HPV Vaccine Uptake and Cervical Cancer Trends in Panama: A Reference Point for Future Impact Studies

Background: Cervical cancer (CC) continues to be an important public health concern in Latin America, where it is the second cause of cancer-related deaths among women. With its strong culture of vaccination, Panama was the first country to implement the HPV vaccine as part of its Essential Program on Immunization (EPI). Recently, the government implemented the 90:70:90 PAHO/WHO strategy to reach milestones toward CC elimination. Objective: This analysis triangulates and assesses national data on HPV vaccination coverage, screening practices, and cervical cancer incidence and mortality in Panama, to understand historical tendencies to date and establish a comprehensive foundation for future impact evaluations and research studies. The analysis aims to identify trends and gaps in prevention efforts and to serve as a reference point for future research on HPV-associated cancers. Methods: Population-based, descriptive, observational, ecological study where four, aggregate, de-identified data sources by various curators in Panama were match-merged by year, sex, and administrative division. Reported outcomes include HPV vaccine coverage, CC incidence and mortality rates, screening Pap tests, and CC behavior at diagnosis (in situ vs. invasive). Results: Panama has high HPV vaccine uptake (≥85% most years) in spite of low Pap test coverage (~10%). A decreasing trend in CC incidence has been observed continuously since the 1990s, counterintuitively to significantly increasing CC mortality rates, with most cases diagnosed as invasive and among younger women (30-69 years old). Conclusions: This report provides a comprehensive foundation for understanding trends in HPV vaccination coverage, cervical cancer incidence and mortality, and screening practices in Panama. While high vaccine uptake and declining incidence trends are encouraging, persistent low screening rates and elevated mortality-particularly at invasive stages among younger women-highlight critical gaps in prevention efforts. The need for integrated strategies that strengthen data systems, improve early detection, and address structural and sociocultural barriers are discussed, framed within Panama's progress toward achieving the 90:70:90 targets. Future studies should focus on understanding non-medical influences on health and further vaccine impact with patient-level data, and other forms of HPV-related cancers in immunosuppressed populations. Public strategies would benefit from the implementation of real-life data and efficient data management, consolidation systems, systematic health promotion interventions, and an increase in resource allocation for women at the highest risk.