AccScience Publishing / EJMO / Volume 10 / Issue 1 / DOI: 10.36922/EJMO025490509
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ORIGINAL RESEARCH ARTICLE

Risk factors and human papillomavirus genotypes: Investigating their interplay in cervical cancer

Raditya Wratsangka1† ,  Monica D. Hartanti2,3†* ,  Gatot Purwoto4 ,  Lily M. Surjadi1 ,  Miranti P. Aulia5 ,  Alvionita Kogoya6
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1 Department of Obstetric and Gynecology, Faculty of Medicine, Universitas Trisakti, Jakarta, Indonesia
2 Department of Biology, Faculty of Medicine, Universitas Trisakti, Jakarta, Indonesia
3 Center for Biomedical Research, Research Organization for Health, National Research and Innovation Agency, Bogor, West Java, Indonesia
4 Department of Obstetrics and Gynecology, Cipto Mangunkusumo National Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
5 Independent Researcher, Jakarta, Indonesia
6 Biomolecular Laboratory, Faculty of Medicine, Universitas Trisakti, Jakarta, Indonesia
†These authors contributed equally to this work.
EJMO 2026, 10(1), 318–327; https://doi.org/10.36922/EJMO025490509
Received: 6 December 2025 | Revised: 14 January 2026 | Accepted: 20 January 2026 | Published online: 27 February 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
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Abstract

Introduction: Cervical cancer continues to pose a substantial worldwide health challenge, primarily linked to human papillomavirus (HPV) infection. In regions like Indonesia, understanding local genotype distribution is critical for refining screening and vaccination efforts.

Objective: This research explores the complex relationship between various risk factors and the types of HPV detected in cervical cancer patients at a national referral center in Indonesia.

Methods: Ninety-one women diagnosed with cervical cancer were recruited for this cross-sectional study at Cipto Mangunkusumo National Hospital, Jakarta—the toptier referral facility in Indonesia. This setting provides a diverse patient demographic representing various geographical regions across the archipelago. Cervical swabs were collected for HPV genotyping using dot blot hybridization. Various clinical risk factors, including age, age at marriage, age at first pregnancy, parity, smoking habits, hormonal contraceptive history, and the stage of cervical cancer diagnosis, were assessed. Statistical analysis was conducted using Fisher’s exact test to accommodate the distribution of the data.

Results: High-risk (HR) HPV was detected in 62.6% of participants. HPV type 18 was the most prevalent (15.4%), followed by types 52 (14.3%) and 16 (12.1%). Statistically significant associations were observed between HR-HPV presence and both early age at marriage (p = 0.004) and the use of hormonal contraception (p = 0.002). No significant correlations were observed between some patient characteristics (age, parity, and smoking habits) and HPV genotypes (p > 0.05). A total of 35.2% of samples were HPV-negative, potentially reflecting technical challenges or viral integration in advanced-stage cases.

Conclusion: These findings suggest that early marriage and hormonal contraceptive use are significant clinical markers for HR-HPV in this Indonesian population. The dominance of HPV 18 and 52 highlights the need for locally relevant diagnostic tools and the potential transition to nonavalent vaccines. These data are essential for developing locally relevant diagnostic tools and optimizing cervical cancer prevention strategies tailored to the Indonesian demographic.

Keywords
Cervical cancer
HPV genotypes
Hormonal contraception
Age at marriage
Indonesia
Funding
This research was supported by the RIIM LPDP Grant and BRIN (grant number 51/IV/KS/06/2022).
Conflict of interest
The authors declare they have no competing interests.
References
  1. ASCO. Challenges and Opportunities for Global Cervical Cancer Elimination: How Can We Build a Model for Other Cancers? Am Soc Clin Oncol Educ Book. 2025;45(3):e473702. doi: 10.1200/EDBK-25-473702

 

  1. World Health Organization, 2008. Cervical cancer, Fact Sheet. Updated December 2, 2025. Available from: https://www.who.int/news-room/fact-sheets/detail/cervical-cancer (Last accessed on 2025 Feb 23).

 

  1. Wu J, Jin Q, Zhang Y, et al. Global burden of cervical cancer: current estimates, temporal trend and future projections based on the GLOBOCAN 2022. J Natl Cancer Cent. 2025;5(3):322-329. doi: 10.1016/j.jncc.2024.11.006

 

  1. World Health Organization, 2024. WHO, UNFPA commend Indonesia’s efforts to eliminate cervical cancer, urge streamlined vaccine strategy and enhanced screening. Posted November 15, 2024. Available from: https://www.who.int/indonesia/news/detail/15-11-2024-who--unfpacommend-indonesia-s-efforts-to-eliminate-cervicalcancer--urge-streamlined-vaccine-strategy-and-enhancedscreening#:~:text=The%20UN%20agencies%2C%20which%20supported,invasive%20cancer%20to%20be%20managed (Last accessed on 2025 Dec 28).

