HPV Vaccination for Cervical Cancer Prevention is not Cost-Effective in Japan

Background: Our study objectives were to evaluate the medical economics of cervical cancer prevention and thereby contribute to cancer care policy decisions in Japan. Methods: Model creation: we created presenceabsence models for prevention by designating human papillomavirus (HPV) vaccination for primary prevention of cervical cancer. Cost classification and cost estimates: we divided the costs of cancer care into seven categories (prevention, mass-screening, curative treatment, palliative care, indirect, non-medical, and psychosocial cost)and estimated costs for each model. Cost-benefit analyses: we performed cost-benefit analyses for Japan as a whole. Results: HPV vaccination was estimated to cost $291.5 million, cervical cancer screening $76.0 million and curative treatment $12.0 million. The loss due to death was $251.0 million and the net benefit was -$128.5 million (negative). Conclusion: Cervical cancer prevention was not found to be cost-effective in Japan. While few cost-benefit analyses have been reported in the field of cancer care, these would be essential for Japanesepolicy determination.     

Knowledge and Attitudes of Medical and Non-Medical Turkish University Students about Cervical Cancer and HPV Vaccination

Background: This study was conducted to determine knowledge, attitudes and practices about cervical cancer and HPV vaccination of students studying in various faculties of Erciyes University. Materials and Methods: The study was performed among the first and fourth grade students of Medicine, Theology, Education and Economics and Administrative Sciences (FEAS) faculties of Erciyes University. It was aimed to reach 1,073 students and 718 were evaluated. A questionnaire consisting of 48 questions related to the socio-demographic characteristics, knowledge, attitude and practices about cervical cancer and HPV vaccination was administered to the students. The chi-square test and logistic regression were used for the statistical analyses. Results: Of the students, 78.3% were aware of cervical cancer, while 36.1% of them were aware of the HPV vaccine. The percentage hearing about cervical cancer and HPV vaccination was significantly higher among the students of the medical faculty than the others and among fourth grade students comparing with the first grade. The marital status and the presence of a health worker in the family had no significant impact on the knowledge level of the students. The acceptability of the HPV vaccination was low among all students. Conclusions: The knowledge levels of the university students about cervical cancer and HPV vaccination are inadequate. This deficiency is more pronounced among the non-medical students and there is no significant increase during the faculty years. Non-medical students must be provided with information about important public health issues by elective courses. HPV vaccination could provide many benefits for men and women by decreasing the morbidity and mortality of cervical, anal, and penile cancers.     

Cervical Cancer and HPV Vaccines in Developing Countries

Cervical cancer is the second most common cancer among women in the world. Despite a decline of up to70% in its incidence and prevalence through screening programs, it is still the most common gynecologicalcancer worldwide. Since the human papilloma virus (HPV) was conclusively identified as the etiological factorinducing cervical cancer, investigations during the last two decades have been concentrating on producing avaccine against HPV virus. Thus prevention of HPV infection has been the main purpose and vaccination isexpected to reduce up to 70% of related cervical cancer and prevent precancerous and cancerous lesions of thegenitalia. However, screening programs are still essential for those who have already been exposed to the highrisk forms of the virus and educational and information programs continue to play important roles to increasethe success rate of screening, by whichever of the modalities is most appropriate for the local conditions.     

Innovations in HPV Vaccination and Roles of Nurses in Cervical Cancer Prevention

The human papilloma virus (HPV) is the main aetiological agent for cervical cancer, one of the most frequentcancers observed in women throughout the world. There are effective programs for reducing the incidence ofcervical cancer with HPV vaccination. The objective of this study was to discuss the applicability of the HPVvaccination and the role of nurses in prevention of cervical cancer. Use of bivalent and quadrivalent vaccineshas been initiated against the types of HPV which are the primary cause of cancer. The quadrivalent HPVvaccination has entered into the routine vaccination schedule in many European countries for use in children andadolescents between 9-15 years of age and for women between 16-26 years of age, whereas it has been proposedthat the bivalent vaccination should be given to girls between 9-18 years of age. While cervical cancer is amongthe cancers that can be prevented, it is essential to continue screening tests while introducing vaccination in asystematic manner for protection. On this subject, among the most important roles of nurses is to implementthe screening programs by fulfilling the caregiving, training and consultancy roles for the society and especially,for high risk groups and to increase the awareness of the people.     

