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. 2022 Jul 12;10(8):e1115–e1127. doi: 10.1016/S2214-109X(22)00241-8

Table 1.

Main characteristics of cervical cancer screening in 139 countries with documented official recommendations

World (N=139)* Countries by income
High (n=56)* Upper middle (n=46) Lower middle (n=25) Low (n=12)
Screening invitations sent to individuals 40 (29%) 30 (54%) 9 (20%) 1 (4%) 0
Year of introduction of current recommendations§
2016–20 54 (39%) 23 (41%) 19 (41%) 8 (32%) 4 (33%)
2011–15 30 (22%) 10 (18%) 13 (28%) 5 (20%) 2 (17%)
2010 and earlier 36 (26%) 14 (25%) 8 (17%) 10 (40%) 4 (33%)
Recommended age to begin screening, years
24 or younger 46 (33%) 28 (50%) 13 (28%) 5 (20%) 0
25–29 55 (40%) 23 (41%) 10 (22%) 18 (72%) 4 (33%)
30–34 31 (22%) 5 (9%) 11 (24%) 9 (36%) 6 (50%)
35–39 6 (4%) 0 3 (7%) 1 (4%) 2 (17%)
40 or older 1 (1%) 0 1 (2%) 0 0
Recommended age to end screening, years
49 or younger 18 (13%) 1 (2%) 6 (13%) 5 (20%) 6 (50%)
50–59 16 (12%) 4 (7%) 5 (11%) 4 (16%) 3 (25%)
60–64 45 (32%) 16 (29%) 20 (43%) 7 (28%) 2 (17%)
65–69 46 (33%) 26 (46%) 12 (26%) 7 (28%) 1 (8%)
70 or older 14 (10%) 9 (16%) 3 (7%) 2 (8%) 0
Cytology-based screening 109 (78%) 53 (95%) 41 (89%) 13 (52%) 2 (17%)
Recommended ages and interval for cytology-based screening§
Age 29 years and younger 88/109 (81%) 49/53 (92%) 29/41 (71%) 10/13 (77%) 0
Every 1–2 years 13/88 (15%) 8/49 (16%) 4/29 (14%) 1/10 (10%) 0
Every 3 years 67/88 (76%) 38/49 (78%) 22/29 (76%) 7/10 (70%) 0
Every 4 years or more 5/88 (6%) 1/49 (2%) 2/29 (7%) 2/10 (20%) 0
Age 30–49 years 98/109 (90%) 47/53 (89%) 37/41 (90%) 12/13 (92%) 2/2 (100%)
Every 1–2 years 14/98 (14%) 8/47 (17%) 4/37 (11%) 1/12 (8%) 1/2 (50%)
Every 3 years 65/98 (66%) 31/47 (66%) 26/37 (70%) 8/12 (67%) 0
Every 4 years or more 13/98 (13%) 5/47 (11%) 6/37 (16%) 2/12 (17%) 0
Age 50 years and older 90/109 (83%) 44/53 (83%) 34/41 (83%) 11/13 (85%) 1/2 (50%)
Every 1–2 years 14/90 (16%) 7/44 (16%) 5/34 (15%) 1/11 (9%) 1/1 (100%)
Every 3 years 58/90 (64%) 27/44 (61%) 23/34 (68%) 8/11 (73%) 0
Every 4 years or more 14/90 (16%) 8/44 (18%) 5/33 (15%) 1/11 (9%) 0
Recommended triage test for cytology-based screening
HPV test 34/109 (31%) 27/53 (51%) 7/41 (17%) 0 0
HPV-based screening 48 (35%) 25 (45%) 16 (35%) 4 (16%) 3 (25%)
Recommended ages and interval for HPV screening§
Age 29 years and younger 8/48 (17%) 7/25 (28%) 1/16 (6%) 0 0
Every 3–4 years 3/8 (38%) 3/7 (43%) 0 0 0
Every 5 years 4/8 (50%) 4/7 (57%) 0 0 0
Every 5 years or more 1/8 (13%) 0 1/1 (100%) 0 0
Age 30–49 years 47/48 (98%) 24/25 (96%) 16/16 (100%) 4/4 (100%) 3/3 (100%)
Every 3–4 years 6/47 (13%) 5/24 (21%) 1/16 (6%) 0 0
Every 5 years 37/47 (79%) 19/24 (79%) 13/16 (81%) 4/4 (100%) 1/3 (33%)
Every 5 years or more 3/47 (6%) 0 2/16 (13%) 0 1/3 (33%)
Age 50 years and older 43/48 (90%) 25/25 (100%) 14/16 (88%) 3/4 (75%) 1/3 (33%)
