Cervical Cancer elimination strategy: action plan

Section 1 – The foundations of elimination

1.1 Three pillars of elimination

First, HPV vaccination can prevent up to 90% of cervical cancers^[28].

Since the vaccination programme began in 2008, it has changed substantially, increasing protection and effectiveness for those who take it up. In 2008, the vaccine protected against 5 HPV types^[29]; required three doses to achieve complete protection; and was only routinely offered to girls. As of 2026, the vaccine in Scotland protects against nine HPV types^[30]; requires only one dose; and is offered to both girls and boys. This gender-neutral approach extends protection to boys against other HPV-related cancers and also minimises the chances that they will be a source of infection for women.

Multiple Scottish studies show dramatic reductions in HPV infection, high grade cervical disease, and to date —with long term follow up—no cervical cancer cases detected in fully vaccinated women^[31].

Second, cervical screening can detect abnormalities before they develop into cancer, and has historically helped halve cervical cancer incidence in the UK^[32]. It is likely to remain a vital tool for elimination despite the vaccine, because vaccination does not cover all cancer-causing HPV strains.

At present, women aged 25-64 are eligible to be invited for screening, which is usually carried out in GP practices by trained sample takers.

As with vaccinations, the screening programme has undergone significant change in recent years. Since 2020, screening has been able to test specifically for the presence of HPV. This is a more sensitive and accurate test than screening prior to 2020. It means women at higher risk may be identified earlier, and has reduced the number of cervical screens a woman needs if no HPV is detected.

As of March 2026, kits have started to be offered to under-screened women that allow them to carry out the screening test themselves. There is evidence that this could be particularly useful for women who have undergone trauma, or face other physical or emotional barriers to screening. The first phase of roll out will focus on women in some of the most deprived areas of Scotland, where we know cervical cancer outcomes are poorer.

Third, where signs of cervical cancer are detected, women are referred for colposcopy, which can either result in immediate treatment or further diagnostic tests to inform treatment options. This ensures early identification of pre-cancerous changes while minimising invasive treatments for people who do not need them.

Together, these services form a coordinated system to prevent cervical cancer, and we can expect future improvements on the way to 2040. Self-sampling may, for example, become the main screening test, meaning all eligible women could carry it out in their homes. Screening frequency for vaccinated women may also change if evidence of the vaccine’s effectiveness continues to grow. Our actions here must therefore improve the programmes we currently have, while ensuring they can continue to deliver in the years ahead.

1.2 A future-proofed cervical cancer elimination system

As the previous sections have made clear, there is no single answer that will increase uptake. However, the work of the Expert Group^[33], as well as extensive research from organisations such as Cancer Research UK, and the Scottish Government’s own stakeholder engagement, already provide very clear indications of what good systems look like.

Firstly, and most importantly, both vaccination and screening services must be person-centred. For screening that means:

• Booking appointments by phone, text or online
• Flexible appointments that can accommodate working and caring patterns
• A range of settings for screening that make opportunistic screening possible, or allow participants to be screened where they are comfortable
• Individual needs met from the outset – whether that is communications materials or adjustments at appointments

For vaccines it means:

• Consent processes are easy and accessible for young people and parents
• There are clear and proactive routes to vaccination that do not rely on school-based delivery alone.
• Catch-up vaccines, offered to women under 25, are provided in a range of settings that make the process easy.

And for both, there must be:

• Accessible records – participants should be able to easily find out their own screening and vaccine status
• Communications materials co-produced with participants, particularly under-served groups, who may benefit most from more effective messaging

Second, both services must be digitally capable. Many of the person-centred requirements set out above hinge on front-facing services. Just as crucially, the infrastructure that underpins service delivery must be capable of responding to medical or technological advances that could change how screening or vaccines are delivered.

Finally, they must be data driven. They must be able to identify disparities in uptake among and between groups, both to target interventions to tackle these, and to assess their effectiveness.

1.3 Key Challenges

The previous sections demonstrate how much Scotland has to celebrate. However, it is also clear that there are a range of interconnected issues that prevent both systems from reaching their full potential. This is likely contributing to falling uptake, or hampering the scope to address it.