Cost-Effectiveness of HPV Vaccination in the Prevention of Cervical Cancer in Malaysia

Introduction: Cervical cancers (CC) demonstrate the second highest incidence of female cancers in Malaysia.The costs of chronic management have a high impact on nation’s health cost and patient’s quality of life that canbe avoided by better screening and HPV vaccination. Methodology: Respondents were interviewed from sixpublic Gynecology-Oncology hospitals. Methods include experts’ panel discussions to estimate treatment costsby severity and direct interviews with respondents using costing and SF-36 quality of life (QOL) questionnaires.Three options were compared i.e. screening via Pap smear; quadrivalent HPV Vaccination and combined strategy(screening plus vaccination). Scenario based sensitivity analysis using screening population coverage (40-80%)and costs of vaccine (RM 300-400/dose) were calculated. Results: 502 cervical pre invasive and invasive cervicalcancer (ICC) patients participated in the study. Mean age was 53.3 ± 11.21 years, educated till secondary level(39.39%), Malays (44.19%) and married for 27.73 ± 12.12 years. Life expectancy gained from vaccination is13.04 years and average Quality Adjusted Life Years saved (QALYs) is 24.4 in vaccinated vs 6.29 in unvaccinated.Cost/QALYs for Pap smear at base case is RM 1,214.96/QALYs and RM 1,100.01 at increased screening coverage;for HPV Vaccination base case is at RM 35,346.79 and RM 46,530.08 when vaccination price is higher. Incombined strategy, base case is RM 11,289.58; RM 7,712.74 at best case and RM 14,590.37 at worst case scenario.Incremental cost-effectiveness ratio (ICER) showed that screening at 70% coverage or higher is highly costeffective at RM 946.74 per QALYs saved and this is followed by combined strategy at RM 35,346.67 per QALYssaved. Conclusion: Vaccination increase life expectancy with better QOL of women when cancer can be avoided.Cost effective strategies will include increasing the Pap smear coverage to 70% or higher. Since feasibility andlong term screening adherence is doubtful among Malaysian women, vaccination of young women is a more costeffective strategy against cervical cancers.     

城市地区女性和医护人员对HPV及疫苗的认知调查

[目的]探讨中国城市地区女性和医护人员对HPV及疫苗的认知状况和接种意愿。[方法]采用Logisitic回归方法分析以医院为基础的机会性筛查的女性以及医护人员对HPV及疫苗的认知情况及影响接种意愿的因素。[结果]筛查女性中32.85%听说过HPV但72.31%愿意自己接种HPV疫苗,72.59%愿意让其女儿接种疫苗;而医护人员中89.62%知道HPV感染是宫颈癌的必要因素,且69.22%了解宫颈癌是可以通过疫苗预防,69.77%愿意自己接种疫苗,68.74%愿意让其女儿接种疫苗。高学历(OR=3.67～9.70)、高收入(OR=2.15～6.68)、初次性生活年龄较大(OR=1.14～1.50)、初次怀孕年龄较大(OR=1.36～1.98)、怀孕次数较少(OR=1.21～1.34)、生产次数较少(OR=1.77～2.66)的女性对HPV疫苗的接受程度较高,且均存在剂量反应关系(P<0.05);家人患有肿瘤(OR=1.41,95%CI:1.20～1.65)、听说过HPV(OR=2.68,95%CI:2.33～3.07)者更愿意接种疫苗。不愿意接种疫苗的主要原因是认为HPV疫苗还没有大面积推广(筛查女性占43.55%,医护人员占39.84%)且不认为自己有这方面的危险(筛查女性占26.21%,医护人员占38.28%);而对于疫苗的付费途径,希望国家负担全部费用的筛查女性占41.46%,医护人员占35.76%,希望国家负担部分费用的筛查女性占14.33%,医护人员占43.31%。[结论]筛查女性对HPV及疫苗认知低,但大多数女性均愿意接种疫苗,而高学历、高收入、家族有肿瘤史、听说过HPV者更愿意接种疫苗。因此,关于HPV及疫苗知识的宣传教育,应根据不同的社会文化背景来制定,尤其是针对医护人员,需要更多有关疫苗安全性和有效性的证据来提高接种意愿,达到疫苗防治宫颈癌的目的。     

Knowledge about Human Papillomavirus and Cervical Cancer: Predictors of HPV Vaccination among Dental Students

