





































Special Edition: Junior Clinical Research (2022), Vol. 2 No. S2 
 https://doi.org/10.47488/dhrp.v2iS2.59 

 

 

 
 
 DHR Proceedings ǀ http://dhrproceedings.org  78 2022, Vol. 2 No. S2 78-85 
   

 

COMMENTARY 

Cervical Cancer Risks and Outcomes in 

Hispanic Women 

Adrian Alberto Salinas1,2, Daniella Barrera1,2, Mia Brizuela1,3, Andrea Sophia Cordova1,3, Natalia 

Palau1,3, Alysa Gonzalez1,2, Juan Correa Jr.1,3, Esmeralda Rios1,2, Rosa Villarreal1,3 

 
12nd Annual Junior Clinical Research Internship, South Texas Academy for Education & Training in Research, DHR Health 

Institute for Research & Development 
2Edinburg High School, Edinburg, TX 
3Lyndon B Johnson, Laredo, TX 

 

All correspondence should be addressed to Program Director, 2nd Annual Junior Clinical Research Internship Program, DHR 

Health Institute for Research & Development, 5323 S McColl Road, Edinburg Texas, 78539 

 
Received 07/01/2022 

Accepted for publication 08/05/2022 

Published 08/05/2022 

 

Keywords: Cervical cancer; HPV-16; HPV-18  

 

 

Introduction  

 

Cervical cancer is a worldwide threat 

affecting women, particularly in impoverished 

communities that lack adequate healthcare.  Cervical 

cancer is a malignant tumor of the lower part of the 

uterus.  Cervical cancer affects women throughout the 

world from all walks of life.   Although it affects all 

races, there are disparities among ethnic groups 

depending on geographic location.  Certain geographic 

locations such as the Rio Grande Valley have higher 

incidence of cervical cancer.  The Rio Grande Valley 

has a large Hispanic population and many of these 

women do not seek medical care which could prevent 

or improve cervical cancer diagnosis (1). In 2018 there 

were 570,000 cases of cervical cancer and 311,000 

deaths from it around the world (2). Cervical cancer 

was the fourth most common disease in women. China 

and India together contributed more than a third of the 

global cervical burden, with 106,000 cases and 48,000 

deaths in China, and in India 97,000 cases and 60,000 

deaths (2). Cervical cancer ranked in the top three 

cancers affecting women younger than 45 years in 146  

 

 

(79%) of 185 countries assessed (2). In Texas, it was 

recorded by the Texas Health and Human Services in  

2019 that there were over 1,395 women affected by 

cervical cancer and an estimated 447 would die from 

the disease (2). 

 

Risks  

 

Human Papillomavirus  

 
Human Papillomavirus also known as HPV is 

a non-enveloped, double-stranded, circular DNA virus 

that has been proven to be a leading factor in the 

development of cervical cancer in women (3). HPV 

has over 100 subtypes identified, and from those 100 

there are many subtypes that are specifically 

associated with the development of cervical cancer 

some of them being subtypes 16, 18, 31, 33, 35, 45, 

52, and 58 (4) For example, HPV 16 has been shown 

to affect the genomes of the host (13). Even though 

HPV is not genetically inherited, recent studies have 

discovered the variant to be transmitted naturally. The 

variant has been discovered in European-Asians, 

Europeans, and Africans (5). HPV also contains viral 



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proteins that cause infection and ultimately progress 

into cancer some being E1-E7 and L1-L2 which again 

are essential for a viral propagation (3). The virus for 

the most part is acquired through sexual activity and 

develops into the body when it enters the epithelium 

through disruptions of the skin/mucosa and starts 

infecting the basal stem cells (see Figure 1) (4). But 

this viral DNA doesn’t instantly merge into a person’s 

genome, it remains as an independent episome for a 

period before that. And even though HPV is a leading 

factor associated with cervical cancer. It alone cannot 

cause cancer and there are factors that trigger it to 

happen such as smoking, pregnancy/childbirth, and 

the use of oral contraception (4). To prevent certain 

cancerous lesions and subtypes there is a vaccine that 

has been shown to be helpful when it comes to the 

prevention of cancers that HPV can cause, and it is 

said to be most effective when given during the ages 

of 9-12 or before teens initiate in sexual activity (4). 

