Human papilloma virus (HPV) vaccination effectively reduces cervical cancer incidence, and invasive cervical cancer is preventable if pre‑cancerous or pre‑invasive changes are detected and treated before progression occurs. However, about 196 000 women in the WHO South-East Asia Region and 185 000 women in the WHO Western Pacific Region were expected to be newly diagnosed with cervical cancer, and almost 120 000 women in the South-East Asia Region and over 70 000 women in the Western Pacific Region were estimated to have died of cervical cancer in 2022 (IARC, 2024[1]).
Cervical cancer incidence rate varies by over 7‑fold across countries in Asia-Pacific in 2022. The age‑standardised rate was around 5 per 100 000 women in New Zealand, Australia and Pakistan while it was over 25 per 100 000 in Fiji, Papua New Guinea and Solomon Islands. The average incidence rate was low for high-income countries in the region (10 per 100 000), although above the OECD average of 5 per 100 000. But the average rate was high for lower-middle countries (15 per 100 000) and upper-middle-income countries (20 per 100 000) (Figure 7.10).
WHO recommends one or two doses of HPV vaccination for the primary target population of girls aged 9‑14 years, and one or two doses for girls aged 15‑20 years and two doses with a 6‑month interval for women older than 21 years if affordable and feasible (WHO, 2024[2]). An increasing number of countries and territories in Asia-Pacific have national HPV vaccination programmes, although the target populations vary, based on epidemiological and other evidence such as cost-effectiveness that is specific to each country.
In 2022, HPV vaccination coverage ranges widely between 3% of girls in the target age group in the Philippines and more than 90% in Sri Lanka (Figure 7.11). The vaccination coverage increased substantially in Singapore which introduced school-based screening programme in 2019 (Goei and Vijayalakshmi, 2023[3]). However, Malaysia, which introduced school-based vaccination programme in 2010, reduced vaccination coverage substantially in recent years, because it was affected by global vaccine shortage caused by the pandemic. It aims to resolve vaccine backlog by the end of 2024 and in the meantime, catch-up vaccination for girls who missed vaccination due to shortage are being carried out (Malay Mail, 2024[4])
To prevent cervical cancer and promote early detection, a growing number of countries and territories in the region have also started implementing population-based cervical cancer screening programmes. HPV test, recommended for women starting at age 30 years every 5‑10 years by WHO (WHO, 2021[5]), is provided through cervical cancer screening programme every 5 years, starting at age 25 in Australia and New Zealand and every 5 years, starting at age 30 in Singapore, while most other countries in the region including Brunei Darussalam, China, Fiji, Japan, Korea, Malaysia, Mongolia, Sri Lanka, Thailand and Viet Nam use Pap smear in the screening programme. A few other countries, mostly low and lower-middle countries in the region such as Bangladesh, Cambodia, India, Indonesia, DPRK, Myanmar, Nepal and the Philippines provide visual inspection of the cervix with acetic acid (VIA) test instead (WHO, 2021[6]).
Following preventive vaccination and screening programmes, cervical cancer incidence has decreased in countries such as Australia, New Zealand, Korea, Singapore and Thailand in recent years. On the contrary, it increased significantly in Japan and China (IARC, 2024[7]). A rapid increase in Japan is likely to be related to an eight‑year pause of HPV vaccination programme, which resumed in 2022.
Cervical cancer mortality rates vary over 16‑fold across countries in Asia-Pacific in 2022 (Figure 7.12). High-income Asia-Pacific countries had low mortality rates, but the rates were high at around 20 deaths or more per 100 000 women in Fiji, Papua New Guinea and Solomon Islands where incidence rates for cervical cancer are also high.
Reflecting prevention through of HPV vaccination and screening, and effective early detection and treatment, the mortality rates for cervical cancer have decreased in Australia, New Zealand and Korea. Australia now aims to eliminate cervical cancer by 2035 as per its National Strategy for the Elimination of Cervical Cancer in Australia. However, the mortality rate slowly increased in Japan (IARC, 2024[7]) where HPV vaccination uptake was very low between 2013 and 2021 (Ministry of Health, Labour and Welfare, 2022[8])
