencias. Estos resultados contribuyen a fortalecer la gestión pública mediante la integración de vacunación, educación y tamizaje, en línea con las metas de eliminación del cáncer cervical propuestas por la OMS.
Descargas
Referencias
Adhikari, I., Eriksson, T., Luostarinen, T., Lehtinen, M., & Apter, D. (2018). The risk of cervical atypia in oral contraceptive users. European Journal of Contraception and Reproductive Health Care, 23(1), 12–17. https://doi.org/10.1080/13625187.2018.1431214
Alcántara-Quintana, L. E., Terán-Figueroa, Y., González-Pérez, M. E., & Loyola-Leyva, A. (2022). Effect of exosomes from patients with grade one cervical intraepithelial neoplasia on cell cultures: A preliminary study. Cancer Management and Research, 14, 2225–2233. https://doi.org/10.2147/CMAR.S355689
Alligood-Percoco, N., & Kesterson, J. P. (2015). Addressing the barriers to cervical cancer prevention among Hispanic women. Journal of Racial and Ethnic Health Disparities, 3(3), 489–495. https://doi.org/10.1007/s40615-015-0166-z
Almeida, G. F., Heráclio, S., Souza, A. S. R., & Amorim, M. M. (2019). Profile of women with anal neoplasia associated with cervical neoplasia receiving care at a tertiary healthcare facility in northeastern Brazil. Journal of Coloproctology (Rio de Janeiro), 39(4), 297–302. https://doi.org/10.1016/j.jcol.2019.05.013
Anaya Rodríguez, A. F. (2024). Vacuna nonavalente contra el virus del papiloma humano: Una estrategia para prevenir el cáncer de cuello uterino. Ginecología y Obstetricia de México, 92(6), 267–273. https://doi.org/10.24245/gom.v92i6.9659
Arellano Ortiz, A. L., Jiménez Vega, F., & Salcedo Vargas, M. (2013). Dietary supplements as a treatment for cervical cancer: A systematic review. Nutrición Hospitalaria, 28(6), 1770–1780. https://doi.org/10.3305/nh.2013.28.6.6816
Banila, C., Ladoukakis, E., Ścibior-Bentkowska, D., Santiago, L. R., Reuter, C., Kleeman, M., & Nedjai, B. (2025). A longitudinal pilot study in pre-menopausal women links cervicovaginal microbiome to CIN3 progression and recovery. Communications Biology, 8(1). https://doi.org/10.1038/s42003-025-08328-w
Bao, X., Hanson, A. L., Madeleine, M. M., Wang, S. S., Schwartz, S. M., Newell, F., Pettersson-Kymmer, U., Hemminki, K., Tiews, S., & Steinberg, W. (2018). HLA and KIR associations of cervical neoplasia. Journal of Infectious Diseases, 218(12), 2006–2015. https://doi.org/10.1093/infdis/jiy483
Bogani, G., Raspagliesi, F., Sopracordevole, F., Ciavattini, A., Ghelardi, A., Simoncini, T., Petrillo, M., Plotti, F., Lopez, S., Casarin, J., Serati, M., Pinelli, C., Valenti, G., Bergamini, A., Gardella, B., Dell’Acqua, A., Monti, E., Vercellini, P., D’Ippolito, G., … Di Donato, V. (2020). Assessing the long-term role of vaccination against HPV after loop electrosurgical excision procedure (LEEP): A propensity-score matched comparison. Vaccines, 8(4). https://doi.org/10.3390/vaccines8040717
Bogani, G., Sopracordevole, F., Ciavattini, A., Ghelardi, A., Vizza, E., Vercellini, P., Casarin, J., Pinelli, C., Ghezzi, F., & De Vincenzo, R. (2024). HPV-related lesions after hysterectomy for high-grade cervical intraepithelial neoplasia and early-stage cervical cancer: A focus on the potential role of vaccination. Tumori, 110(2), 139–145. https://doi.org/10.1177/03008916231208344
Bogdanova, A., Andrawos, C., & Constantinou, C. (2022). Cervical cancer, geographical inequalities, prevention and barriers in resource-depleted countries (Review). Oncology Letters, 23(4). https://doi.org/10.3892/ol.2022.13233
