Global trends and future projections of cervical cancer burden: an integrated analysis of GBD 2021, UN population and WHO HPV vaccination data.
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BACKGROUND: Cervical cancer remains a leading cause of morbidity and mortality among women, disproportionately affecting low- and middle-income countries (LMICs). We sought to: (1) characterize temporal and geographic patterns of cervical cancer burden (1990-2021), with a focus on age-related differences; (2) identify attributable risk factors for cervical cancer, emphasizing the impact of HPV vaccination; (3) forecast cervical cancer burden through 2050. METHODS: We combined: (a) age-specific female population estimates (UN World Population Prospects 2024), (b) cervical cancer incidence, mortality and disability-adjusted life-years (DALYs) from Global Burden of Disease (GBD) 2021, and (c) HPV vaccination coverage (WHO). We calculated age-standardized incidence (ASIR), mortality (ASMR), and DALYs rate (ASDR) using the WHO world standard population. Stratified analyses were performed by Socio-demographic Index (SDI) category and 5-year age groups. Future burdens were projected under current intervention coverage. FINDINGS: From 1990 to 2021, global ASIR, ASMR and ASDR declined by 15, 31 and 32%, respectively, yet absolute cases rose due to population growth and ageing. The greatest burdens remain in low-SDI regions, especially Southern Sub-Saharan Africa, which uniquely saw rising ASIR and ASMR. Women aged 55-59 bear the highest rates, while young women (15-39) experienced a small but significant incidence increase in 92 countries (notably Russia, Brazil and China). Unsafe sex and smoking accounted for the majority of cervical cancer DALYs. A profound disparity in HPV vaccine coverage persists between high- and low-SDI regions. Projections to 2050 indicate a continued rise in absolute case numbers, despite modest declines in age-standardized rates (ASRs). CONCLUSION: While ASRs show improvement, the growing absolute burden and profound geographic inequities highlight an urgent public health challenge. Accelerating the scale-up of HPV vaccination, screening, and other preventive measures, with a strategic focus on LMICs, is critical to achieving the WHO elimination targets for cervical cancer.