Abstract

Research Article

Cervical Squamous Intraepithelial Lesions in Women with Polycystic Ovary Syndrome: A Descriptive Series of 9 Cases

Maydelin Frontela-Noda*, Maite Cabrera-Gamez, Eduardo Cabrera-Rode, Maite Hernandez-Menendez, Raquel Duran-Bornot, Tania Trujillo-Perdomo and Susana Dominguez-Bauta

Published: 24 June, 2026 | Volume 10 - Issue 1 | Pages: 26-33

Introduction: Few studies have explored the vulnerability of women with polycystic ovary syndrome (PCOS) to developing cervical cancer and its precursor lesions. Objective: To describe the clinical, metabolic, and endocrine characteristics of a series of women with cervical squamous intraepithelial lesions and polycystic ovary syndrome, aiming to generate hypotheses regarding the potential pathophysiological mechanisms linking both conditions.
Methods: A descriptive and hypothesis-generating study was conducted. The series consisted of nine women with a cytological diagnosis of cervical squamous intraepithelial lesions (SIL) who also met the Rotterdam criteria for PCOS. Characterization included age, sexual behavior, toxic habits, history of hypertension and diabetes mellitus, body mass index (BMI) and waist-to-hip ratio (WHR), metabolic parameters (insulin resistance, dyslipidemia), serum hormone levels (testosterone, prolactin, estradiol), human papillomavirus (HPV) 16/18 infection, grade of the lesion, and PCOS phenotypes. 
Results: The mean age was 37,11 ± 12,8 years. Abdominal obesity was detected in 55,5% and insulin resistance in 44,4% of cases. Hyperprolactinemia was present in 33,3%. HPV 16/18 infection was identified in 77,7% of cases. Most patients presented high-grade squamous intraepithelial lesions (HSIL) and PCOS phenotype D. 
Conclusion: The presence of HSIL in more than a third of the women in this case series is compatible with the hypothesis that PCOS, particularly those with insulin resistance, abdominal obesity, or hyperprolactinemia, may act as a multifactorial risk factor for cervical lesions, either independently or synergistically through metabolic and hormonal pathways that interact with HPV. These findings should be interpreted as preliminary observations that warrant confirmation in larger, controlled studies.

Read Full Article HTML DOI: 10.29328/journal.acem.1001035 Cite this Article Read Full Article PDF

Keywords:

Cervical squamous intraepithelial lesions; Human Papillomavirus (HPV); Polycystic Ovary Syndrome (PCOS); Multifactorial risk factor