Background: The objective of this study is to determine the influence of dental students’ knowledge and attitude regarding human papillomavirus infection of cervical cancer on willingness to pay for vaccination. Basic research design: A convenience sampling method was used. The minimal sample size of 136 was calculated using the Raosoft calculator with a 5 % margin of error and 95% confidence level. Participants: The study population were all final year dental students from the School of Dentistry. Methods: A self-administered questionnaire was used to measure knowledge levels and attitudes regarding human papillomavirus vaccination. Contingent valuation was conducted for willingness to pay for vaccination. Main outcome measures: The Center for Disease Control and Prevention has stated that human papillomavirus are associated with oropharynx cancer and the American Dental Association insist on expanding public awareness of the oncogenic potential of some HPV infections. Thus, as future dental practitioners, dental students should be aware of human papillomavirus and their links with cancer and the benefits of vaccination. Results: Knowledge on HPV and cervical cancer did not impact on attitudes towards vaccines. However, significant correlation existed between knowledge and willingness to pay for vaccination. Conclusions: Dental students’ knowledge on HPV and cervical cancer has no influence on their attitude towards HPV vaccines. However, their willingness to pay for HPV vaccination is influenced by their knowledge of cervical cancer and HPV vaccination.     

Knowledge and Awareness of Human Papillomavirus (HPV), Cervical Cancer and HPV Vaccine among Women in Two Distinct Nepali Communities

Background: This study assessed human papillomavirus (HPV), cervical cancer, and HPV vaccine knowledgeand awareness among women in two sub-populations in Nepal - Khokana, a traditional Newari village in theLalitpur District about eight kilometers south of Kathmandu, and Sanphebagar, a village development committeewithin Achham District in rural Far-Western Nepal. Methods: Study participants were recruited during healthcamps conducted by Nepal Fertility Care Center, a Nepali non-governmental organization. Experienced staffadministered a Nepali language survey instrument that included questions on socio-demographics, reproductivehealth and knowledge on HPV, cervical cancer, and the HPV vaccine. Results: Of the 749 participants, 387 (51.7%)were from Khokana and 362 (48.3%) were from Sanphebagar. Overall, 53.3% (n=372) of women were awareof cervical cancer with a significant difference between Khokana and Sanphebagar (63.3% vs 43.0%; p=0.001).Overall, 15.4% (n=107) of women had heard of HPV and 32% (n=34) of these women reported having heard ofthe HPV vaccine. If freely available, 77.5% of the women reported willingness to have their children vaccinatedagainst HPV. Factors associated with cervical cancer awareness included knowledge of HPV (Khokana: OddsRatio (OR)=24.5; (95% Confidence Interval (CI): 3.1-190.2, Sanphebagar: OR=14.8; 95% CI: 3.7-58.4)) andsexually transmitted infections (Khokana: OR=6.18; 95% CI: 3.1-12.4; Sanphebagar: OR=17.0; 95% CI: 7.3-39.7) among other risk factors. Conclusions: Knowledge and awareness of HPV, cervical cancer, and the HPVvaccine remains low among women in Khokana and Sanphebagar. Acceptance of a freely available HPV vaccinefor children was high, indicating potentially high uptake rates in these communities.     

Mapping HPV Vaccination and Cervical Cancer Screening Practice in the Pacific Region-Strengthening National and Regional Cervical Cancer Prevention

Objective : To provide background information for strengthening cervical cancer prevention in the Pacificby mapping current human papillomavirus (HPV) vaccination and cervical cancer screening practices, as wellas intent and barriers to the introduction and maintenance of national HPV vaccination programmes in theregion. Materials and Methods: A cross-sectional questionnaire-based survey among ministry of health officialsfrom 21 Pacific Island countries and territories (n=21). Results: Cervical cancer prevention was rated as highlyimportant, but implementation of prevention programs were insufficient, with only two of 21 countries andterritories having achieved coverage of cervical cancer screening above 40%. Ten of 21 countries and territorieshad included HPV vaccination in their immunization schedule, but only two countries reported coverage of HPVvaccination above 60% among the targeted population. Key barriers to the introduction and continuation ofHPV vaccination were reported to be: (i) Lack of sustainable financing for HPV vaccine programs; (ii) Lackof visible government endorsement; (iii) Critical public perception of the value and safety of the HPV vaccine;and (iv) Lack of clear guidelines and policies for HPV vaccination. Conclusion: Current practices to preventcervical cancer in the Pacific Region do not match the high burden of disease from cervical cancer. A regionalapproach, including reducing vaccine prices by bulk purchase of vaccine, technical support for implementationof prevention programs, operational research and advocacy could strengthen political momentum for cervicalcancer prevention and avoid risking the lives of many women in the Pacific.     