In screening, some of the most pressing issues revolve around digital and data collection:

• Older IT systems make implementing changes to pathways or processes unduly cumbersome and expensive. These limitations are present in both large and small interventions, from changing the text of invitation letters, to introducing self-sampling
• Communication methods cannot flex to meet the needs of participants – at present, only paper-based communications are possible, and there is no way to accommodate particular requirements, such as providing information in languages other than English, easy read or large print.
• Data collection can only provide detailed demographic information on age and socioeconomic status. Uptake trends based on other protected characteristics, such as disability or ethnicity, cannot easily be obtained.
• There is no scope to monitor participant experience – for example, to understand how easily individuals can make appointments when invited; to understand accessibility challenges; or to take systemic action to improve how either are offered.

On a delivery level, over time, alternatives to screening appointments outwith primary care have largely disappeared; there is, for example, only very limited access to screening in sexual health clinics, where some women, particularly those who have experienced trauma, may be more comfortable. Additionally, resources that allowed women to seek support before or after screening, such as Jo’s Cervical Cancer Trust, have disappeared.

Likewise, in vaccines, digital limitations mean individuals cannot look up their own vaccine status, but rather must seek the information from primary care. There is no scope to book appointments, or for vaccine consent to be managed digitally, which could make it easier to give.

1.4 Key Actions

1.4.1 Establishing a community network

We will ensure that interventions, from short to long term, are shaped by partners all across the country by:

• building a wide community network of expertise and lived experience to ensure new ideas and perspectives reinvigorate our approach, and that we are held to account by people who are often under-served by our systems.

What we will achieve

New interventions will be developed with and scrutinised by people with lived experience of inequalities, and by communities that work most closely with under-served groups. They will have a role in shaping our delivery plans, annual reports, and in influencing the direction and outcomes of the actions in this plan. In this way, we will be continually accountable for developing truly person-centred interventions that are focused on fairness and reducing barriers.

1.4.2 A modernised screening programme

We will:

• Establish a Cervical Screening Modernisation Programme

What we will achieve

Similar to the programme established to modernise breast screening, which provided its final report in 2025^[34], a Cervical Screening Modernisation Programme will be tasked with examining the entire screening programme, right through from identification of participants, to the transfer to treatment pathways. As with breast screening modernisation, the Scottish Government will not seek to pre-empt or direct the findings of this review. Its overarching mandate will be to interrogate the whole programme through the lens of equity and access, and provide evidence-based recommendations on how both can be improved.

1.4.3 Digital Services

We will:

• Improve digital capabilities across both vaccination and screening by:
  • Procuring a new IT system for cervical screening
  • Developing a modernised digital solution to optimise HPV vaccination delivery which strengthens identification of vaccine eligibility; improves appointment scheduling and recording capability across different settings; and enhances reporting capabilities.
  • Piloting a vaccination digital consent solution, with ongoing evaluation informing national rollout.
  • Scoping options to provide patients with secure digital access to HPV vaccination records, building on current work to improve citizen access to vaccination data.

What we will achieve

Significant digital upgrades for both programmes will offer greater scope for users to take control of their data; increase potential for them to manage scheduling of their own appointments; and open the possibility for parents, carers and young people to consent to vaccines in a way that is more in keeping with a 21^st century programme. A new screening platform will also future proof the programme, making it easier to implement new tests or initiatives, including any recommendations arising from the modernisation work. Finally, collectively, the work will increase the range and breadth of data available, supporting our ambition to better understand and serve groups that traditionally do not attend for screening or vaccines.

1.4.4 Data and monitoring

We will:

• Improve data analysis by:
  • Improving national HPV vaccination data dashboards for Health Boards to support monitoring and targeted action to improve uptake
  • Improving collection and analysis of colposcopy data, allowing better understanding of waiting times and any inequalities of uptake
  • Developing a programme-wide evaluation for cervical cancer elimination, bringing together all available vaccination, screening and treatment data, and resulting in the production of a Cervical Cancer elimination dashboard.
  • Establishing a joint data group to oversee implementation of the elimination strategy, ensuring that it supports a plan, do, study quality improvement approach for all CCE interventions.

What we will achieve

Robust data gathering and analysis will strengthen our ability to monitor routine programme performance, which is critical for quality assurance, and to more systematically track progress against WHO^[35] and Scotland-wide^[36] elimination targets. It will also be crucial to achieve our overarching aim of significantly improving uptake among a wide range of groups, including those with disabilities, those from ethnic minority backgrounds, and those who are otherwise under-served, for example as a result of homelessness, trauma, or because of where they live.

This work will, in part, hinge on the digital actions set out above, but in the next three years, we are committed to maximising the data we have available, and to developing a detailed strategy to guide us to 2040, with the ultimate ambition of being able to set more defined targets for each Health Board if evidence suggests this would be helpful.