References

  1. Monteagudo G, Ovies G, Gómez M, Cabrera M, Rodríguez K. Guía consensuada por la Sociedad Cubana de Endocrinología para el diagnóstico y tratamiento del síndrome de ovario poliquístico. Rev Cubana Endocrinol [Internet].. 2022 [Access 4/04/2026].;33(3):e346. Available from: https://revendocrinologia.sld.cu/index.php/endocrinologia/article/view/346/366
  2. Teede HJ, Tay CT, Laven JJE, Dokras A, Moran LJ, Piltonen TT, et al. Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. J Clin Endocrinol Metab. 2023 Sep 18;108(10):2447-2469. Available from: https://doi.org/10.1210/clinem/dgad463
  3. Joham AE, Teede HJ. PCOS is a metabolic condition with health impacts on women and men. Nature Reviews Endocrinology. 2022;18: 197–198. Available from: https://doi.org/10.1038/s41574-022-00636-z
  4. Lizneva D, Suturina L, Walker W, Brakta S, Gavrilova-Jordan L, Azziz R. Criteria, prevalence, and phenotypes of polycystic ovary syndrome. Fertil Steril. 2016;106(1):6-15. Available from: https://doi.org/10.1016/j.fertnstert.2016.05.003
  5. Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W, et a. Task Force on the Phenotype of the Polycystic Ovary Syndrome of The Androgen Excess and PCOS Society. The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril. 2009; 91(2):456-88. Available from: https://doi.org/10.1016/j.fertnstert.2008.06.035
  6. Wolf WM, Wattick RA, Kinkade ON, Olfert MD. Geographical Prevalence of Polycystic Ovary Syndrome as Determined by Region and Race/Ethnicity. Int J Environ Res Public Health. 2018; 15:2589-602. Available from: https://doi.org/10.3390/ijerph15112589
  7. Ajmal N, Khan SZ, Shaikh R. Polycystic ovary syndrome (PCOS) and genetic predisposition: a review article. Eur J Obstet Gynecol Reprod Biol. 2019; 3: 100060. Available from: https://doi.org/10.1016/j.eurox.2019.100060
  8. Shetty C, Rizvi S, Sharaf J, et al. Risk of Gynecological Cancers in Women With Polycystic Ovary Syndrome and the Pathophysiology of Association. Cureus. 2023; 15(4): e37266. Available from: https://doi.org/10.7759/cureus.37266
  9. Chittenden BG, Fullerton G, Maheshwari A, Bhattacharya S: Polycystic ovary syndrome and the risk of gynecological cancer: a systematic review. Reprod Biomed Online. 2009; 19:398-405. Available from: https://doi.org/10.1016/s1472-6483(10)60175-7
  10. Ding DC, Chen W, Wang JH, Lin SZ: Association between polycystic ovarian syndrome and endometrial, ovarian, and breast cancer: a population-based cohort study in Taiwan. Medicine (Baltimore). 2018, 97. Available from: https://doi.org/10.1097/MD.0000000000012608
  11. Teede HJ, Khomami MB, Morman R, Laven JSE, Joham AE, Costello MF, et al. Polyendocrine metabolic ovarian syndrome, the new name for polycystic ovary syndrome: a multistep global consensus process. The Lancet. 2026; 0. Available from: https://doi.org/10.1016/S0140-6736(26)00717-8
  12. Frontela-Noda M, Cabrera-Rode E, Hernández-Menéndez M, Cabrera-Gámez M, Durán-Bornot R, Delgado-Herrera DC, et al. Association of Serum Concentrations of Testosterone and Insulin with the Degree of Cervical Squamous Intraepithelial Lesions in Cuban Women. J Cervical Cancer Res. 2022;4(1):327-36. Available from: https://doi.org/10.36959/749/524
  13. Nayar R, Wilbur DC. 3rd ed. Switzerland: Springer International Publishing; 2015. The Bethesda System for Reporting Cervical Cytology: Definitions, Criteria and Explanatory Notes. Available from: https://doi.org/10.1007/978-3-319-11074-5
  14. Sambrook J, Fritsch ER, & Maniatis T. Molecular Cloning: A Laboratory Manual (2nd ed.). Cold Spring Harbor, NY: Cold Spring Harbor Laboratory Press; 1989.