A Cross Sectional Study on Knowledge,Attitude and Practice related to Human Papillomavirus Vaccination for Cervical Cancer Prevention between Medical and Non-Medical Students in Hong Kong

Background: One of the most important aetiologies of cervical cancer is Human Papillomavirus (HPV) infection. While vaccination is an effective way in preventing high risk HPV infection, HPV vaccine uptake rate in Hong Kong has been low. Considering the proven effectiveness of HPV vaccination and the low vaccination uptake rate in Hong Kong, this study was conducted to compare the knowledge, attitude and practice towards HPV vaccination for cervical cancer prevention between medical and non-medical students in the University of Hong Kong. Methods: A total of 420 full time undergraduates from the University of Hong Kong were recruited and evaluated. Questionnaires covering demographics, sexual risk profile, knowledge, attitude and practice towards HPV vaccination were applied, with the Chi-square test analysis. Results: Medical students had more comprehensive knowledge than their non-medical counterparts on HPV vaccination, including the carcinogenicity of HPV (P<0.001), available vaccines on the market (P<0.001) and the outcome of vaccination (P<0.001). In particular, senior medical students (Year 3 or above) were shown to be more knowledgeable than their juniors (below Year 3) with statistical significance (P<0.001). Positive attitudes toward HPV vaccination were observed more frequently among medical students when compared to non-medical students, especially regarding the usefulness of HPV vaccination in males (P<0.001). However, there was no significant difference in the vaccination rate between medical and non-medical students (P=0.671), suggesting an importance for factors other than knowledge, such as cost of vaccination and anxiety of side effects. Conclusions: Medical students in Hong Kong, especially those in senior years, had more comprehensive knowledge and positive attitudes towards HPV vaccination than non-medical students. Yet, there was no significant difference in the practice of HPV vaccination between medical and non-medical students. In addition to medical education, other factors such as health beliefs, risk perception and financial considerations, may have a role in determining HPV vaccination for cervical cancer prevention.     

Improved Survival of Cervical Cancer Patients in a Screened Population in Rural India

Objectives: To describe the survival experience of cervix cancer patients in a screened rural population in India. Methods: Included 558 cervical cancer patients diagnosed in 2000-2013 in a cohort of 100,258 women invited for screening during 2000-2003. The primary end point was death from cervical cancer. We used the Kaplan-Meier method to estimate cumulative observed survival and Cox proportional hazards regression to assess the effect of patient characteristics on survival after diagnosis. Results: Of the 558 cases included, 143 (26%) and 114 (20%) were diagnosed in stages IA and IB respectively; 252 (45.2%) were dead, and 306 (54.8%) were alive at the last follow-up. The overall 5-year observed survival was 60.5%. The 5-year survival of stage IA patients was 95.1% and 5.3% for stage IV patients. All surgically treated stage IA patients, 94.1% of stage IB patients receiving intracavitary radiotherapy, 62% of stage IIB, 49% of stage III and 25% of stage IV patients receiving radiotherapy survived for 5 years. Conclusion: Higher 5-year survival in our study than elsewhere in India is due to the high proportion of early stage cancers detected by screening combined with adequate treatment, resulting into a favourable prognosis.     

Comparative Cost-Effectiveness of HPV Vaccines in the Prevention of Cervical Cancer in Malaysia