Bruera, J. A., Bobbio, A., & Arbach, K. (2024). Lesiones proliferativas ginecológicas y victimización sexual en Córdoba, Argentina. Facultad Nacional de Salud Pública: El Escenario para la Salud Pública desde la Ciencia, 42(1). https://dialnet.unirioja.es/servlet/extart?codigo=10303386
Butorac, D., Stojanović, I., Potkonjak, A.-M., Margreitner, M., & Nemeth-Blažić, T. N. (2022). Awareness and attitude of doctors about the HPV vaccine in Croatia. Lijecnicki Vjesnik, 144(9), 331–339. https://doi.org/10.26800/LV-144-9-10-7
Chen, M., Li, C., Cui, Q., Zhou, C., Chen, P., & Yao, S. (2023). The efficacy of human papillomavirus prophylactic vaccination after conization in preventing cervical intraepithelial neoplasia recurrence: A prospective observational study in China. European Journal of Obstetrics & Gynecology and Reproductive Biology, 286, 10–15. https://doi.org/10.1016/j.ejogrb.2023.04.014
Chidyaonga-Maseko, F., Chirwa, M. L., & Muula, A. S. (2015). Underutilization of cervical cancer prevention services in low- and middle-income countries: A review of contributing factors. Pan African Medical Journal, 21. https://doi.org/10.11604/pamj.2015.21.231.6350
Cohen, O., Schejter, E., Agizim, R., Schonman, R., Chodick, G., Fishman, A., & Hershko Klement, A. (2019). Postcoital bleeding is a predictor for cervical dysplasia. PLOS ONE, 14(5), e0217396. https://doi.org/10.1371/journal.pone.0217396
Donkoh, E. T., Asmah, R. H., Agyemang-Yeboah, F., Dabo, E. O., & Wiredu, E. K. (2022). Prevalence and distribution of vaccine-preventable genital human papillomavirus (HPV) genotypes in Ghanaian women presenting for screening. Cancer Control, 29, 10732748221094721. https://doi.org/10.1177/10732748221094721
Escobar Escobar, M. B., Escobar, R. A., & Henao Buritica, A. (2023). Impacto de una intervención educativa en el conocimiento de la prevención de la neoplasia del cuello uterino en estudiantes de enfermería y sus familias. Interdisciplinaria, 40(2), 335–353. https://doi.org/10.16888/interd.2023.40.2.20
Galdos Kajatt, O. (2018). Vacunas contra el virus papiloma humano. Revista Peruana de Ginecología y Obstetricia, 64(3), 437–444. https://doi.org/10.31403/rpgo.v64i2109
Giovannetti, O., Tomalty, D., Velikonja, L., Gray, G., Boev, N., Gilmore, S., Oladipo, J., Sjaarda, C., Sheth, P. M., & Adams, M. A. (2023). Pre- and post-LEEP: Analysis of the female urogenital tract microenvironment and its association with sexual dysfunction. Sexual Medicine, 11(4), qfad039. https://doi.org/10.1093/sexmed/qfad039
Hurtado-Salgado, E., Ortiz-Panozo, E., Salmerón, J., Saavedra-Lara, N., Kuri-Morales, P., Pesqueira-Villegas, E., Luna-Gordillo, R., Franco, E. L., & Lazcano-Ponce, E. (2018). Use of HPV testing in cervical cancer screening services in Mexico, 2008–2018: A nationwide database study. Salud Pública de México, 60(6), 722–733. https://doi.org/10.21149/9891
Kjaer, S. K., Nygård, M., Sundström, K., Dillner, J., Tryggvadottir, L., Munk, C., Berger, S., Enerly, E., Hortlund, M., Ágústsson, Á. I., Bjelkenkrantz, K., Fridrich, K., Guðmundsdóttir, I., Sørbye, S. W., Bautista, O., Group, T., Luxembourg, A., Marshall, J. B., Radley, D., … Saah, A. (2020). Final analysis of a 14-year long-term follow-up study of the effectiveness and immunogenicity of the quadrivalent human papillomavirus vaccine in women from four Nordic countries. EClinicalMedicine, 23, 100401. https://doi.org/10.1016/j.eclinm.2020.100401
