CERVICAL CANCER: EARLY DETECTION AND MODERN PREVENTION
Kamolabonu Rasuljon qizi Inomova
6th-year student, Faculty of General Medicine, Andijan State Medical Institute
ORCID: 0009-0005-4285-4578
ABSTRACT
Cervical cancer is one of the most common malignancies among women, and persistent infection with high-risk human papillomavirus (HPV) is the principal etiological factor in its development. A defining feature of the disease is that it is preceded by a precancerous stage, meaning that invasive cancer does not develop suddenly. Consequently, cervical cancer can be substantially prevented through HPV vaccination, screening, and timely treatment of precancerous lesions. This article reviews current epidemiological indicators of cervical cancer, the pathogenetic role of HPV infection, and the clinical significance of HPV vaccination, HPV-DNA-based screening, genotyping, and individual risk assessment. According to GLOBOCAN 2022, 662,301 new cases of cervical cancer and 348,874 deaths were recorded worldwide. A modern prevention strategy integrates HPV vaccination, high-performance screening, risk stratification of HPV-positive results, and timely treatment of detected precancerous changes into a single continuum of care. In conclusion, reducing the burden of cervical cancer requires strengthening an uninterrupted system of prevention and early diagnosis.
Keywords: cervical cancer, HPV, human papillomavirus, screening, HPV-DNA, vaccination, genotyping, CIN, precancerous lesions, gynecologic oncology.
INTRODUCTION
Cervical cancer remains one of the major medical and social problems affecting women’s health. According to the World Health Organization (WHO), approximately 660,000 women worldwide were diagnosed with cervical cancer in 2022, and nearly 350,000 women died of the disease. Cervical cancer is among the most common cancers in women, ranking fourth among female cancers worldwide according to the WHO [1,2].
According to the IARC Global Cancer Observatory, 662,301 new cases and 348,874 deaths from cervical cancer were recorded in 2022. The age-standardized incidence rate was 14.1 per 100,000 women, and the age-standardized mortality rate was 7.1 per 100,000 [3].
Nearly all cases of cervical cancer are associated with high-risk HPV infection. According to the WHO, approximately 99% of cervical cancer cases are linked to high-risk HPV [1].
An important feature of this disease is that precancerous changes develop in the cervical epithelium before an invasive tumor forms. Detecting and appropriately treating the disease at this stage can prevent progression to invasive cancer. HPV vaccination and screening are therefore the cornerstones of modern prevention.
The aim of this review is to analyze current approaches to the prevention and early detection of cervical cancer, in particular HPV vaccination, HPV-DNA-based screening, and individual risk assessment through HPV genotyping.
MATERIALS AND METHODS
This article was prepared as a narrative scientific review. WHO and IARC documents, together with contemporary scientific literature on cervical cancer epidemiology, HPV infection, vaccination, screening, and HPV genotyping, were analyzed.
Primary attention was given to international clinical recommendations, epidemiological data, and recent meta-analyses. Epidemiological indicators were assessed using GLOBOCAN 2022 data, while screening and HPV genotyping recommendations were evaluated against current WHO guidance documents [3–6].
RESULTS AND DISCUSSION
The role of HPV infection in cervical cancer
HPV is a widespread group of viruses, certain genotypes of which carry high oncogenic risk. HPV-16 and HPV-18 in particular are strongly associated with cervical cancer [1,2].
HPV infection does not always lead to cancer. Most infections are controlled by the immune system and resolve spontaneously. However, if high-risk HPV infection persists, cervical intraepithelial neoplasia may develop [1].
This pathological process can be summarized schematically as follows:
High-risk HPV infection → persistent infection → cervical intraepithelial neoplasia (CIN) → high-grade precancerous changes → invasive cancer.
Table 1. Key epidemiological indicators of cervical cancer, 2022
| Indicator | Value |
| New cases | 662,301 |
| Deaths | 348,874 |
| Age-standardized incidence rate | 14.1 per 100,000 |
| Age-standardized mortality rate | 7.1 per 100,000 |
Source: IARC Global Cancer Observatory, GLOBOCAN 2022 [3].
HPV vaccination
HPV vaccination is one of the most important tools of primary prevention for cervical cancer. The WHO identifies girls aged 9–14 as the primary target group for HPV vaccination. Vaccination before HPV exposure provides the greatest preventive benefit [4].
A large cohort study demonstrating the clinical effectiveness of HPV vaccination followed 1,672,983 girls and women aged 10–30 years in Sweden. The study found that HPV vaccination was associated with a significant reduction in the risk of invasive cervical cancer, with the protective effect being greatest among those vaccinated before age 17 [5].
However, HPV vaccination does not eliminate the need for screening. Screening in accordance with national recommendations must continue even after vaccination.
HPV-based screening
For many years, the Pap test was the principal cytological screening method for the prevention of cervical cancer. High-risk HPV-DNA testing has since become a major primary screening method owing to its high sensitivity.
