Readiness Assessment for Cervical Cancer Elimination in Europe

OBJECTIVES: Human papillomavirus (HPV) is a well-established cause of cervical and other cancers. The World Health Organization (WHO) and European Commission released strategies and recommendations to facilitate cervical cancer (CC) elimination with a special focus on broad HPV vaccination, screening, and CC treatment availability, program implementation, and surveillance systems. We intended to assess readiness of 31 European countries to eliminate CC by defining status of programmes and policies, implementation, and existing data systems essential for decision-making.

METHODS: The scoring framework used for this assessment comprised of three domains: vaccination, screening, and treatment, each comprising of two subdomains: decision- making and implementation. Countries were assigned scores based on availability of predefined parameters and tiered into one of four archetypes: low readiness (0-25% of maximum points collected), moderate-low readiness (26-50%), moderate-high readiness (51-75%), and high readiness (76-100%).

RESULTS: Sweden, Ireland, and the United Kingdom achieved the highest overall scores, demonstrating the highest readiness for CC elimination (93%, 89%, and 87%, respectively). Western countries generally outperformed Eastern European countries, with Bulgaria, Cyprus, and Greece showing lowest readiness. Vaccination domain scores were generally higher than screening and treatment domain scores with Sweden, Portugal, and Ireland showing highest readiness (91%, 88%, and 88%, respectively) and Czechia, Greece, Croatia, Poland, and Bulgaria showing lowest (50%). Across all three domains, countries generally scored lower across the implementation subdomain compared to the decision-making subdomain. One third of countries have limited/no vaccination and screening uptake monitoring systems or publicly reported rates essential for informed decision-making.

CONCLUSIONS: Our assessment highlights the diversity in decision-making and implementation of vaccination, screening, and treatment programmes across European countries. This framework illustrates current progress and highlights key areas for improvement to strive towards CC elimination as a public health problem.