Lalinde, J., Santana, D., Morales, S., Toquica, A., & Ospina, M. (2022). Presentación inusual de compromiso metastásico cutáneo por carcinoma escamocelular de cuello uterino. Revista Colombiana de Cancerología, 26(1), 117–123. https://doi.org/10.35509/01239015.734
Lieb, J. A., Mondal, A., Lieb, L., Fehm, T. N., & Hampl, M. (2023). Pregnancy outcome and risk of recurrence after tissue-preserving loop electrosurgical excision procedure (LEEP). Archives of Gynecology and Obstetrics, 307(4), 1137–1143. https://doi.org/10.1007/s00404-022-06760-5
Long, T., Zhang, C., He, G., Hu, Y., Lin, Z., & Long, L. (2023). Bacterial vaginosis decreases the risk of cervical cytological abnormalities. Cancer Prevention Research, 16(2), OF1–OF9. https://doi.org/10.1158/1940-6207.CAPR-22-0288
Lugović-Mihić, L., Cvitanović, H., Djaković, I., Kuna, M., & Šešerko, A. (2021). The influence of psychological stress on HPV infection manifestations and carcinogenesis. Cellular Physiology and Biochemistry, 55, 71–88. https://doi.org/10.33594/000000395
Luvián-Morales, J., Gutiérrez-Enríquez, S. O., Granados-García, V., & Torres-Poveda, K. (2024). Risk factors for the development of cervical cancer: Analysis of the evidence. Frontiers in Oncology, 14. https://doi.org/10.3389/fonc.2024.1378549
Maria, H., Dana, H., Françoise, M., Michael, P., & Jürgen, W. (2018). Human papillomaviruses in Western Africa: Prevalences and risk factors in Burkina Faso. Archives of Gynecology and Obstetrics, 298(4), 789–796. https://doi.org/10.1007/s00404-018-4860-z
Melo, A., Montenegro, S., Liempi, S., Moreno, S., de-La-Barra, T., Guzmán, P., Bustos, L., & Fonseca-Salamanca, F. (2019). Frecuencia de alteraciones citológicas cervicales y virus papiloma humano en una muestra de estudiantes universitarias en Temuco, Chile. Revista Chilena de Infectología, 36(4), 421–427.
Montero Lora, Y., Ramón Jimenéz, R., Valverde Ramón, C., Escobedo Batista, F. E., & Hodelín Pozo, E. (2018). Principales factores de riesgo en la aparición del cáncer cervicouterino. MEDISAN, 22(5), 531–537.
Morales, R. (2003). Cáncer cervicouterino y el VPH. Opciones de detección. https://www.medigraphic.com/pdfs/facmed/un-2003/un032f.pdf
Nascimento, S. G. do, Carvalho, C. P. A. L. de, Silva, R. S. da, Oliveira, C. M. de, & Bonfim, C. V. do. (2018). Decline of mortality from cervical cancer. Revista Brasileira de Enfermagem, 71, 585–590. https://doi.org/10.1590/0034-7167-2016-0530
Ngu, S. F., Cheung, A. N. Y., Jong, K. K., Law, J. Y. P., Lee, A. Y., Lee, J. H. S., Li, W. H., Ma, V., Wong, G. C. Y., Wong, R. W. C., & Chan, K. K. L. (2024). 2024 Hong Kong College of Obstetricians and Gynaecologists guidelines for cervical cancer prevention and screening. Hong Kong Medical Journal, 30(6), 488–497. https://doi.org/10.12809/hkmj2411547
Novais, I. R., Coelho, C. O., da Costa Machado, H. C., Surita, F., Zeferino, L. C., & Vale, D. B. (2023). Cervical cancer screening in Brazilian Amazon Indigenous women: Towards the intensification of public policies for prevention. PLOS ONE, 18(12). https://doi.org/10.1371/journal.pone.0294956
Organización Mundial de la Salud. (2020). Estrategia mundial para acelerar la eliminación del cáncer del cuello uterino como problema de salud pública. https://www.who.int/es/publications/i/item/9789240014107
Pecinato, V., Jacobo, A., & Silva, S. G. da. (2022). Tendência temporal de mortalidade por neoplasia maligna de mama e de colo de útero em Passo Fundo, Rio Grande do Sul: Uma análise segundo faixa etária e escolaridade, 1999–2019. Epidemiologia e Serviços de Saúde, 31(3). https://doi.org/10.1590/s2237-96222022000300021