  15. Schmitt M, Dondog B, Waterboer T, Pawlita M. Homogeneous amplification of genital human alpha papillomaviruses by PCR using novel broad-spectrum GP5+ and GP6+ primers. J Clin Microbiol. 2008;46(3):1050-9. Available from: https://doi.org/10.1128/JCM.02227-07
  16. Dunbar SA, Vander Zee CA, Oliver KG, Karem KL, Jacobson JW. Quantitative, multiplexed detection of bacterial pathogens: DNA and protein applications of the Luminex LabMAP system. J Microbiol Methods. 2003;53:245-52. Available from: https://doi.org/10.1016/s0167-7012(03)00028-9
  17. Soto-Brito Y, Sánchez-Domínguez Y, Ortega-León D, Kouri-Cardellá V, Palenzuela-Díaz A, Rodríguez-Lay L, et al. Evaluación de estuches de PCR-tiempo real para detección de virus del papiloma humano de alto riesgo. Revista Cubana de Medicina Tropical [Internet].. 2022 [Access 14/05/2026].;74(1). Available from: https://revmedtropical.sld.cu/index.php/medtropical/article/view/752
  18. Calle EE, Kaaks R. Overweight, obesity and cancer: epidemiological evidence and proposed mechanisms. Nat Rev Canc 2004;4(8): 579- 91. Available from: https://doi.org/doi:10.1038/nrc1408
  19. World Health Organization (WHO). Obesity: preventing and managing the global epidemic. World Health Organization; 2000 (No. 894).
  20. Hernández Rodríguez J, Moncada Espinal OM, Domínguez Alonso E, Díaz Díaz O, Arnold Domínguez Y, García Esplugas DM, et al. Valor de corte del índice cintura/cadera como predictor independiente de disglucemias. Rev Cubana Endocrinol [Internet].. 2020 30(3). Available from: https://revendocrinologia.sld.cu/index.php/endocrinologia/article/view/212
  21. American Diabetes Association Professional Practice Committee for Diabetes*; 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes—2026. Diabetes Care 1 January 2026; 49 (Supplement_1): S27–S49. Available from: https://doi.org/10.2337/dc26-S002
  22. Mathews DR, Hosker JP, Rudenki AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and Beta Cell Function from fasting plasma glucose and insulin concentration in man. Diabetologia 1985;28(7):412e9. Available from: https://doi.org/10.1007/BF00280883
  23. Arranz C, González RM, Álvarez A, Rodríguez B, Reyes A. Criterios de referencia para los indicadores de secreción de insulina y de los parámetros lipídicos en una población mixta hospitalaria. Rev Cubana de Endocrinol [Internet].. 2010 Abr [Access 28/05/2026].;21(1):1-12. Available from: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1561-29532010000100001&lng=es.2010;21(1)1-12
  24. Miranda JJ, Herrera VM, Chirinos JA, Gómez LF, Perel P, Pichardo R, et al. Major cardiovascular risk factors in Latin America: a comparison with the United States. The Latin American Consortium of Studies in Obesity (LASO). PLoS One. 2013;8(1):54056. Available from: https://doi.org/10.1371/journal.pone.0054056
  25. Colectivo de autores. Enfermedades no trasmisibles en Cuba. Tamayo Muñiz S, Pérez Perea L, Pérez González RD, coordinadores. La Habana: Editorial Ciencias Médicas; [Internet]. 2022 [Access 10/05/2026].. Available from: http://www.bvscuba.sld.cu/libro/enfermedades-notransmisibles-en-cuba
  26. World Medical Association Declaration of Helsinki Ethical Principles for Medical Research Involving Human Participants. 75th WMA General Assembly, Helsinki, Finland, October 2024. JAMA 2024; E1-4. Available from: https://doi.org/10.1001/jama.2024.21972
  27. Nygård, M.; Nygård, S. The Future of Cervical Cancer Prevention: From “One-Size-Fits-All” to Personalized Screening. J Pers Med. 2023;13:161. Available from: https://doi.org/10.3390/jpm13020161