Prevention of contracting HPV may also include 

abstinence practicing safe sex.  

 

 
Figure 1 

 

Smoking  

 
Smoking does not only cause long-term 

effects with your lungs, but it has more recently been 

proven to be linked with HPV and cervical cancer. In 

a study published in the Journal of Epidemiology and 

Public Health, researchers found that women who 

were exposed to second-hand smoke had a 73% 

increase in risk for developing cervical cancer, 

especially if they were already exposed to HPV (6). 

Researchers also stated that women that were exposed 

have a 12.57% more likely chance of having cervical 

cancer (6). Tobacco products affect the body's immune 

system, and this makes it harder for women who 

smoke to fight off infections and viruses that they may 

contract into their bodies (6). Therefore, avid smokers 

or women with constant exposure to second-hand 

smoke who experience frequent HPV infections may 

be more likely to develop a cancer like Cervical 

Cancer over time. 

 

Use of Oral Contraceptives  

 
Oral contraceptives (OCs) are currently 

prescribed as an effective way of preventing unwanted 

pregnancies. However, similar to other medications, 

OCs come with a plethora of unwanted side-effects. 

Some of these side effects could lead to cervical 

cancer. The specific OCs associated with these 

cervical cancers are implants, vaginal rings, and other 

progesterone contraceptives (7). According to 

research on estrogen-progestogen and progestogen-

only contraceptives, synthetic steroids stimulate 

receptors all over the body and may lead to 

development of cancer. These receptors are very 

prominent in reproductive tissues. However, immune 

cells and other tissues are also affected by these 

hyperactive receptors. The longer the OCs are used, 

the higher the risk of developing cervical cancer. 

Moreover, a study conducted over a 10-year span 

concluded that women who use OC’s are at a 95% 

increase of cervical cancer. It was discovered that 

OC’s not only higher the risk of cervical cancer but 

also influence its formation (8). 

 

Diet 

 
Although there is an insignificant amount of 

information regarding diet and nutrition in relation to 

HPV and cervical cancer, a western diet is considered 

a high-risk for cervical cancer. In a study done by the 

University of Catania where they monitored the 

dietary patterns, women following a western diet were 

considered to be high-risk (9). Research indicated 

women consuming a “western” diet which consisted 

of a higher intake of red and processed meats and 

foods such as chips and other snacks were generally 

associated with a higher risk of developing HPV and 

other HPV-related cervical lesions (9). Alternatively, 

women that had a more “prudent” diet that consisted 

of a higher intake of raw vegetables, legumes, and 

vegetable soups were less likely to be at risk of 

developing HPV and other infections (see Figure 2)  

(9).  Dietary antioxidants such as vitamin D and 

carotenes have also been proven to help fight 

against/neutralize harmful ROS that may be in a 

woman's body or on its own (10).  

 



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Figure 2. 

Foods that positively (green) and negatively (red) 

characterize dietary patterns.  

PCA1: Western Diet & PCA2: Prudent Diet. 

 

 

Genetics 

 
Researchers have discovered through several 

research studies that some genetic aspects may 

increase the probability of developing cervical cancer. 

It is considered that 36% of cervical cancer cases may 

be linked to genetics (11). DECIR 1 is a gene that has 

been linked to an increased risk of cervical cancer as 

well as other types of cancer. DICER1 is a rare genetic 

mutation that makes an individual more prone to the 

development and growth of tumors. These tumors 

have been associated with cervical cancer (12). 

DICER1 syndrome typically affects young females 

with cervical cancer patients who are in their twenties 

or younger (13). DICER1 syndrome is not the only 

genetic link between cervical cancer and women.  

 

Cervical Cancer Screening 

 
Screening is essential, particularly for 

younger females to detect cervical cancer. Ages 

starting from 21 to as much as 65 years old are at 

critical risk to receive cervical cancer. Papanicolaou 

screenings is a procedure where tissue is removed 

from the surface and around the cervix to check for 

malignant cells. These tests are recommended for 

females aged 21–29-year-old at least every three years 

(14). Using Human papillomavirus DNA test and pap 

smear are tests recommended for early detection and 

risks of cervical cancer (15). 