The WHO recommends HPV-DNA-based testing as the preferred method for primary cervical cancer screening. The starting age and screening interval depend on the national program; the WHO’s 2021 recommendations describe strategies using HPV-DNA testing from age 30, with a 5–10-year interval [6].
A systematic review and meta-analysis published in 2026 analyzed data from 8 studies involving 414,846 participants. HPV-based screening detected CIN2+ lesions at a 61% higher rate than cytology (RR 1.61; 95% CI 1.30–1.98). The authors emphasized the need for risk stratification to appropriately manage HPV-positive patients and to avoid overdiagnosis and overtreatment [7].
Table 2. Comparison of cervical cancer screening methods
| Method | What it detects | Advantage | Limitation |
| Pap test | Cytological changes | Extensive clinical experience | Potential for subjective interpretation |
| HPV-DNA test | High-risk HPV | High sensitivity | A positive result does not indicate cancer is present |
| HPV genotyping | Specific HPV genotypes | Individual risk assessment | Requires specialized laboratory capacity |
| Self-sampling | HPV | Can expand screening coverage | Requires follow-up after a positive result |
HPV genotyping and individual risk assessment
Modern screening strategy is not limited to determining whether HPV is present. Equally important is assessing, among HPV-positive women, the risk of developing clinically significant precancerous changes.
On 8 May 2026, the WHO issued an updated guideline on HPV-DNA genotyping. It describes three approaches to HPV genotyping — no genotyping, partial genotyping, and extended genotyping — and their role in risk stratification and molecular triage [8].
This approach can be represented through the following algorithm:
HPV-DNA test → genotyping → risk stratification → triage → colposcopy/biopsy → treatment or follow-up.
The purpose of this strategy is not to examine all HPV-positive women with the same intensity, but to more rapidly identify clinically high-risk groups and provide them with priority diagnostic and treatment support.
The WHO’s 2026 recommendations note that the choice of genotyping strategy must take into account laboratory capacity, availability of follow-up and treatment services, and the resources and capabilities of the health system [8].
The WHO 90–70–90 strategy
To eliminate cervical cancer as a public health problem, the WHO has established the 90–70–90 global targets [9].
Table 3. WHO 90–70–90 global targets
| Domain | Target |
| HPV vaccination | ≥90% of girls fully vaccinated by age 15 |
| Screening | ≥70% of women screened with a high-performance test by ages 35 and 45 |
| Treatment | ≥90% of women with identified cervical disease appropriately managed |
The essence of this strategy is to unite all stages of prevention into a single system: strengthening primary prevention through HPV vaccination, detecting precancerous changes through high-performance screening, and providing timely treatment of identified disease.
The WHO has defined the elimination threshold for cervical cancer as fewer than 4 new cases per 100,000 women per year [9].
Self-sampling and digital technologies
HPV self-sampling — in which a woman collects her own specimen for HPV testing — can expand access to screening services. This approach may be particularly important for women with limited access to healthcare or those who are less engaged with conventional screening.
However, the effectiveness of self-sampling is not determined by specimen collection alone. Triage, colposcopy, and appropriate treatment must also be available following a positive HPV result.
Digital medicine and artificial intelligence are also promising directions in gynecologic oncology. They may be used to analyze colposcopic images, digitize cytological material, monitor patients, and support clinical decision-making. However, before such technologies are introduced into clinical practice, their diagnostic accuracy, validation across diverse populations, and patient data privacy must be evaluated.
PRACTICAL RELEVANCE FOR UZBEKISTAN
International strategies for the prevention of cervical cancer are also of practical relevance to the healthcare system of Uzbekistan.
To improve the effectiveness of prevention, it is important to engage women in screening at the primary healthcare level, raise public health literacy regarding HPV and its prevention, refer patients with positive results to further diagnostic stages, and build an uninterrupted system through to treatment.
Family physicians can play an important role at the primary healthcare level in identifying at-risk groups, referring patients for screening, and ensuring follow-up of patients with positive screening results.
At the same time, in improving screening programs in Uzbekistan, it is important to adapt international recommendations to the local epidemiological situation, laboratory capacity, medical infrastructure, and available resources.
CONCLUSION
Cervical cancer is one of the oncological diseases with the greatest potential for prevention. Persistent high-risk HPV infection is the principal etiological factor in its development, a feature that makes it possible to control the disease through primary and secondary prevention.
HPV vaccination is a key component of primary prevention, while HPV-DNA-based screening is a key component of secondary prevention. Modern HPV genotyping technologies make it possible to stratify HPV-positive women by individual risk level and to improve clinical management.
An effective prevention system should be built on the following sequence:
HPV vaccination → HPV-DNA-based screening → risk stratification → triage → colposcopy and biopsy where indicated → treatment of precancerous lesions → follow-up.
Thus, integrating prevention, early detection, and individualized risk-based clinical management into a single system remains one of the most promising strategies for reducing the global burden of cervical cancer.
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