Modelling the time to cervical cancer elimination in England: strategies for achieving elimination by 2040

National Health Service (NHS) England has committed to eliminating cervical cancer as a public health problem by 2040, defined as an incidence of below 4 per 100 000 woman-years. This study aims to estimate the contributions of currently available interventions to cervical cancer elimination and assess how improvements in human papillomavirus (HPV) vaccination coverage, cervical cancer screening and treatment following an abnormal screen would impact the timeline for achieving this elimination target.

Using a previously published mathematical model that captured historical changes in HPV vaccination and screening programmes in England, cervical cancer incidence was forecasted from 2024 through 2124. Various scenarios were explored to assess the impact of resolving issues in disparities of screening coverage, low adherence to follow-up of abnormal screens and increasing vaccination coverage over time. Consistent with other cervical cancer elimination models in high-income countries, we also considered a more ambitious cervical cancer incidence threshold of below 1 per 100 000 woman-years.

With current screening and vaccination levels, it was estimated that England could achieve cervical cancer elimination (incidence of below 4 per 100 000) by approximately 2050. Achieving this target by 2040 would necessitate improved follow-up of abnormal screens and increased cervical cancer screening uptake in under-screened populations. The aspirational threshold can only ever be achieved with both improved screening (in follow-up and coverage disparities) and high vaccination rates. These results are consistent with other UK-specific model results.

Improvements in follow-up of abnormal screens and decreasing disparities in screening coverage will be necessary if England is to attain the 2040 elimination goal. Meanwhile, consistent high vaccination coverage will ensure future population protection and enable more aspirational thresholds to be achieved.