 

Ethnic Differences and Disparities in Hispanic 

Women  

 
Through research it was found that women 

from both Hispanic and African American populations 

run a higher risk of developing cervical cancer. 

Hispanic women are nearly twice as likely to be 

diagnosed with cervical cancer as opposed to other 

populations and furthermore African American 

women are more likely to die from this disease (15, 

16). Access to testing such the pap-smear test is 

difficult for women of these populations due to lack of 

access to health care, education, and awareness 

campaigns (14). According to research, ethnicity is a 

major factor and a disparity as well to access to health 

care, therefore the lack of screening tools to detect 

early signs of cervical cancer is a huge problem in our 

country. All of the above may contribute to the 

increase in cervical cancer cases in these populations 

(14). 

Another very important factor as far as ethnic 

differences and disparities is the issue of health 

literacy and why it is important for health care 

facilitators to educate populations of Hispanic women. 

Research has found that Health illiteracy and cervical 

cancer screening among Mexican American women 

needs to be addressed and is essential to improving 

outcomes (17).  

 

Culture 

 
In addition to the high prevalence of cervical 

cancer in Hispanic women, culture and social factors 

contribute to the lack of understanding of the disease. 

Due to the lack of understanding of the disease, 

families and caretakers are unable to communicate and 

provide awareness about the importance of getting 



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tested (18). The Latina women’s stigma of privacy 

especially when it comes to certain healthcare 

practices is a big factor, therefore putting them at risk 

(18). Hispanic cultural beliefs such as stigma 

surrounding sensitive health topics, alternative 

remedies promoted and consumed, and the gender of 

the physician may often lead to negative outcomes 

because they are not well informed of the awareness 

and dangers of cervical cancer. Lack of education, 

healthcare services, and additional resources may 

possibly contribute to negative outcomes for these 

women (18). 

 

Stages, Signs, and Symptoms of Cervical 

cancer progressing 

 

Stages of Cervical Cancer 

 
Through research, it has been discovered that 

cervical cancer is an abnormal growth of malignant 

cells located in the cervix and metastasizes as the 

tumor grows (19). Cervical cancer has four stages, 

each containing sub-stages (20). Stages are organized 

by severity, determined by the depth of the tumor and 

whether it has spread (21).  

 

Stage I 

 
In the initial stage I, the cancer or tumor is 

limited to the cervix (21). As previously mentioned, 

cancer has sub-stages known as IA1, IA2, IB1, IB2, 

and IB3 (21). The difference in sub-stages between 

IA1 and IA2 is that the tumors in IA1 are less than or 

equal to 3 mm (⅛ inches) deep (21). Whereas in IA2, 

the tumor’s depth is between 3 mm and 5 mm (⅕ 

inches). From sub-stage IB1, the tumor is deeper than 

5 mm but no more than 2 cm (⅘ inches). The tumor’s 

size in IB2 is between 2 cm- 4cm. Stage IB3 cancer is 

at least 4 cm in size but is only limited to the cervix 

(21).  

 

Stage II 

 
Stage II consists of three sub-stages, IIA1, 

IIA2, and IIB1 (Figure 3). Cancer in sub-stages IIA1 

and IIA2 spread beyond the cervix and the uterus, yet 

it has not reached the parametrium, which is a 

connective tissue to the pelvis, surrounding the uterus 

(22). The size of the tumor is no larger than 4 cm 

(about 1 3/5 inches) in IIA1, and in IIA2, the cancer is 

4 cm or larger. Unlike IIA1 and IIA2, cancer in the 

IIB1 phase has developed in the tissue of the cervix, 

the parametria, and beyond the cervix and uterus.  

 

Stage III 
 

Stage III cancer has metastasized to the lower 

area of the vagina and/or walls of the pelvis and has 

three sub-levels known as IIIA, IIIB, and IIIC (Figure 

3) (21). Cancer in IIIA has invaded the lower part of 

the vagina. On the contrary, the tumor in IIIB can 

spread to the walls of the pelvis. In this stage, not only 

can it block one or both of the ureters, but it could also 

affect the kidneys and cause hydronephrosis (21). 

