Cervical Cancer in Sub-Saharan Africa: A Narrative Review of Screening Strategies, HPV Vaccination, and Survival Outcomes

Abstract

Background: Cervical cancer remains a leading cause of cancer-related morbidity and mortality among women in Sub-Saharan Africa (SSA). Limited access to preventive services, low awareness, and infrastructural challenges contribute to disproportionately high incidence and mortality rates compared to high-income regions. Effective screening strategies, widespread uptake of human papillomavirus (HPV) vaccination, and improved treatment pathways are critical to reducing disease burden. Aim: The present review seeks to provide a comprehensive analysis of cervical cancer in SSA with a specific focus on three key domains: screening strategies, HPV vaccination, and survival outcomes Methods: A narrative review of peer-reviewed literature published between January 2010 to June 2024 was conducted using PubMed, Scopus, and Google Scholar. Keywords included “cervical cancer,” “screening,” “HPV vaccination,” “survival outcomes,” and “Sub-Saharan Africa.” The initial database search yielded approximately 2,400 articles. After removing duplicates, titles and abstracts were screened for relevance, and 356 articles were selected for full-text review. Studies evaluating screening modalities, HPV vaccination programs, and survival outcomes in SSA were included. Data were synthesised to highlight regional disparities, progress, and persisting challenges. Results: Screening coverage in SSA remains below 20%, with visual inspection with acetic acid (VIA) being the most widely implemented due to its low cost and feasibility in resource-limited settings. Pap smears and HPV DNA testing are available but largely restricted to urban and tertiary centres. Pilot HPV vaccination programs have been initiated in several countries, with Rwanda and Botswana achieving relatively high coverage rates, while many others lag due to financial and logistical barriers. Survival outcomes remain poor, with five-year survival rates below 40% in most countries, largely attributable to late-stage presentation, limited access to radiotherapy, and fragmented follow-up systems. Conclusion: The review highlights significant gaps in cervical cancer prevention and control across SSA. While VIA offers a pragmatic approach, integration of HPV DNA testing and scale-up of HPV vaccination are essential for long-term disease reduction. Improving survival outcomes requires investment in treatment infrastructure, training of oncology personnel, and community-based education to promote early presentation. Multisectoral collaboration and sustained political commitment are key to achieving the WHO’s 2030 elimination targets in the region.