Cervical Cancer Elimination in Scotland Expert Group Final Report

5. Scotland specific information on WHO Targets and indicators

The WHO framework provides a global blueprint for eliminating cervical cancer as a public health problem. It is, however, intended primarily for low and middle-income countries where cervical cancer prevention strategies (or capacity) are quite different. To effectively address local challenges and reduce health inequalities, Scotland must adapt this framework to its specific needs.

Monitoring progress towards achieving the WHO targets should focus on coverage of national programmes and address disparities to ensure they reach all women, including underserved groups, across different regions.

Scotland has well-established national vaccination and cervical screening programmes, along with universally available treatment services, supported by a data and digital infrastructure that enables routine monitoring of coverage, outcomes, and impact. To ensure equitable progress in cervical cancer elimination, existing data systems must be enhanced, with improved linkages to collect and utilise data effectively. These improvements will help identify and address disparities, advancing health equity and ensuring elimination efforts benefit all populations. Table 1 outlines the group’s analysis of the current status in Scotland towards achieving the World Health Organisation’s targets.

Analysis of current status in Scotland

2030 WHO Target

Fewer than 4 new cases per 100,000 women

Current Status

Cervical cancer incidence

• 8.4^[9] per 100,000 women in 2023.
• Incidence of cervical cancer in Scotland has a clear deprivation gradient. Taking data from 2022, incidence in women from the most deprived backgrounds (13.6^~ per 100,000 person-years, 95% CI 10.7 – 17) is almost double that of women from the least deprived backgrounds (7.4^[10] per 100,000, 95% CI 5.3 – 9.9).
• (Data adapted from Cancer incidence in Scotland. To December 2023 and Cancer
• incidence in Scotland. Deprivation data to December 2022)

2030 WHO Target

90% of girls vaccinated by the age of 15 years

Current Status

• Full course vaccination coverage in S4 females historically has been over 90% overall, falling below 90% for the first time in school year 2021/22.
• This continues a long-term gradual decline in HPV coverage rates over the past 10 years, with disruption to delivery during the COVID-19 pandemic, and in subsequent years, rates not returning to pre-pandemic rates.
• During the school year 2024/25, coverage of one dose of HPV vaccine among girls in S1 was 75.7%. Pupils who do not take up the offer of vaccination in S1 are re-offered it in subsequent school years resulting in increasing coverage in later years. During the 2024/25 school year, coverage reached 85.7% in S4.
• In each year cohort, pupils living in the most deprived quintiles had lower coverage of the HPV vaccine compared with pupils from the least deprived quintiles. These inequalities have worsened over time. For HPV coverage rates over time in all S4 pupils, by deprivation, see Figure 2.
• Among all pupils, coverage of one dose of HPV immunisation by the end of S4 ranged between 74.6% in the most deprived and 90.7% in the least deprived pupils in 2024/25. In S4 pupils in 2019/20, there was a difference of 3.1 percentage points between the most and least deprived groups (91.1% vs 94.2%); by 2024/25, this was 16.1 percentage points (74.6% vs 90.7%).
• Coverage of one dose of HPV immunisation by the end of S4 ranged from 77.8% among girls residing in the most deprived areas to 92.3% in those from the least deprived areas in 2024/25.
• While the WHO indicators focus on vaccination coverage among girls, Scotland's inclusion of boys in the HPV vaccination programme supports efforts to eliminate cervical cancer, by reducing overall virus prevalence and transmission. It also helps protect unvaccinated individuals, lowering their risk of HPV-related cancers.

(Data derived from HPV immunisation statistics in Scotland. School year 2024/25)

2030 WHO Target

Screening participation by 2030

70% of women screened using a high-performance test by age 35 years and again by age 45 years

Current Status

• For 2023/24, the percentage of eligible women (those aged 25 to 64) who were up to date with their screening participation, was 63.3% (screened within the preceding 3.5 to 5.5 years).
• Screening coverage is lower in younger age groups and in women in the two most deprived SIMD quintiles.
• Screening coverage is around 11% less in women from the most deprived areas compared to the those in the least deprived areas.

(Data derived from published^[11] Scottish Cervical Screening Programme Statistics 2023/24 )

2030 WHO Target

Treatment of cervical precancer by 2030

90% of women with identified precancer are treated

Current Status

• 94.9% of CIN2 cases were treated.
• 98.6% of CIN3 cases were treated.

(Unpublished data derived from the Interim Report on Progress Toward Achieving the Third Pillar of the WHO Call for Elimination of Cervical Cancer).

2030 WHO Target

Treatment of cervical cancer by 2030

Management of 90% of women with invasive cervical cancer

Current Status

• 96.2% of women diagnosed with cervical cancer in 2023 received treatment.
• In the quarter ending June 2025, 38.9% of patients referred through the cervical screening programme, started treatment within 62 days of referral, compared to 46.7% of patients not referred through the screening programme.
• In the same time period, 94.4% of patients referred through the cervical screening programme began treatment within 31 days of date of decision to treat, compared to 96.8% who were not referred through the screening programme.

(Data derived from Cancer Waiting times in NHS Scotland. 1 April to 30 June 2025).

HPV immunisation coverage rates from school year 2019/20 to 2024/25, for S4 pupils, by Scottish Index of Multiple Deprivation (SIMD) quintile. It shows five lines, with rates displayed for quintile 1 (most deprived) to quintile 5 (least deprived). The trend is one of long-term decline with gaps in uptake between SIMD1 and SIMD5 widening over time. Uptake in the most deprived quintile (SIMD1) has lower uptake than the least deprived quintile (SIMD>5)."/>

Although Scotland is performing to a level that is in line with the WHO targets, exceeding the target treatment indicator, and almost reaching the remaining targets on HPV vaccination and cervical screening, much more must be done to address widening inequities. These disparities are not limited to deprivation alone; they intersect with other dimensions such as geography, ethnicity, and disability. Ensuring cervical cancer becomes a rare disease for all women in Scotland requires a comprehensive approach that tackles these overlapping inequalities. This also needs to be viewed in context of a downward trend of uptake, with a new and rapidly widening inequalities gap. This must be addressed to deliver equitable outcomes for every community.