Cervical Cancer Deaths Could Surge In Poorer Nations Without Urgent HPV Vaccination Push, Warns Lancet Study

Even as many developed countries are moving steadily towards eliminating cervical cancer through widespread HPV vaccination and organised screening programmes, a new global study has warned that countries with weaker healthcare systems could face a sharp rise in disease burden over the coming decades if preventive measures are not urgently expanded.

The study, published in The Lancet by researchers from Université Laval and the CHU de Québec – Université Laval Research Centre, warns that inequalities in cervical cancer incidence between high-income and low-income countries may widen dramatically by the end of the century.

The findings assume significance for India at a time when awareness regarding HPV vaccination is gradually increasing, but national coverage remains inconsistent across states.

Although several Indian states have initiated pilot vaccination drives and awareness campaigns, experts say large sections of adolescent girls continue to remain outside organised immunisation coverage.

“Currently, the incidence of cancer in lower-income countries is three times higher than in wealthier countries. If HPV vaccination coverage remains the same, it could be 12 times higher by the end of the century. Compared to Canada, we’re even talking about 40 times higher,” said Marc Brisson, a professor in Université Laval’s Faculty of Medicine and a researcher at the CHU de Québec – Université Laval Research Centre, who led the study.

For countries such as India, which continue to account for a substantial share of the global cervical cancer burden, the findings are being viewed as a serious warning for public health systems already struggling with uneven screening coverage and delayed diagnosis.

Cervical cancer remains one of the most common cancers among Indian women, particularly in rural and underserved regions where awareness, screening facilities, and HPV vaccination coverage remain limited.

The research team examined whether countries are on track to meet the cervical cancer elimination targets set by the World Health Organization (WHO) in 2020.

The WHO strategy defines elimination as reducing incidence to below four cases per 100,000 women and recommends vaccinating 90% of girls before the age of 15, screening 70% of women, and ensuring treatment for 90% of precancerous lesions and cancers.

However, five years after the targets were announced, researchers found that many countries with the highest cervical cancer incidence continue to lag behind because of poor vaccination coverage and limited access to screening programmes.

“High-income countries are on the path to elimination, but that is not the case for many low-income nations,” the researchers noted.

The study modelled multiple future scenarios, ranging from the continuation of existing vaccination trends to the full implementation of WHO recommendations.

According to the researchers, failure to strengthen prevention programmes could result in widening global inequalities in cervical cancer incidence over the next several decades.

The study also warned that delays in implementing HPV vaccination programmes could have irreversible consequences.

“If we delay achieving WHO targets by even five years, hundreds of thousands of girls may become infected with HPV during that period, later developing cervical cancer and facing avoidable deaths,” the lead researchers cautioned.

According to the study, the most effective strategy for reducing global inequalities would involve universal HPV vaccination for both girls and boys, combined with catch-up campaigns and improved screening systems.

Such measures, researchers estimate, could prevent nearly 37 million cervical cancer cases worldwide by the end of the century.

Dr. Akansha Sinha, Senior Consultant at the Preventive Oncology Department, Delhi State Cancer Institute, Delhi, pointed out that cervical cancer is among the few cancers that can largely be prevented through vaccination and early detection. (Dr. Sinha was not part of the study.)

She said that while the government’s HPV vaccination campaign is currently focused on girls aged around 15 years, women up to 45 years of age can also opt for the vaccine after medical consultation. Dr. Sinha favoured giving the vaccine to boys also.

She also pointed to persistent social stigma surrounding gynaecological screening, lack of awareness in rural areas, and delayed healthcare-seeking behaviour among women as major barriers to early diagnosis.

While large metropolitan centers in India are increasingly witnessing an uptake of HPV vaccination and routine Pap smear screening, access remains uneven across districts and smaller towns, experts said.