 

  1. World Health Organization, 2021. WHO recommends DNA testing as a first-choice screening method for cervical cancer prevention. Posted September 11, 2011. Available from: https://www.who.int/europe/news/item/11-09-2021-who-recommends-dna-testing-as-a-first-choice-screeningmethod-for-cervical-cancer-prevention (Last accessed on 2025 Jan 31).

 

  1. Kusakabe M, Taguchi A, Sone K, Mori M, Osuga Y. Carcinogenesis and management of human papillomavirus associated cervical cancer. Int J Clin Oncol. 2023;28(8):965- 974. doi: 10.1007/s10147-023-02337-7

 

  1. United Nations Children’s Fund (UNICEF). 2023. Fast facts about HPV and cervical cancer. Available from: https://www.unicef.org/stories/fast-facts-hpv-cervical-cancer (Last accessed on 2025 Feb 15).

 

  1. Calagna G, Maranto M, Paola C, et al. “Secondary prevention” against female HPV infection: literature review of the role of carrageenan. Expert Rev Anti Infect Ther. 2020;18(9):865-874. doi: 10.1080/14787210.2020.1770082

 

  1. Capra G, Giovannelli L, Matranga D, et al. Potential impact of a nonavalent HPV vaccine on HPV related low and high-grade cervical intraepithelial lesions: A referral hospital-based study in Sicily. Hum Vaccin Immunother. 2017;13(8):1839-1843. doi: 10.1080/21645515.2017.1319026

 

  1. Ministry of Health, Republic of Indonesia. Pedoman Nasional Pelayanan Kedokteran Tata Laksana Kanker Serviks [National guidelines for treatment of cervical cancer]. 2018. HK.01.07/MENKES/349/2018. Available from: https://yankes.kemkes.go.id/unduhan/fileunduhan_1610415049_651524.pdf (Last accessed on 2025 Mar 15).

 

  1. Ministry of Health, Republic of Indonesia, 2023. National Cervical Cancer Elimination (NCCE) Plan for Indonesia 2023-2030. Updated Dec 22, 2023. Available from: https://kemkes.go.id/id/national-cervical-cancer-elimination-planfor-indonesia-2023-2030 (Last accessed on 2025 Dec 28).

 

  1. Robbers GML, Bennett LR, Spagnoletti BRM, Wilopo SA. Facilitators and barriers for the delivery and uptake of cervical cancer screening in Indonesia: A scoping review. Glob Health Action. 2021;14(1):1979280. doi: 10.1080/16549716.2021.1979280

 

  1. Hutajulu SH, Prabandari YS, Bintoro BS, et al. Delays in the presentation and diagnosis of women with breast cancer in Yogyakarta, Indonesia: A retrospective observational study. PloS one. 2022;17(1):e0262468. doi: 10.1371/journal.pone.0262468

 

  1. Burd EM. Human papillomavirus and cervical cancer. Clin Microbiol Rev. 2023;16(1):1-17. doi: 10.1128/CMR.16.1.1-17.2003

 

  1. Kombe Kombe AJ, Li B, Zahid A, et al. Epidemiology and Burden of Human Papillomavirus and Related Diseases, Molecular Pathogenesis, and Vaccine Evaluation. Front Public Health. 2020;8:552028. doi: 10.3389/fpubh.2020.552028

 

  1. Bosco L, Serra N, Fasciana T, et al. Potential impact of a nonavalent anti HPV vaccine in Italian men with and without clinical manifestations. Sci Rep. 2021;11(1):4096. doi: 10.1038/s41598-021-83639-6

 

  1. Hu Z, Zhu D, Wang W, et al. Genome-wide profiling of HPV integration in cervical cancer identifies clustered genomic hot spots and a potential microhomology-mediated integration mechanism. Nat Genet. 2015;47(2):158-163. doi: 10.1038/ng.3178

 

  1. Hartanti MD, Rachmadhany EDA, Mustopa ITI, et al. High mobility group AT-Hook 2 expression is elevated in cervical cancer. Int J Pharm Res. 2020;12:2332-2338. doi: 10.31838/ijpr/2020.12.04.322

 

  1. Doorbar J. The human Papillomavirus twilight zone - Latency, immune control and subclinical infection. Tumour Virus Res. 2023;16:200268. doi: 10.1016/j.tvr.2023.200268

 

  1. Kogoya A, Hartanti MD. Correlations of Expression of KLF5, FHIT and DLG2 with Cervical Cancer. In: Advances in Social Science, Education and Humanities Research. Paris, France: Atlantis Press SARL; 2024:1302-1309. doi: 10.2991/978-2-38476-273-6_132

 

  1. World Health Organization. Global strategy to accelerate the elimination of cervical cancer as a public health problem. Updated Nov 17, 2020. Available from: https://www.who.int/publications/i/item/9789240014107 (Last accessed on 2025 Apr 18).