Petrillo, M., Dessole, M., Tinacci, E., Saderi, L., Muresu, N., Capobianco, G., Cossu, A., Dessole, S., Sotgiu, G., & Piana, A. (2020). Efficacy of HPV vaccination in women receiving LEEP for cervical dysplasia: A single institution’s experience. Vaccines, 8(1). https://doi.org/10.3390/vaccines8010045
Phoolcharoen, N., Kremzier, M., Eaton, V., Sarchet, V., Acharya, S. C., Shrestha, E., Carns, J., Baker, E., Varon, M. L., Karmacharya, S., Aryal, B., Richards-Kortum, R., Salcedo, M. P., Schmeler, K. M., & Pariyar, J. (2021). American Society of Clinical Oncology (ASCO) Cervical Cancer Prevention Program: A hands-on training course in Nepal. JCO Global Oncology, 7, 204–209. https://doi.org/10.1200/GO.20.00513
Pimple, S. A., & Mishra, G. A. (2016). Global strategies for cervical cancer prevention and screening. Minerva Ginecologica, 71(4). https://doi.org/10.23736/s0026-4784.19.04397-1
Priya, K. P., Singh, N., Ch, G. B., M, R., & Kumar, A. (2022). A review on the prevalence of cervical dysplasia in various geographical locations. Journal of Clinical and Pharmaceutical Research, 58–60. https://doi.org/10.61427/jcpr.v.i..71
Punchoo, R., Dreyer, G., & Pillay, T. S. (2025). 25-Hydroxycholecalciferol serum level shows an inverse relationship with high-grade uterine cervical dysplasia in HIV-uninfected Black women in South Africa. Journal of Clinical Medicine, 14(11). https://doi.org/10.3390/jcm14113817
Ramachandran, D., Wang, Y., Schürmann, P., Hülse, F., Mao, Q., Jentschke, M., Böhmer, G., Strauss, H.-G., Hirchenhain, C., & Schmidmayr, M. (2021). Association of genomic variants at PAX8 and PBX2 with cervical cancer risk. International Journal of Cancer, 149(4), 893–900. https://doi.org/10.1002/ijc.33614
Rantshabeng, P. S., Tsima, B. M., Ndlovu, A. K., Motlhatlhedi, K., Sharma, K., Masole, C. B., Moraka, N. O., Motsumi, K., Maoto-Mokote, A. K. T., Eshetu, A. B., Tawe, L., Gaolathe, T., Moyo, S., & Kyokunda, L. T. (2024). High-risk human papillomavirus diversity among indigenous women of western Botswana with normal cervical cytology and dysplasia. BMC Infectious Diseases, 24(1), 1163. https://doi.org/10.1186/s12879-024-10058-z
Reynolds, C. W., Lieb, W., Schecter, A., Gaisa, M. M., McGill, S. K., Adofo, E. L., & Beddoe, A. M. (2024). Piloting of a screen–triage–treat surgical approach model for management of anal cancer in Liberia. Annals of Global Health, 90(1), 75. https://doi.org/10.5334/aogh.4576
Rippinger, N., Heinzler, J., Bruckner, T., Brucker, J., Dinkic, C., Hoffmann, J., Dornhöfer, N., Seitz, S., Rom, J., Sohn, C., Schott, T. C., & Schott, S. (2019). The impact of a cervical dysplasia diagnosis on individual cancer prevention habits over time: A bicentric case-control study. Archives of Gynecology and Obstetrics, 299(3), 847–855. https://doi.org/10.1007/s00404-018-5029-5
Rosa, L. M. da, Hames, M. E., Dias, M., Miranda, G. M., Bagio, C. B., Santos, M. J. dos, & Kalinke, L. P. (2021). Epidemiological profile of women with gynecological cancer in brachytherapy: A cross-sectional study. Revista Brasileira de Enfermagem, 74(5). https://doi.org/10.1590/0034-7167-2020-0695
Rosas Salinas, D. K., Vargas Hernández, F., Bermúdez Zapata, D. A., López López, D. M., Saucedo Martínez, M. G., Pérez Cabrera, D. L., López Hernández, V., & Falcón Ramírez, L. A. (2024). Terapia de reemplazo hormonal local y su asociación con lesión intraepitelial escamosa de bajo grado en mujeres mexicanas: Cohorte histórica. Ciencia Latina: Revista Multidisciplinar, 8(6), 2718–2732.