Objectives: Cervical cancer(CC) had the second highest incidence of female cancers in Malaysia in 2003-2006. Prevention is possible by both Pap smear screening and HPV vaccination with either the bivalent vaccine (BV) or the quadrivalent vaccine (QV). In the present study, cost effectiveness options were compared for three programs i.e. screening via Pap smear; modeling of HPV vaccination (QV and BV) and combined strategy (screening plus vaccination). A scenario based sensitivity analysis was conducted using screening population coverages (40-80%) and costs of vaccines (RM 100-200/dose) were calculated. Methods: This was an economic burden, cross sectional study in 2006-2009 respondents were interviewed from six public Gynecology-Oncology hospitals. Methods included expert panel discussions to estimate treatment costs of CC, Genital warts and Vulva Vagina Cancers by severity and direct interviews with respondents using costing and SF-36 quality of life questionnaires. Results: A total of 502 cervical cancer patients participated with a mean age at 53.3±11.2 years and a mean marriage length of 27.7±12.1 years, Malays accounting for 44.2%. Cost/quality adjusted life year (QALY) for Pap smear in the base case was RM 1,215 and RM 1,100 at increased screening coverage. With QV only, in base case it was RM 15,662 and RM 24,203 when the vaccination price was increased. With BV only, the respective figures were RM 1,359,057 and RM 2,530,018. For QV combined strategy cost/QALY in the base case it was RM 4,937, reducing to RM 3,395 in the best case and rising to RM 7,992 in the worst case scenario. With the BV combined strategy, these three cost/QALYs were RM 6,624, RM 4,033 and RM 10,543. Incremental cost-effectiveness ratio (ICER) showed that screening at 70% coverage or higher was highly cost effective at RM 946.74 per QALYs saved but this was preceded by best case combined strategy with QV at RM 515.29 per QALYs saved. Conclusions: QV is more cost effective than BV. The QV combined strategy was more CE than any method including Pap smear screening at high population coverage.     

Distribution of HPV Genotypes in Cervical Cancer in Multiethnic Malaysia

Background: Cervical cancer is the third commonest type of cancer among women in Malaysia. Our aim wasto determine the distribution of human papilloma virus (HPV) genotypes in cervical cancer in our multi-ethnicpopulation. Materials and Methods: This was a multicentre study with a total of 280 cases of cervical cancer from4 referral centres in Malaysia, studied using real-time polymerase chain reaction (qPCR) detection of 12 highrisk-HPV genotypes. Results: Overall HPV was detected in 92.5% of cases, in 95.9% of squamous cell carcinomasand 84.3%of adenocarcinomas. The five most prevalent high-risk HPV genotypes were HPV 16 (68.2%), 18 (40%),58 (10.7%), 33 (10.4%) and 52 (10.4%). Multiple HPV infections were more prevalent (55.7%) than single HPVinfections (36.8%). The percentage of HPV positive cases in Chinese, Malays and Indians were 95.5%, 91.9%and 80.0%, respectively. HPV 16 and 18 genotypes were the commonest in all ethnic groups. We found that thepercentage of HPV 16 infection was significantly higher in Chinese (75.9%) compared to Malays (63.7%) andIndians (52.0%) (p<0.05), while HPV 18 was significantly higher in Malays (52.6%) compared to Chinese (25.0%)and Indians (28%) (p<0.05). Meanwhile, HPV 33 (17.9%) and 52 (15.2%) were also more commonly detectedin the Chinese (p<0.05). Conclusions: This study showed that the distribution of HPV genotype in Malaysia issimilar to other Asian countries. Importantly, we found that different ethnic groups in Malaysia have differentHPV genotype infection rates, which is a point to consider during the implementation of HPV vaccination.     

Knowledge of Human Papillomavirus Infection,Cervical Cancer and Willingness to pay for Cervical Cancer Vaccination among Ethnically Diverse Medical Students in Malaysia

The primary objective of this study was to assess the knowledge of medical students and determine variationbetween different cultural groups. A secondary aim was to find out the willingness to pay for cervical cancervaccination and the relationships between knowledge and attitudes towards Human Papillomavirus vaccination.A cross-sectional survey was conducted in a private medical university between June 2014 and November 2014using a convenient sampling method. A total of 305 respondents were recruited and interviewed with standardquestionnaires for assessment of knowledge, attitudes and practice towards human papilloma virus and theirwillingness to pay for HPV vaccination. Knowledge regarding human papilloma virus, human papilloma virusvaccination, cervical cancer screening and cervical cancer risk factors was good. Across the sample, a majority(90%) of the pupils demonstrated a high degree of knowledge about cervical cancer and its vaccination. Therewere no significant differences between ethnicity and the participants’ overall knowledge of HPV infection,Pap smear and cervical cancer vaccination. Some 88% of participants answered that HPV vaccine can preventcervical cancer, while 81.5% of medical students said they would recommend HPV vaccination to the publicalthough fewer expressed an intention to receive vaccination for themselves.     

