Summary
This systematic review and meta-analysis of 25 studies (14,304 participants) found that low folate status—measured by dietary intake, serum, and red blood cell folate—was associated with elevated cervical intraepithelial neoplasia and cervical cancer risk. Dose–response analysis suggested that an additional 240–280.5 μg/day of folate supplementation could reduce CIN/CC risk by up to 26%, and each 5-nmol/L increase in serum folate and 50-nmol/L increase in red blood cell folate were associated with 21% and 5% risk reductions, respectively. Mendelian randomisation provided genetic support for a causal association between higher folate intake and reduced cervical cancer risk.
Regional applicability
The findings are globally relevant and applicable to United Kingdom clinical practice and public health policy, particularly for cervical cancer prevention strategies and nutritional guidance for women. The UK's cervical screening programme and dietary recommendations could consider folate status monitoring, though implementation would depend on local epidemiological context and cost-effectiveness evaluation.
Key measures
Dietary folate intake (μg/day); serum folate (nmol/L); red blood cell folate (nmol/L); odds ratios for CIN/CC risk; CIN regression rates
Outcomes reported
The study examined associations between folate status (dietary intake, serum and red blood cell folate concentrations) and cervical intraepithelial neoplasia (CIN) and cervical cancer (CC) risk, as well as folate supplementation and CIN regression. Dose–response meta-analysis quantified risk reductions associated with additional folate supplementation and changes in circulating folate biomarkers.
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