Cervical cancer elimination is not a given

Cervical cancer is one of the most preventable cancers worldwide. We know its cause: persistent infection with high-risk human papillomavirus (HPV), responsible for over 99% of cases. We also have the tools to stop it: HPV vaccination, high-performance tests for cervical screening, and treatment.

Yet cervical cancer remains the fourth leading cause of cancer-related mortality among women globally and the leading cause of cancer death in multiple countries across sub-Saharan Africa, with a similarly high incidence and mortality in parts of Southeast Asia and Latin America.

Recent data make this paradox impossible to ignore. Cervical cancer cases are projected to increase by more than 50% by 2050, surpassing one million new cases annually, with deaths rising by over 80% to approximately 630,000 each year.

This widening gap between incidence and mortality is telling. It suggests that while cases may be identified, too many women are unable to access timely treatment.

This is not a failure of innovation. It is a delivery failure driven by gaps in financing, health system readiness and the inability to scale proven interventions for cervical cancer elimination.

In some countries, the barrier is the lack of sustained domestic budgets to translate policy into implementation. In others, programmes exist but struggle to scale due to constraints that impact laboratory capacity, the healthcare workforce and patient care pathways.

In 2020, all 194 WHO Member States endorsed the Global Strategy to Accelerate the Elimination of Cervical Cancer, setting clear targets: vaccinate 90% of girls, screen 70% of women at ages 35 and 45, and treat 90% of women with disease. On paper, the global commitment to cervical cancer elimination is unprecedented. In practice, progress remains uneven.

Global HPV vaccination coverage remains below target, although significant progress has been driven by partners such as Gavi, the Vaccine Alliance, in expanding access to low- and middle-income countries.

Screening remains one of the weakest links in the elimination pathway. Around 36% of women have been screened at least once, and fewer than 10% have been screened with a high-performance test, the HPV-DNA test.

Treatment capacity also lags. In many settings, pathology services remain limited and radiotherapy remains unavailable or inaccessible, despite being essential for many women with invasive disease. The result is a widening gap between global ambition and country-level implementation.

As Heather White, Executive Director, TogetHER For Health, notes: “The WHO’s cervical cancer elimination strategy created a clear policy framework for countries to act. But systems have been slower to evolve to deliver what is needed at scale, from products and services to data and coordination.

“There remains a significant gap between what we know works and our ability to get these tools into the hands of those who need them most. Closing the gap is essential if elimination is to become a reality.”

This gap between policy commitment and delivery is at the core of the challenge. Without systems that can translate strategy into action, progress toward elimination will remain limited.

Much of the global narrative has rightly focused on vaccinating adolescent girls. This is essential but it is not sufficient. Evidence shows that elimination requires a combined approach: vaccination of younger cohorts alongside systematic screening and treatment for adult women already at risk.

Approximately 85% of new cases and 90% of deaths occur in women aged 40 and older. Vaccinating a 12-year-old girl today may prevent cancer decades from now. But it will not prevent the death of a 45-year-old woman tomorrow.

As Mercy Moses, a cervical cancer patient, shares: “I was 22 when I was diagnosed with stage 2B cervical cancer in 2023. Three years later, I am still struggling to access the full care I need. Surviving cancer is not just about the will to live; it is about access to treatment.

“The biggest barriers I have faced are affordability, availability, and access. The cost of care is high, services are limited, and health systems are stretched. These challenges make it difficult to continue treatment, even when you are willing to fight.

It takes courage to accept a cancer diagnosis, and even more to continue treatment. But without the resources to access care, that courage can quickly be exhausted. No one chooses to die when treatment should be possible.”

Her experience reflects a broader reality that for many women, the challenge is not whether solutions exist but whether health systems are able to deliver them in time. Without a parallel focus on scaling screening and treatment, mortality will continue to rise even as vaccination coverage improves.

As Tamika Felder, cervical cancer survivor and founder of the Cervivor movement, highlights, “The primary barrier isn’t just the absence of a clinic; it is the presence of a trust gap, shaped by stigma and systemic neglect. Even where screening services exist, medical mistrust and the shame associated with HPV keep many women from accessing care.

“To achieve elimination, we need to treat community trust as seriously as clinical capacity, and recognize survivors as trusted voices who can help turn services into action.”

Addressing inequity is therefore not only about expanding services, but also about building trust and ensuring that women are willing and able to access care.

Global averages obscure the true nature of the problem of cervical cancer elimination. Countries with medium Human Development Index (HDI) levels are projected to see the largest absolute increases in cervical cancer cases and deaths. These are health systems in transition, facing a dual burden of infectious and non-communicable diseases without a fully developed cancer control infrastructure.

At the same time, low-HDI countries are expected to experience the largest relative increases, with some facing up to a 150% rise in mortality. The contrast is already visible today. Cervical Cancer incidence in Africa stands at approximately 26 per 100,000 women, compared to 6.4 per 100,000 in North America.

The threshold for elimination is 4 per 100,000. But the divide is not only between countries; It exists within them. A country may show strong national progress while significant portions of its population remain excluded from screening and treatment. This is not simply a gap in access. It is a gap in system design, delivery and prioritization.