A SYSTEMATIC REVIEW ON CERVICAL CANCER PREVENTION AND SCREENING IN LOW- AND MIDDLE-INCOME COUNTRIES: EPIDEMIOLOGICAL BURDEN, HEALTH SYSTEM GAPS, AND STRATEGIC PATHWAYS FOR ELIMINATION

Abstract

Cervical cancer is among the most readily preventable cancers affecting women worldwide, yet it continues to claim 
an inordinate share of female cancer deaths in low- and middle-income countries (LMICs). The co-existence of 
proven preventive technologies and persistently high mortality in settings such as Nigeria points not to a knowledge 
deficit but to a fundamental failure of health system implementation.This systematic review critically synthesises 
evidence on the epidemiological burden of cervical cancer, the effectiveness of primary and secondary prevention 
strategies, and the structural determinants that constrain screening utilisation in LMICs, with focused attention on 
sub-Saharan Africa and Nigeria. A systematic review design was adopted, drawing on studies retrieved from 
PubMed, Scopus, Web of Science, and Google Scholar, complemented by grey literature from the World Health 
Organisation (WHO), the International Agency for Research on Cancer (IARC), and the Federal Ministry of Health, 
Nigeria. Searches were conducted using Boolean combinations of terms relating to cervical cancer, human 
papillomavirus (HPV), screening, and health system capacity, restricted to publications from 2000 to 2025. 
Thematic synthesis was applied to integrate findings across four analytical domains. The review identified four 
consistent patterns in the evidence. First, the concentrated burden of cervical cancer in sub-Saharan Africa reflects 
health system inequities rather than heightened biological vulnerability. Second, existing prevention modalities, 
including HPV vaccination, cytology-based screening, and HPV DNA testing, are demonstrably effective but 
unevenly implemented. Third, health system capacity, particularly the organisation of services, workforce 
availability, and integration within primary care, is the primary driver of screening uptake and early detection. 
Fourth, geographic inaccessibility and opportunistic rather than population-based programme delivery severely limit 
preventive reach. Reducing cervical cancer mortality in Nigeria and comparable settings requires a strategic 
reorientation from technology procurement towards health system strengthening, coordinated programme delivery, 
and the elimination of geographic barriers to service access.