We know how to eliminate cervical cancer – but we must win back trust to do it

Every year in Scotland around 100 women die from cervical cancer and up to 400 women are newly diagnosed with the disease. This should not happen.

For decades, cervical cancer has been detectable and treatable at an early stage and recently it has become preventable. The World Health Organization (WHO) calculates that if 90 per cent of girls are vaccinated each year, at least 70 per cent of women are screened, and if 90 per cent of women with pre-cancer are treated and those with invasive cancer managed appropriately, cervical cancer can be eliminated as a public health problem.

Cervical cancer is caused by the human papillomavirus (HPV). Since 2008, girls in Scotland have been offered vaccination against HPV in their first year at secondary school and, since 2016, the vaccine has been offered to boys. To date, in Scotland there have been no reported cases of cervical cancer caused by the types of HPV against which the vaccine provides protection, among women fully vaccinated between 2008 and 2010, and the vaccine continues to be effective more than 12 years after it was given.¹

Cervical screening allows early detection of cervical changes which, left untreated, may become malignant. Currently screening (testing for HPV infection) is offered every five years to women from age 25.

So, the systems are in place to eliminate cervical cancer in Scotland. However, cervical screening rates remain stubbornly below the required threshold for elimination of cancer and vaccination rates fell dramatically during the Covid pandemic. Although they have recovered somewhat, the rate remains below the requisite 90 per cent, thanks, in part, to a growing mistrust of institutions and public health messaging.

Confusing or conflicting messages coming from different sources, particularly from social media, fuel misinformation and disinformation and undermine public trust, which is difficult to counteract.

According to mathematical modelling, with current levels of HPV vaccination coverage and screening uptake, Scotland could reach elimination within the next 25 years. If an immense effort were made to increase vaccination and screening uptake, it could be done within just 15 years.²

However, the incidence of cervical cancer in Scotland has a clear deprivation gradient. Women living in the most deprived areas of the country are almost twice as likely to be diagnosed with cervical cancer. They are more likely to present at a later stage of the disease and are almost four times more likely to die from it than women living in the most affluent areas. And there is a clear deprivation gradient in the uptake of both vaccination and screening. In the school year 2024/25, more than 80 per cent of pupils at schools in the most affluent areas of Scotland were vaccinated – still below 90 per cent – while in the most deprived areas, that figure barely reached 60 per cent – again, well below the 90 per cent the WHO says we need to hit.

Likewise, age-appropriate cervical screening coverage was above 70 per cent in the most affluent areas, but below 60 per cent in the most deprived areas. Projections indicate that without an enormous effort, cervical cancer may never be eliminated as a public health problem in Scotland among women living in the most deprived areas.²

The Health and Wellbeing Community of Interest of the RSE recently held a meeting entitled Eliminating Cervical Cancer – a task of reaching the missing. Through presentations and roundtable discussions, we talked about the reasons for the inequalities, alongside interventions designed to reduce them among women living not only in deprived and black and minority ethnic communities but also homeless and physically disabled women.

In years to come there will be many other cancers for which vaccination and early diagnosis will enable elimination. Uptake of those interventions will likely face the same issues as vaccination and screening for cervical cancer – perhaps redoubled, if we continue to leak trust in expertise.

To reach the communities that are seemingly less engaged or less able to engage in health prevention, and to eliminate many diseases equitably, we need to change beliefs, change behaviour and win back trust, and that is not easy to do. Events like our recent meeting, enabling experts from different specialties to come together, are vital to our understanding of how to achieve success.

References

1 Palmer TJ, Kavanagh et al. Journal of the National Cancer Institute, Volume 116, Issue 6.

2 Cervical Cancer Elimination in Scotland Expert Group Final Report, December 2025.

Professor Anna Glasier FRSE, physician and Scottish Government’s Scotland’s first Women’s Health Champion

This article originally appeared in ReSourcE Spring/Summer 2026.

The RSE’s blog series offers personal views on a variety of issues. These views are not those of the RSE and are intended to offer different perspectives on a range of current issues.