HPV-related cancer prevention in Spain: progress and remaining challenges in vaccination, screening, and surveillance

Human papillomavirus (HPV) is a necessary causal factor for most cervical cancers and contributes to several other HPV-related malignancies. The nonavalent HPV vaccine targets the most prevalent oncogenic genotypes and has the potential to prevent up to 90% of HPV-attributable cancers. However, cervical cancer screening remains essential, as vaccination does not cover all oncogenic HPV genotypes, does not treat established HPV infection, and cannot prevent disease in individuals after HPV exposure. Available Spanish data do not yet show a clear sustained decline in HPV-related cancers comparable to that reported in some other high-income countries. This narrative review examines HPV vaccination, cervical cancer screening, and the burden of HPV-related cancers in Spain, with a focus on implementation gaps, surveillance limitations, and opportunities for improvement. Strengthening vaccination coverage, population-based screening, follow-up after abnormal results, and national data integration will be essential to accelerate progress toward cervical cancer elimination.