Published in PLOS One on 2026-09-11, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Emily R Spencer, Rachel L Winer, Selly Ba, Marie Pierre Sy, John Lin, Qinghua Feng, Geoffrey S Gottlieb, Papa Salif Sow, Nancy B Kiviat, Stephen E Hawes, Ricardo Cobucci
Source: PLOS One • DOI 10.1371/journal.pone.0358080
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Hormonal and immunologic changes related to menopause may play a role in human papillomavirus (HPV) and cervical neoplasia detection, yet this relationship has not been examined in West African populations, where cervical cancer remains a leading cause of cancer-related death. The purpose of this study was to assess whether menopausal status is associated with HPV and cervical neoplasia detection in Senegalese women aged 40–60. We conducted a secondary analysis of three prospective cervical cancer studies in Dakar, Senegal (1998–2011). Participants with known menopausal status and a satisfactory HPV test (N = 3,118) and/or Pap smear (N = 2,907) were included, excluding those with cervical cancer or pregnancy; participants without known HIV status were additionally excluded from the cervical neoplasia analysis. Multivariable logistic regression and generalized estimating equations were used to estimate adjusted odds ratios and 95% confidence intervals, adjusting for age, gravidity, and HIV status. Compared with premenopausal women, postmenopausal women had significantly higher odds of HPV detection (OR = 1.48; 95% CI: 1.18, 1.85), including both high-risk (OR = 1.55; 95% CI: 1.25, 1.93) and low-risk types (OR = 1.64; 95% CI: 1.30, 2.08). Odds of cervical neoplasia were elevated, but non-significant, among postmenopausal women (OR = 1.36; 95% CI: 0.97, 1.90), with increased odds for both high-grade (OR = 1.43; 95% CI: 0.90, 2.28) and low-grade lesions (OR = 1.30; 95% CI: 0.84, 2.02). However, in a sensitivity analysis restricted to participants with known HIV status, these cervical neoplasia odds were attenuated, suggesting caution in interpreting the magnitude of these findings. These findings suggest menopause may contribute to HPV persistence or reactivation, and development of cervical neoplasia. Our results highlight the importance of continued surveillance for HPV and cervical neoplasia among older women, particularly in low-resource settings with disproportionately high cervical cancer burden.
Introduction
Cervical cancer is the fourth most common malignancy among women globally, disproportionately affecting low- and middle-income countries (LMICs), which account for 85% of cervical cancer deaths [1,2]. Over the next two decades, an estimated 11 million women in LMICs will be diagnosed with cervical cancer, many of whom will be of menopausal age [2,3]. In Senegal, cervical cancer is the most prevalent cancer among women, with an incidence rate of 34.7 cases per 100,000 woman years, 261% higher than the global average [4–6], and is the leading cause of cancer-related mortality [7]. This figure likely underestimates the true burden, as many cases remain undiagnosed due to gaps in screening and healthcare infrastructure.
Persistent infection with high-risk oncogenic types of human papillomavirus (HPV) is responsible for roughly 99.7% of cervical cancer cases [1]. HPV infection can cause precancerous lesions, which if left unidentified and/or untreated, may develop into invasive cancers [1]. Although vaccination programs have successfully reduced HPV infection [8,9] and cervical cancer [10] in some populations, their reach in West Africa remains limited. As of 2021, only nine countries in the region have initiated pilot programs, focusing on the vaccination of girls aged 9–14, and only Senegal and Gambia have implemented national vaccination programs. Despite these programs, only about 20% of Senegalese girls have been vaccinated, and just 10% of women aged 30–69 have ever been screened for cervical cancer [6,11,12]. This underscores the ongoing need for screening to reduce cervical cancer risk, even with vaccination efforts in place.
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider public health desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Emily R Spencer, Rachel L Winer, Selly Ba, Marie Pierre Sy, John Lin, Qinghua Feng, Geoffrey S Gottlieb, Papa Salif Sow, Nancy B Kiviat, Stephen E Hawes, Ricardo Cobucci. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
Explore connected evidence
- Evidence brief: Prevalence of high-risk human papillomavirus genotypes and associated factors among HIV-infected women in a reproductive age group attending antiretroviral therapy in Nekemte town, Oromia, Ethiopia
- Evidence brief: Human papillomavirus genotypes and factors associated with major cervical smear abnormalities in a sickle cell endemic area of Kisangani, Democratic Republic of the Congo
- Evidence brief: Cervical leukoplakia in Ghana: Unveiling diagnostic challenges and informing low-resource screening strategies
![Study flowchart showing screening techniques and primary screening outcome.A total of 13,861 women were screened. Of these, 12,847 underwent visual inspection (VIA or enhanced visual assessment [EVA]/mobile colposcopy) with leukoplakia assessment, while 1,014 were screened using non-visual methods (HPV DNA testing and/or cytology) without leukoplakia assessment. Overall leukoplakia prevalence was 0.9% (n = 120/13,861; 95% CI: 0.7–1.1). Prevalence was 0.2% (n = 23) among VIA-screened women and 3.7% (n = 97) among EVA-screened women.](https://healthsignalafrica.com/wp-content/uploads/2026/10/hs-pmc13557359-figure-1024x576.jpg)