Every 3–4 years 4/43 (9%) 3/25 (12%) 1/14 (7%) 0 0
Every 5 years 37/43 (86%) 21/25 (84%) 12/14 (86%) 3/3 (100%) 1/1 (100%)
Every 5 years or more 2/43 (5%) 1/25 (4%) 1/14 (7%) 0 0
Recommended triage test for primary HPV-based screening
Cytology 18/48 (38%) 12/25 (48%) 6/16 (38%) 0 0
Cytology or HPV genotyping 6/48 (13%) 2/25 (8%) 4/16 (25%) 0 0
Cytology or VIA 1/48 (2%) 0 1/16 (6%) 0 0
HPV genotyping 2/48 (4%) 1/25 (4%) 0 0 1/3 (33%)
VIA 2/48 (4%) 0 0 2/4 (50%) 0
Screen and treat strategy 4/48 (4%) 0 0 2/4 (50%) 0
VIA as primary screening test 41 (29%) 1 (2%) 13 (28%) 18 (72%) 9 (75%)
Recommended ages and interval for VIA screening§
Age 29 years and younger 17/41 (41%) 0 5/13 (38%) 8/18 (44%) 4/9 (44%)
Every 1–2 years 1/17 (6%) 0 1/5 (20%) 0 0
Every 3 years 11/17 (65%) 0 4/5 (80%) 5/8 (63%) 2/4 (50%)
Every 4 years or more 2/17 (12%) 0 0 2/8 (25%) 0
Age 30–49 years 38/41 (93%) 0 13/13 (100%) 16/18 (89%) 9/9 (100%)
Every 1–2 years 3/38 (8%) 0 2/13 (15%) 1/16 (6%) 0
Every 3 years 17/38 (45%) 0 8/13 (62%) 7/16 (44%) 2/9 (22%)
Every 4 years or more 14/38 (37%) 0 3/13 (23%) 7/16 (44%) 4/9 (44%)
Age 50 years and older 18/41 (44%) 0 5/13 (38%) 9/18 (50%) 4/9 (44%)
Every 1–2 years 0 0 0 0 0
Every 3 years 9/18 (50%) 0 3/5 (60%) 5/9 (56%) 1/4 (25%)
Every 4 years or more 6/18 (33%) 0 2/5 (40%) 3/9 (33%) 1/4 (25%)
Underserved populations 4/41 (10%) 1/1 (100%) 2/13 (15%) 1/18 (6%) 0
Screen and treat strategy with VIA 31/41 (76%) 0 7/13 (54%) 16/18 (89%) 8/9 (89%)

HPV=Human papillomaviruses. VIA=visual inspection with acetic acid.

*

Partial implementation in United Arab Emirates (Abu-Dabi).

Variability among country regions in Belgium, Canada, and Spain. Organised programmes in small regions in Greece not included.

Including introduction of modifications in the recommended primary tests, modifications to ages to start and end screening, and modifications to screening interval.

§

No information was available about the year of introduction of current recommendations in 19 countries (Bosnia and Herzegovina, Cyprus, Monaco, Guinea, Antigua and Barbuda, The Bahamas, Bermuda, Dominican Republic, Grenada, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines, Trinidad and Tobago, Venezuela, Cook Islands, Vanuatu, Bahrain, North Korea, and Timor-Leste), about the recommended screening interval for cytological screening in seven countries (Albania, Cyprus, Dominica, Cook Islands, Vanuatu, Iran, and Syria), and about the recommended screening interval for VIA screening in six countries (Guinea, Madagascar, Mozambique, Bolivia, Panama, and Timor-Leste).

Combined with other main screening tests or alone.

Including countries that are transitioning to HPV as the main test. Not including countries that reported plans in 2019 for introduction of HPV-based screening by 2024 (Canada, New Zealand, Belgium, Belarus, Japan, and Trinidad and Tobago).