  28. Nagelhout G, Mf Ebisch R, Van Der Hel O, Meerkerk GJ, Magnée T, De Bruijn T, et al. Is smoking an independent risk factor for developing cervical intra-epithelial neoplasia and cervical cancer? A systematic review and meta-analysis. Expert Rev Anticancer Ther. 2021;21(7):781-94. Available from: https://doi.org/10.1080/14737140.2021.1888719
  29. Yuan R, Ren F, Xie Y, MPH, Li K, Tong Z. The Global, Regional, and National Burdens of Cervical Cancer Attributable to Smoking From 1990 to 2019: Population-Based Study. JMIR Public Health Surveill 2022;8(12):e40657. Available from: https://doi.org/10.2196/40657
  30. Zhang Y, Zhang J, Li H, Zhuang Y, You Q, Su Y, et al. Synergistic impact of dysglycemia and HPV on cervical cancer risk: a potential mediating role of Ki-67. Front. Endocrinol. 2025;16:1422881. Available from: https://doi.org/10.3389/fendo.2025.1422881
  31. Kamrul-Hasan AB, Aalpona FZ, Mustari M, Akter F, Rahman MM, Selim S. Divergences in clinical, anthropometric, metabolic, and hormonal parameters among different phenotypes of polycystic ovary syndrome presenting at endocrinology outpatient departments: A multicenter study from Bangladesh. J Hum Reprod Sci 2020;13:277-84. Available from: https://doi.org/10.4103/jhrs.JHRS_34_20
  32. Ahmed KY, Aychiluhm SB, Thapa S, Tegegne TK, Ketema DB, Kassa ZY, et al. Cardiometabolic Outcomes Among Adults With Abdominal Obesity and Normal Body Mass Index. JAMA Netw Open. 2025;8(10):e2537942. Available from: https://doi.org/10.1001/jamanetworkopen.2025.37942
  33. Ssedyabane F, Ngonzi J, Kajabwangu R, Najjuma JN, Tusubira D, Randall TC. Association between obesity and cervical intraepithelial neoplasia: results from a case-control study in southwestern Uganda. BMC Women's Health. 2023;23:159. Available from: https://doi.org/10.1186/s12905-023-02315-1
  34. Okoro SA, Ajah LO, Nkwo PO, Aniebue UU, Ozumba BC, Chigbu CO. Association between obesity and abnormal Papanicolaou (Pap) smear cytology results in a resource-poor Nigerian setting. BMC Women's Health. 2020;20:119. Available from: https://doi.org/10.1186/s12905-020-00984-w
  35. Serrano ML, Romero-Rojas AE, Cendales R, Sánchez-Gómez M, Bravo M. Niveles séricos de los factores de crecimiento similares a la insulina I y II y su proteína 3 de enlace en mujeres con lesiones escamosas intraepiteliales y cáncer de cuello uterino. Biomédica. 2006;26:258. Available from: https://doi.org/10.7705/biomedica.v26i2.1415
  36. Chen Y, Bao H, Man S, Sun Y, Huang Y, Luo Y, et al. Prevalence of human papillomavirus infection and its associations with metabolic risk factors in China: a nationwide population-based study. BMC Infect Dis. 2025 Nov 17;25(1):1599. Available from: https://doi.org/10.1186/s12879-025-11791-9
  37. Gu Y, Mu Q, Cheng D. Androgens in cervical cancer: Their role in epidemiology and biology. iScience. 2024 Jun 1;27(7):110155. Available from: https://doi.org/10.1016/j.isci.2024.110155
  38. Stumbar SE, Stevens M, Feld Z. Cervical Cancer and Its Precursors. A Preventative Approach to Screening, Diagnosis, and Management. Prim Care Clin Office Pract. 2019;46:117-34. Available from: https://doi.org/10.1016/j.pop.2018.10.011
  39. Seoung-Ae L, Baik S, Chung SH. Functional roles of female sex hormones and their nuclear receptors in cervical cancer. Essays Biochem. 2021; 65 (6): 941–950. Available from: https://doi.org/10.1042/EBC20200175
  40. Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W, et al. Task Force on the Phenotype of the Polycystic Ovary Syndrome of The Androgen Excess and PCOS Society. The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril. 2009;91(2):456-88. Available from: https://doi.org/10.1016/j.fertnstert.2008.06.035
