ArticleBMJ oncology2026
Global determinants of cervical cancer outcomes: a health systems analysis.
Article in BMJ oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
4 citing papers in PubMed.
- International Western Radiation Therapy Guidelines Applicability in Low- and Middle-Income Countries for Cervical Cancer Management: A Comparative Survey Example from South and North Border of the Mediterranean Area Countries.Advances in radiation oncology · 2026Article
- The Cervical Cancer Paradox in Eastern Europe: How Knowledge and Institutional Trust Shape HPV Vaccination Attitudes in Romania.Medical sciences (Basel, Switzerland) · 2026Observational
- Feasibility of decentralized cervical cancer survivorship care at district hospitals in Rwanda: a multi-site pilot implementation study.The oncologist · 2026Article
- The implications and mechanisms of vaginal microbiota metabolites on cervical cancer progression.Frontiers in cellular and infection microbiology · 2026Review
Corrections and comments
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Authors and funding
29 authors.
Funding
Abstract
Objective: Significant global health disparities persist in cervical cancer, with over 85% of cases and deaths occurring in low- and middle-income countries (LMICs). In many settings, access to screening, vaccination and treatment is limited. Despite cervical cancer being largely preventable through human papillomavirus (HPV) vaccination and early detection, many women around the world face inadequate healthcare infrastructure, lack of awareness, cultural stigma and gender barriers to seeking care. Therefore, we evaluated global health system metrics that may inform efforts to improve equity in access to cervical cancer care globally. Methods and analysis: We derived estimates of age-standardised mortality-to-incidence ratios (MIRs) for female patients with cervical cancer of all ages from the Global Cancer Observatory (GLOBOCAN 2022 database), with complete data available for 121 of 185 countries in the database. We selected the following health system metrics: health spending as a per cent of gross domestic product (GDP), physicians/1000 population, nurses and midwives/1000 population, surgical workforce/1000 population, GDP per capita, Universal Health Coverage Service Coverage Index (UHC index), availability of pathology services, Human Development Index (HDI), Gender Inequality Index (GII) (a combined metric of health, empowerment and economic agency), radiotherapy centres/1000 population, out-of-pocket expenditure as percentage of current health expenditure, availability of cervical cancer screening, and HPV coverage.We evaluated the association between MIR and each metric using univariable linear regressions. To account for multiple comparisons, a Bonferroni correction using a p<0.0045 was applied. Metrics meeting this threshold were included in multivariable models. Variation inflation factor (VIF) allowed exclusion of variables with significant multicollinearity. R Results: On univariable analysis, 12 of the 13 metrics were significantly associated with MIR of cancer (p<0.001 for all). HPV coverage was not significantly associated with MIR (β=-0.0007, p=0.290). After including metrics that were significant on univariable analysis, HDI demonstrated significant collinearity (VIF=19). Therefore, after correcting for multicollinearity, the final multivariable model with 11 variables had R Conclusion: This comprehensive and global analysis of health system metrics suggests promoting progress towards UHC and strengthening the nursing/midwifery workforce may be independently associated with improved cervical cancer MIR. Furthermore, greater gender inequality was associated with worse MIR. These findings may inform efforts to improve global cervical cancer care and underscore the importance of reducing gender inequality to improve global cervical cancer outcomes.
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