Closing the gap to cervical cancer elimination in Portugal: a modelling study

Background

Cervical cancer (CC) elimination is now a realistic goal, but even high-coverage countries need to identify which interventions can accelerate progress. Portugal has sustained high HPV vaccination uptake and organised cervical screening. We estimated future CC incidence under alternative vaccination and screening scenarios, to assess if elimination is achievable before 2050.

Methods

We developed a deterministic, dynamic compartmental model of high-risk HPV transmission and cervical carcinogenesis, stratified by sex and single-year age (0–99 years), for mainland Portugal, 2018–2050, that links HPV infection, immunity and vaccination in both sexes with cervical intraepithelial neoplasia (CIN) grades 1 and 2/3 and invasive CC in women. We compared three scenarios: current routine vaccination and screening (S1); S1 plus 2026 catch-up vaccination to age 26 years (S2); and S2 plus screening strengthening from 57% to 70% coverage by 2030, with the eligible age range extended from 25–60 to 30–69 years (S3). The primary outcome was age-standardised CC incidence per 100,000 women-years; elimination defined as < 4/100,000 (WHO). Results are preliminary pending further calibration.

Results

Modelled incidence declined from 11.0/100,000 in 2018 to 9.1/100,000 by 2021, stabilising through 2026 as vaccinated cohorts had not yet reached peak-incidence ages. From 2027, incidence fell continuously at approximately 0.4/100,000 per year. S1 and S2 crossed the elimination threshold in 2042, reaching 1.79 and 1.57/100,000 by 2050. S3 reached elimination in 2039 and produced the lowest residual burden: 36% lower incidence, 36% fewer prevalent CIN2/3 cases and 20% fewer CC deaths versus S1.

Conclusions

Preliminary projections suggest CC elimination in Portugal is achievable before 2050. High vaccination coverage provides the foundation; strengthening screening could accelerate progress and reduce residual burden. Integrated monitoring will be essential.

Key messages

• Cervical cancer elimination in Portugal appears achievable before 2050 under current vaccination and screening strategies, with the WHO threshold projected to be reached by 2042.

• Increasing effective screening coverage from 57% to 70%, combined with catch-up HPV vaccination, could accelerate elimination by three years and substantially reduce pre-cancer burden.