  41. Sharmin F, Mirza TT, Latif T, Islam FA, Shamsi S, Kabir MA, et al. Hormonal Parameters in Diverse Phenotypes of Polycystic Ovarian Syndrome. Mymensingh Med J. 2023 Jan;32(1):3-9. Available from: https://pubmed.ncbi.nlm.nih.gov/36594292/
  42. González R, Díaz A, Trimiño L, Suárez GA, Guardarrama L, Acosta FA. Hyperandrogenism and metabolic disorders among women with polycystic ovary syndrome. Rev Cubana Endocrinol. 2018;29(3):1-11. Available from: http://dx.doi.org/10.1016/j.fertnstert.2017.06.026
  43. Melgar V, Espinosa E, Sosa E, Rangel MJ, Cuenca D, Ramírez C, et al. Diagnóstico y tratamiento actual de la hiperprolactinemia. Rev Med Inst Mex Seguro Soc [Internet]. 2016 [Access 14/05/2026].;54(1):110-21. Available in: http://www.ncbi.nlm.nih.gov/pubmed/26820213
  44. Mastnak L, Herman R, Ferjan S, Janež A, Jensterle M. Prolactin in Polycystic Ovary Syndrome: Metabolic Effects and Therapeutic Prospects. Life (Basel). 2023 Oct 26;13(11):2124. Available from: https://doi.org/10.3390/life13112124
  45. Davoudi Z, Araghi F, Vahedi M, Mokhtari N, Gheisari M. Prolactin Level in Polycystic Ovary Syndrome (PCOS): An approach to the diagnosis and management. Acta Biomed 2021;92(5):e2021291. Available from: http://dx.doi.org/10.23750/abm
  46. Ascencio Cedillo R, López Pulido EI, Muñoz Valle JF, Villegas Sepúlveda N, Del Toro Arreola S, Estrada Chávez C, et al. Prolactin and prolactin receptor expression in cervical intraepithelial neoplasia and cancer. Pathol Oncol Res. 2015;21:241-6. Available from: https://doi.org/10.1007/s12253-014-9814-6
  47. Ramírez De Arellano A, Riera Leal A, López-Pulido EI, González-Lucano LR, Macías Barragán J, Del Toro Arreola S, et al. A 60 kDa prolactin variant secreted by cervical cancer cells modulates apoptosis and cytokine production. Oncol Rep. 2018;39(3):1253-60. Available from: https://doi.org/10.3892/or.2018.6222
  48. Standing D, Dandawate P, Anant S. Prolactin receptor signaling: A novel target for cancer treatment - Exploring anti-PRLR signaling strategies. Front. Endocrinol. 2023;13:1112987. Available from: https://doi.org/10.3389/fendo.2022.1112987
  49. Chua BWB, Ma VY, Alcántar-Fernández J, Wee HL. Is It Time to Genotype Beyond HPV16 and HPV 18 for Cervical Cancer Screening? Int J Public Health. 2022;67:1604621. Available from: https://doi.org/10.3389/ijph.2022.1604621
  50. Ramírez-de-Arellano A, Villegas-Pineda JC, Hernández-Silva CD y Pereira-Suárez AL. The Relevant Participation of Prolactin in the Genesis and Progression of Gynecological Cancers. Front. Endocrinol. 2021;12:747810. Available from: https://doi.org/10.3389/fendo.2021.747810
  51. Wang H, Liu C, Jin K, Li X, Zheng J, Wang D. Research advances in signaling pathways related to the malignant progression of HSIL to invasive cervical cancer: A review. Biomed Pharmacother. 2024 Nov;180:117483. Available from: https://doi.org/10.1016/j.biopha.2024.117483
  52. Stutts J, Coleman C, Bendre M. High-Risk HPV Negative High Grade Squamous Intraepithelial Lesion - The Value of Pap/HPV Co-testing; Experience at a National Cytology Reference Laboratory. J Am Soc of Cytopathol. 2025;14(5):S1 ISSN 2213-2945. Available from: https://doi.org/10.1016/j.jasc.2025.07.111
  53. Abu-Zaid A, Baradwan S, Alyafi M, Al Baalharith M, Alsehaimi SO, Alsabban M, Alsharif SA, Alqarni SMS, Albelwi H, Jamjoom MZ, Saleh SAK, Adly HM, Alomar O, Salem H. Association between polycystic ovary syndrome and the risk of malignant gynecologic cancers (ovarian, endometrial, and cervical): A population-based study from the U.S.A. National Inpatient Sample 2016-2019. Eur J Obstet Gynecol Reprod Biol. 2024 Aug;299:283-288. Available from: https://doi.org/10.1016/j.ejogrb.2024.06.031

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