Hydronephrosis is a condition where there is an 

abnormal enlargement of the kidneys, caused by 

blockage of the ureters or urine leaving the bladder 

(23). The tumor in IIIC, regardless of the size, can 

metastasize to the pelvic lymph nodes (IIIC1) or para-

aortic lymph nodes (IIIC2).  

 

Stage IV 
 

Ultimately, the last phase of the cancer is 

Stage IV (21). The severity of cancer has grown and 

affected other organs, such as the bladder, rectum, and 

depending on the extremity, the lungs, or bones. Sub-

level IVA focuses on cancer growing out of the pelvis, 

affecting the bladder, and/or rectum. IVB, the other 

phase of Stage IV, is when the tumor has advanced to 

other distant organs outside of the pelvis area, such as 

bones, lymph nodes, and lungs (Figure 3) (24).   

 

 
Figure 3 

Staging in Cervical Cancer  

  

 



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Signs and Symptoms  

 
Regarding the signs and symptoms of 

cervical cancer, patients undergo specific 

characteristics as cancer progresses. Some of these 

signs and symptoms appear early on in certain cancers, 

yet in cervical cancer, they do not appear till later as 

the cancer advances and/or is hard to detect (20). 

Within Stage I, women may find signs of watery or 

vaginal discharge that is dense and may have a foul 

odor. Patients can have vaginal bleeding after 

intercourse, between menstrual cycles, or after 

menopause, and their menstrual periods may be 

heavier and last longer than usual (20). These signs are 

mainly considered within the first stage of cervical 

cancer. However, as the cancer advances and worsens 

throughout the body, such as stages II-IV, patients 

may experience pelvic/abdominal pain, diarrhea or 

pain and rectal bleeding, fatigue, rapid weight loss of 

more than 10 lbs., loss of appetite, backaches or 

swelling in the legs, painful/difficult urination with 

blood in the urine, and an overall sense of feeling ill 

(20). 

 

Trends of Cervical Cancer  

 

Trends in Incidence 

 
Cervical cancer is one of the most common 

cancers in females worldwide. In the United States, its 

incidence and mortality rate has been declining due to 

the wide scale screenings, pap tests, and/or pap smear 

tests (25). The screening procedure can find cervical 

cancer early. Most patients are diagnosed between the 

ages of 35 and 44 and the average age at diagnosis is 

50 years old (26). Patients diagnosed with cervical 

cancer are also likely to have HPV and most patients 

have a history of smoking cigarettes.  

 

Researchers for cervical cancer once stated 

that cervical cancer was one of the most common 

cancerous deaths for women in the United States. The 

cervical cancer rate has dropped significantly with 

women now taking pap tests/pap smear tests (26). 

People younger than 20 years old rarely develop 

cervical cancer; however, the risk does go up for 

women in their mid 30s. Many older women do not 

realize that the risk of developing cervical cancer is 

still going up as they age (26).  

 

Trends in HPV  

 
Every year, about 19,400 women may 

experience cancers caused by HPV including cervical 

cancer. In recent years, the HPV test has been 

approved as another screening test for cervical cancer 

because almost all cervical cancer patients are caused 

by HPV. Many of the patients that found out they had 

HPV was because of their symptoms, for example, 

pelvic pain during intercourse, vaginal bleedings 

between periods or after menopause, and watery, 

blooding vaginal discharge (27). HPV is the most 

common infection of the reproductive tract this can be 

due to the fact that this virus can be transmitted during 

intercourse. Some cervical cancers come from an HPV 

infection of gland cells in the cervix and are called 

adenocarcinomas. Most women find out they have 

HPV when they get an abnormal Pap test result. If 

present, the test can determine whether the HPV is a 

low- or a high-risk type. Studies show that even 

though there is no treatment for the virus itself, there 

are treatments for the health problems that HPV 

causes, for instance, cervical precancer treatment is 

available. Women who get routine Pap tests and 

follow-ups can identify problems before the cancer 

develops. Additionally, the HPV vaccine can be 

administered starting at the age 9, through 26 years 

(28).  