Barriers to Cervical Cancer and Breast Cancer Screening Uptake in Low-Income and Middle-Income Countries: A Systematic Review

Background: Cervical cancer (CCa) and breast cancer (BCa) are the two leading cancers in women worldwide. Early detection and education to promote early diagnosis and screening of CCa and BCa greatly increases the chances for successful treatment and survival. Screening uptake for CCa and BCa in low and middle - income countries (LMICs) is low, and is consequently failing to prevent these diseases. We conducted a systematic review to identify the key barriers to CCa and BCa screening in women in LMICs. Methods: We performed a systematic literature search using Ovid MEDLINE, EMBASE, PsycINFO, SCOPUS, CINHAL Plus, and Google scholar to retrieve all English language studies from inception to 2015. This review was done in accordance with the PRISMA-P guidelines. Results: 53 eligible studies, 31 CCa screening studies and 22 BCa screening studies, provided information on 81,210 participants. We found fewer studies in low-income and lower - middle - income countries than in upper - middle - income countries. Lack of knowledge about CCa and BCa, and understanding of the role of screening were the key barriers to CCa and BCa screening in LMICs. Factors that are opportunities for knowledge acquisition, such as level of education, urban living, employment outside the home, facilitated CCa and BCa screening uptake in women in LMICs. Conclusions: Improvements to CCa and BCa screening uptake in LMICs must be accompanied by educational interventions which aim to improve knowledge and understanding of CCa and BCa and screening to asymptomatic women. It is imperative for governments and health policy makers in LMICs to implement screening programmes, including educational interventions, to ensure the prevention and early detection of women with CCa and BCa. These programmes and policies will be an integral part of a comprehensive population-based CCa and BCa control framework in LMICs.     

Incidence,Treatment and Outcomes of Cervical Cancer in Low- and Middle-income Countries

Cervical cancer is one of the most common cancers in developing nations. It has had a tremendous impact on the lifetime of millions of women over the last century and continues to do so. In this collaborative clinicians' review, we highlight the incidence, treatment and clinical outcomes of cervical cancer in low-income (LICs) and low- and middle-income countries (LMICs) across Asia, South America, South Africa and Eastern Europe. With the cervical cancer burden and locally advanced cancers being high, the majority of LICs/LMICs have been striving to adhere to optimal evaluation and treatment guidelines. However, the huge gap in resource availability, rural versus urban disparity and access to resources have led to poor compliance to evaluation, treatment and post-treatment rehabilitation. To mitigate the overwhelming numbers, various treatment strategies like neoadjuvant chemotherapy, hypofractionation radiation schedules (both external and brachytherapy) have been attempted with no major success. Also, the compliance to concurrent chemoradiation in various regions is a major challenge. With the burden of advanced cancers, the lack of palliative care services and their integration in cancer care is still a reality.     

HPV Vaccination and Cervical Cancer Screening Policies and Practices in 18 Countries,Territories and Entities across Eastern Europe and Central Asia

Background: To assess readiness to achieve the WHO Global Strategy targets for HPV vaccination and cervical screening and to guide capacity building, the current status of these services in 18 Eastern European and Central Asian countries, territories and entities (CTEs) was evaluated. Methods: In order to assess the current status of HPV vaccination and cervical cancer screening in these 18 CTEs, a 30 question survey tool was developed, covering: national policies, strategies and plans for cervical cancer prevention; status of cancer registration; status of HPV vaccination; and current practices for cervical cancer screening and treatment of precancerous lesions. As cervical cancer prevention comes within the mandate of the United Nations Fund for Population Development (UNFPA), the UNFPA offices in the 18 CTEs have regular contact with national experts who are directly involved in cervical cancer prevention actions and are well placed to provide the data required for this survey. Working through the UNFPA offices, the questionnaires were sent to these national experts in April 2021, with data collected from April to July 2021. All CTEs returned completed questionnaires. Results: Only Armenia, Georgia, Moldova, North Macedonia, Turkmenistan and Uzbekistan have implemented national HPV vaccination programmes, with only the last 2 of these reaching the WHO target of 90% of girls fully vaccinated by age 15, while rates in the other 4 range from 8%-40%. Cervical screening is available in all CTEs but only Belarus and Turkmenistan have reached the WHO target of 70% of women screened once by age 35 and again by age 45, while rates elsewhere range from 2%-66%. Only Albania and Turkey follow the WHO recommendation to use a high-performance screening test, while the majority use cervical cytology as the main screening test and Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan use visual inspection. No CTEs currently operate systems to coordinate, monitor and quality assure (QA) the entire cervical screening process. Conclusions: Cervical cancer prevention services in this region are very limited. Achieving the WHO Global Strategy targets by 2030 will require substantial investments in capacity building by international development organisations.