Cervical Cancer Screening Cascade Performance Across Three Regional Districts in Uganda, 2024–2025
J Akamumpa, K Moran, B Dahye, C Mpaamani, M Origa, N N Niyonzima, A N Namuli, F M Mugabe, N E Nankya, J OremAbstract
Background
Cervical cancer is the leading cause of cancer mortality among women in Uganda. This study evaluated screening positivity, diagnostic performance, and treatment cascade outcomes across three districts (2024–2025).
Methods
Retrospective analysis of 24,660 records from the Cervical Cancer Screening and Pre-Cancer Treatment Register (Kampala, Mbarara City, Mbarara District). Modalities included VIA, HPV DNA testing, and Pap smear. Analyses were stratified by district, age, and HIV status.
Results
Of 24,660 women enrolled, 44.9% were from Kampala, 31.6% Mbarara City, and 20.7% Mbarara District. Among initial screeners (n = 14,665), positivity was 12.9%; overall positivity across 23,435 screened women was 13.9% (3,252/23,435). Positivity varied by district (Kampala 14.8%, Mbarara City 11.2%, Mbarara District 11.6%), rose with age (6.5% under 25 to 17.6% aged 50+), and was higher among HIV-positive women (23.1% vs. 10.3%). HPV DNA testing had higher positivity than VIA or Pap smear (25.0% vs. 11.0%); 74.3% of HPV-positive women were also VIA-positive. Invasive cancer was found in 4.3% of screen-positive women (140/3,252), rising to 20.9% in those aged 50+. HIV-positive women accounted for 42 of 140 invasive cases. Approximately 30% of screen-positive women were untreated overall; the gap was highest among first-time screeners (∼40%).
Conclusions
A critical treatment gap persists. Women living with HIV, women aged 40+, and first-time screeners require targeted interventions to improve linkage to treatment and reduce cervical cancer mortality in Uganda.
Key messages
• Despite scale-up, 30% of screen-positive women in Uganda were not treated, rising to 40% among first-time screeners — revealing a critical gap between screening and care.
• HIV-positive women and those aged 50+ bear the highest cervical cancer burden. Targeted interventions are urgently needed to close the treatment gap and save lives in Uganda.