 

  1. Hartanti MD, Amtha R, Wratsangka R, et al. Operational Feasibility and Performance of mRPA Versus PCR for the Detection of HPV Types 16, 18, and 52 in Clinical Samples: An Exploratory Study. Int J Womens Health. 2025;17:955-964. doi: 10.2147/IJWH.S496621

 

  1. Burger EA, Kim JJ, Sy S, et al. Age of Acquiring Causal Human Papillomavirus (HPV) Infections: Leveraging Simulation Models to Explore the Natural History of HPV induced Cervical Cancer. Clin Infect Dis. 2017;65(6):893-899. doi: 10.1093/cid/cix475

 

  1. Liu F, Chang L, Bai T, Liu X, Hu J. Association of human papillomavirus genotype distribution and cervical cytology: a cross-sectional study. Epidemiol Infect. 2021;149:e95. doi: 10.1017/S0950268821000741

 

  1. Tenjimbayashi Y, Onuki M, Hirose Y, et al. Whole-genome analysis of human papillomavirus genotypes 52 and 58 isolated from Japanese women with cervical intraepithelial neoplasia and invasive cervical cancer. Infect Agent Cancer. 2017;12:44. doi: 10.1186/s13027-017-0155-4

 

  1. Lin Y, Lin WY, Lin TW, et al. Trend of HPV Molecular Epidemiology in the Post-Vaccine Era: A 10-Year Study. Viruses. 2023;15(10):2015. doi: 10.3390/v15102015

 

  1. Gadducci A, Cosio S, Fruzzetti F. Estro-progestin Contraceptives and Risk of Cervical Cancer: A Debated Issue. Anticancer Res. 2020;40(11):5995-6002. doi: 10.21873/anticanres.14620

 

  1. Bergqvist L, Kalliala I, Aro K, et al. Distribution of HPV Genotypes Differs Depending on Behavioural Factors among Young Women. Microorganisms. 2021;9(4):750. doi: 10.3390/microorganisms9040750

 

  1. Lee SA, Baik S, Chung SH. Functional roles of female sex hormones and their nuclear receptors in cervical cancer. Essays Biochem. 2021;65(6):941-950. doi: 10.1042/EBC20200175

 

  1. James CD, Morgan IM, Bristol ML. The Relationship between Estrogen-Related Signaling and Human Papillomavirus Positive Cancers. Pathogens (Basel, Switzerland). 2020;9(5):403. doi: 10.3390/pathogens9050403

 

  1. Qi M, Naranjo AR, Duque AJ, et al. Evaluation of Pre-Analytical Variables for Human Papillomavirus Primary Screening from Self-Collected Vaginal Swabs. J Mol Diagn. 2024;26(6):487-497. doi: 10.1016/j.jmoldx.2024.02.006

 

  1. Dai W, Zeng X, Pantanowitz L, Zhao C. Human papillomavirus negative cervical cancers and precancerous lesions: prevalence, pathological and molecular features, and clinical implications. Gynecol Obstet Clin Med. 2025;5:e000160. doi: 10.1136/gocm-2024-000160

 

  1. Martinelli C, Ercoli A, Parisi S, et al. Molecular Mechanisms and Clinical Divergences in HPV-Positive Cervical vs. Oropharyngeal Cancers: A Critical Narrative Review. BMC Medicine. 2025;23(1):405. doi: 10.1186/s12916-025-04247-z

 

  1. Patel A, Galaal K, Burnley C, et al. Cervical cancer incidence in young women: a historical and geographic controlled UK regional population study. Br J Cancer. 2021;106(11):1753-1759. doi: 10.1038/bjc.2012.148

 

  1. Lau HY, Juang CM, Chen YJ, et al. Aggressive characteristics of cervical cancer in young women in Taiwan. Int J Gynaecol Obstet. 2009;107(3):220-223. doi: 10.1016/j.ijgo.2009.07.029

 

  1. Li S, Hu T, Lv W, et al. Changes in prevalence and clinical characteristics of cervical cancer in the People’s Republic of China: A study of 10,012 cases from a nationwide working group. Oncologist. 2013;18(10):1101-1107. doi: 10.1634/theoncologist.2013-0123

 

  1. Itarat Y, Kietpeerakool C, Jampathong N, et al. Sexual behavior and infection with cervical human papillomavirus types 16 and 18. Int J Women’s Health. 2019;11:489-494. doi: 10.2147/IJWH.S218441

 

  1. Luo D, Peng M, Wei X, et al. Prevalence of Human Papillomavirus and Genotype Distribution in Pregnant and Non-Pregnant Women in China. Risk Manag Healthc Policy. 2021;14:3147-3157. doi: 10.2147/RMHP.S288838

 

  1. Aguayo F, Munoz JP, Perez-Dominguez F, et al. High-Risk Human Papillomavirus and Tobacco Smoke Interactions in Epithelial Carcinogenesis. Cancers. 2020;12(8):2201. doi: 10.3390/cancers12082201

 

  1. Ma K, Li S, Wu S, et al. Impact of smoking exposure on human papillomavirus clearance among Chinese women: A follow-up propensity score matching study. Tobacco Induced Diseases. 2023;21:42. doi: 10.18332/tid/161026
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Eurasian Journal of Medicine and Oncology, Electronic ISSN: 2587-196X Print ISSN: 2587-2400, Published by AccScience Publishing
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