Rourke, M., Fitzpatrick, P., Popoola, O., Boms, R., Mooney, T., Heavey, L., Mohan, C. M., Martin, C. M., Jessop, L., & Russell, N. E. (2024). The effect of HPV vaccination on the rate of high-grade cytology in 25-year-old women attending cervical screening in Ireland. Irish Journal of Medical Science, 193(2), 665–668. https://doi.org/10.1007/s11845-023-03551-y
Rozario, S. do, Silva, I. F. da, Koifman, R. J., & Silva, I. F. da. (2019). Characterization of women with cervical cancer assisted at INCA by histological type. Revista de Saúde Pública, 53. https://doi.org/10.11606/s1518-8787.2019053001218
Salcedo, M. P., Gowen, R., Rodriguez, A. M., Fisher-Hoch, S., Daheri, M., Guerra, L., Toscano, P. A., Gasca, M., Morales, J., Reyna-Rodriguez, F. E., Cavazos, B., Marin, E., Perez, C., Guerra, M., Milbourne, A., Varon, M. L., Reininger, B., Fernandez, M. E., Ogburn, T., … Schmeler, K. M. (2023). Addressing high cervical cancer rates in the Rio Grande Valley along the Texas–Mexico border: A community-based initiative focused on education, patient navigation, and medical provider training/telementoring. Perspectives in Public Health, 143(1), 22–28. https://doi.org/10.1177/1757913921994610
Sladič, M., Taneska, P., Cvjetičanin, B., Velikonja, M., Smrkolj, V., & Smrkolj, Š. (2022). Cervical intraepithelial neoplasia grade 3 in a HPV-vaccinated patient: A case report. Medicina, 58(3). https://doi.org/10.3390/medicina58030339
Soto-Fuenzalida, G. A., Hernández-Hernández, J. A., López-Sánchez, R. del C., Aguayo-Millán, C. D., Villela-Martínez, L. M., Espino-Rodríguez, M., Niño-Parra, V. E., & Ortiz-López, R. (2020). Tipificación de serotipos del virus del papiloma humano de alto riesgo. Ginecología y Obstetricia de México, 88(10), 659–666. https://doi.org/10.24245/gom.v88i10.3432
Staples, J. N., Wong, M. S., & Rimel, B. J. (2018). An educational intervention to improve human papillomavirus (HPV) and cervical cancer knowledge among African American college students. Gynecologic Oncology, 149(1), 101–105. https://doi.org/10.1016/j.ygyno.2017.10.015
Swiecki-Sikora, A. L., Lauder, A., Harris, A., Tagai, E. K., Deng, M., Jeronis, S. L., Houck, K. L., Miller, S. M., & Hernandez, E. (2024). Attitudes about the human papillomavirus vaccine among patients with and without cervical dysplasia. Journal of Lower Genital Tract Disease, 28(1), 18–25. https://doi.org/10.1097/LGT.0000000000000778
Tasić, D., Lazarevic, I., Knezevic, A., Tasić, L., Pikula, A., Perišić, Z., Jovanović, T., & Ćupić, M. (2018). The impact of environmental and behavioural cofactors on the development of cervical disorders in HR-HPV-infected women in Serbia. Epidemiology and Infection, 146(13), 1714–1723. https://doi.org/10.1017/S0950268818001668
Torres-Mejía, G., Ortega-Olvera, C., & Ángeles-Llerenas, A. (2013). Patrones de utilización de programas de prevención y diagnóstico temprano de cáncer en la mujer. Salud Pública de México, 55(Suppl 2), 241. https://doi.org/10.21149/spm.v55s2.5121
Tossas, K. Y., Zhu, B., Perera, R. A., Serrano, M. G., Sullivan, S., Sayeed, S., Strauss, J. F., Winn, R. A., Buck, G. A., & Seewaldt, V. L. (2023). Does the vaginal microbiome operate differently by race to influence risk of precervical cancer? Journal of Women’s Health, 32(5), 553–560. https://doi.org/10.1089/jwh.2022.0309
Wang, J., Wang, C., & Su, T. (2024). Risk factors for residual lesions after total hysterectomy in patients with high-grade cervical intraepithelial neoplasia. BMC Women’s Health, 24(1). https://doi.org/10.1186/s12905-024-03212-x
Ybaseta-Medina, J. (2024). Factores de riesgo asociados a la displasia cervical en mujeres atendidas en un hospital peruano. Revista Peruana de Ginecología y Obstetricia, 70(1). https://doi.org/10.31403/rpgo.v70i2596
Zeng, B., Ren, X., Cheng, Y., Wang, C., Li, J., Jiang, L., Zhang, S., Chen, S., Yu, D., & Lin, J. (2025). Correlation analysis between vaginal microecology and high-risk human papillomavirus (HR-HPV)-positive cervical squamous intraepithelial lesions (SIL). Medicine, 104(27), e42914. https://doi.org/10.1097/MD.0000000000042914
Zhang, M., Wang, H., Ding, R., Li, W., He, P., & Li, H. (2025). Prevalence and risk factors of cervical lesion among married women with low socioeconomic status: A study based on a cervical cancer screening program. International Journal of Public Health, 70. https://doi.org/10.3389/ijph.2025.1608482
Zhu, F., Li, L., Zhang, H., Liu, J., Wu, D., & Xu, Q. (2025). Dynamic causal effects of gut microbiota on cervical cancer lesion progression. Scientific Reports, 15(1). https://doi.org/10.1038/s41598-025-00483-8
Descargas
Publicado
Número
Sección
Licencia
Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
La revista se acoge a la licencia Licencia Atribución (CC BY), permitiendo la posibilidad de copiar, distribuir, exhibir, y producir obras derivadas, siempre y cuando se reconozca y cite al autor.
