HPV VACCINATION AND CERVICAL CANCER PREVENTION: A GLOBAL SYSTEMATIC REVIEW

Abstract

Objective: To synthesize global evidence on the effectiveness of prophylactic human papillomavirus vaccination for preventing persistent vaccine-type infection, high-grade cervical intraepithelial neoplasia and invasive cervical cancer and to examine how age at vaccination, dose schedule, programme coverage and socioeconomic context modify population impact. Study design: Systematic review of randomized evidence, population-based cohorts, registry analyses and programme evaluations. Place and duration of the study: Global evidence indexed from database inception was reviewed from February 2025 to may 2026. Methodology: A sensitive MEDLINE/PubMed search was supplemented by citation tracking and authoritative global reports. Eligible reports evaluated prophylactic HPV vaccination and cervical HPV infection, CIN2+, CIN3 or invasive cervical cancer. Two-stage title/abstract and full-text assessment was applied. Results were synthesized by outcome, age at vaccination, dose and setting because designs and estimands were heterogeneous. Results: The initial MEDLINE/PubMed search identified 12,064 records and 32 publications met the focused eligibility criteria. In Sweden, adjusted invasive cervical cancer incidence was lower among vaccinated women (incidence rate ratio 0.37, 95% CI 0.21–0.57) and was lowest when vaccination occurred before age 17 years (0.12, 95% CI 0.00–0.34). England recorded an 87% (95% CI 72–94) reduction in cervical cancer and a 97% (95% CI 96–98) reduction in CIN3 among women offered vaccination at age 12–13 years. Scotland recorded no invasive cancers among women immunized at age 12–13 years. Recent English follow-up estimated 687 (95% CI 556–819) cervical cancers and 23,192 (95% CI 22,163–24,220) CIN3 cases prevented by mid-2020. Conclusion: HPV vaccination provides strong real-world protection against cervical precancer and invasive cervical cancer. The largest benefit occurs with vaccination before sexual exposure. High coverage, equitable delivery and continued HPV-based screening remain necessary for global elimination.