 

History of Cigarette Usage  

 
Women who smoke are about twice as likely 

as those who do not smoke to be diagnosed with 

cervical cancer. When someone smokes, they and 

people around them are exposed to many cancer-

causing chemicals that affect organs other than the 

lungs. These dangerous substances can be absorbed 

through the lungs and carried throughout the 

bloodstream and go around the body. Tobacco by-

products have been found in the cervical mucus of 

women who smoke and who have been diagnosed with 

cervical cancer (29). Studies show that these 

substances can damage the DNA of cervix cells and 

may contribute to the development of cervical cancer 

(30). It has also been studied that smoking can weaken 

your immune system which also makes you more 

likely to be affected by HPV(31). Patients that are 

diagnosed with cervical cancer tend to have a history 

of smoking. Smoking has been known to impact the 

immune system cells that are important in fighting the 

HPV virus, allowing the virus to promote 

precancerous lesions and cancer of the cervix and 

genital areas (32).   

 

Prevention and Treatment  

 
Cervical cancer is a very common cancer in 

women, especially in Latin women, however there are 



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various ways to treat this cancer. In fact, cervical 

cancer rates for Latino women are 44% higher than 

any other race (15). One reason for the higher 

incidence of cervical cancer is that Latinas are less 

likely to get regular Pap tests due to lack of financial 

resources (15). Since they cannot afford to attend the 

doctor regularly and be screened for cervical cancer, 

the cancer can grow undetected and cause damage, 

which can be fatal. Spreading awareness can increase 

screening and mortality can be reduced. Early 

education is also important. Parents should talk with 

their children about these topics regarding their 

reproductive system. Since it may be difficult for 

parents to broach the topic of the reproductive system, 

there should be programs at school to teach students 

more about their bodies. After students gain this 

knowledge, they can help educate others which will 

spread further awareness and maybe in the future, the 

rates of cervical cancer in Latina women may go 

down. The most accessible way women can prevent 

cervical cancer is by taking the HPV vaccine.  It is 

usually given to children between the ages of 11 to 12 

years old (33). If women still develop cervical cancer, 

there are surgical options available such as 

cervicectomy surgery or radical trachelectomy 

surgery. The difference between these two options is 

very crucial. Radical trachelectomy allows the patient 

to still be able to reproduce by removing only the 

cervix unlike in the cervical surgery where both the 

cervix and the uterus are removed (34).  

 

Conclusion  

 
The mortality and morbidity of cervical 

cancer may not be a preventable disease in areas where 

healthcare is not accessible. However, pap tests, which 

are a screening tool for cervical cancer, can be used for 

early detection. Cervical cancer is prevalent in women, 

but health literacy and awareness may be some factors 

that also need to be addressed in communities where it 

is not as accessible, as is the case in South Texas. In 

conclusion, cervical cancer has various treatments but 

many people, especially in cities of South Texas are 

not fully educated to understand the repercussions of 

cancer as well as the stigma that comes with the 

culture. More studies for how to deliver education to 

communities that lack the knowledge of how cervical 

cancer can be prevented, access to healthcare and 

disparities for the low-income families are needed. 

 

 

 

 

 

Acknowledgments 

 
Dr. Monica Betancourt-Garcia, MD, Scientific 

Director; Melissa Eddie, MS, Program Manager; 

Xochitl Lopez, BS, Program Coordinator 

 

Funding 

 
Funded by DHR Health Institute for Research & 

Development; DHR Health; Region One ESC 

GEARUP College Ready, Career Set!; Region One 

ESC GEARUP College Now, Career Connected and 

Region One ESC PATHS 

 

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	Adrian Alberto Salinas1,2, Daniella Barrera1,2, Mia Brizuela1,3, Andrea Sophia Cordova1,3, Natalia Palau1,3, Alysa Gonzalez1,2, Juan Correa Jr.1,3, Esmeralda Rios1,2, Rosa Villarreal1,3
	Introduction

