Cervical cancer screening coverage is a key monitoring indicator of the WHO cervical cancer elimination plan. We present global, regional, and national cervical screening coverage estimates against the backdrop of the 70% coverage target set by WHO. In this review and synthetic analysis, we searched scientific literature, government websites, and official documentation to identify official national recommendations and coverage data for cervical cancer screening for the 194 WHO member states and eight associated countries and territories published from database inception until Oct 30, 2020, supplemented with a formal WHO country consultation from Nov 27, 2020, to Feb 12, 2021. We extracted data on the year of introduction of recommendations, the existence of individual invitation to participate, financing of screening tests, primary screening and triage tests used, recommended ages and screening intervals, use of self-sampling, and use of screen-and-treat approaches. We also collected coverage data, either administrative or survey-based, as disaggregated as possible by age and for any available screening interval. According to data completeness and representativeness, different statistical models were developed to produce national age-specific coverages by screening interval, which were transformed into single-age datapoints. Missing data were imputed. Estimates were applied to the 2019 population and aggregated by region and income level. We identified recommendations for cervical screening in 139 (69%) of 202 countries and territories. Cytology was the primary screening test in 109 (78%) of 139 countries. 48 (35%) of 139 countries recommended primary HPV-based screening. Visual inspection with acetic acid was the most recommended test in resource-limited settings. Estimated worldwide coverage in women aged 30–49 years in 2019 was 15% in the previous year, 28% in the previous 3 years, and 32% in the previous 5 years, and 36% ever in lifetime. An estimated 1·6 billion (67%) of 2·3 billion women aged 20–70 years, including 662 million (64%) of 1·0 billion women aged 30–49 years, had never been screened for cervical cancer. 133 million (84%) of 158 million women aged 30–49 years living in high-income countries had been screened ever in lifetime, compared with 194 million (48%) of 404 million women in upper-middle-income countries, 34 million (9%) of 397 million women in lower-middle-income countries, and 8 million (11%) of 74 million in low-income countries. Two in three women aged 30–49 years have never been screened for cervical cancer. Roll-out of screening is very low in low-income and middle-income countries, where the burden of disease is highest. The priority of the WHO elimination campaign should be to increase both screening coverage and treatment of detected lesions; however, expanding the efforts of surveillance systems in both coverage and quality control are major challenges to achieving the WHO elimination target. Instituto de Salud Carlos III, European Regional Development Fund, Secretariat for Universities and Research of the Department of Business and Knowledge of the Government of Catalonia, and Horizon 2020. For the French, Spanish translations of the abstract see Supplementary Materials section.

中文翻译：

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全球 202 个国家和地区的宫颈癌筛查计划和特定年龄覆盖率估计：回顾和综合分析

宫颈癌筛查覆盖率是世界卫生组织宫颈癌消除计划的关键监测指标。我们以世界卫生组织设定的 70% 覆盖率目标为背景，提出了全球、区域和国家宫颈筛查覆盖率估计值。在本次综述和综合分析中，我们检索了科学文献、政府网站和官方文件，以确定从数据库建立到 10 月 30 日期间发布的 194 个 WHO 成员国和 8 个相关国家和地区的宫颈癌筛查官方国家建议和覆盖数据， 2020 年，并辅以 2020 年 11 月 27 日至 2021 年 2 月 12 日的正式世卫组织国家磋商。我们提取了有关提出建议的年份、是否存在个人参与邀请、筛查测试资金、初级筛查和分类测试的数据使用的、推荐的年龄和筛查间隔、自我采样的使用以及筛查和治疗方法的使用。我们还收集了基于管理或调查的覆盖率数据，并尽可能按年龄和任何可用的筛查间隔进行分类。根据数据完整性和代表性，开发不同的统计模型，按筛选间隔生成全国分年龄覆盖率，并转化为单年龄数据点。对缺失数据进行了估算。估算适用于 2019 年人口，并按地区和收入水平进行汇总。我们确定了 202 个国家和地区中的 139 个 (69%) 的宫颈筛查建议。细胞学是 139 个国家中 109 个国家 (78%) 的主要筛查试验。139 个国家中有 48 个国家 (35%) 建议进行基于 HPV 的初步筛查。在资源有限的环境中，最推荐使用乙酸进行目视检查。2019 年，全球 30-49 岁女性的覆盖率估计为上一年的 15%、过去 3 年的 28%、过去 5 年的 32%、一生中的 36%。据估计，2·30 亿年龄在 20-70 岁的女性中，有 1·60 亿 (67%) 从未接受过宫颈癌筛查，其中包括 1·00 亿年龄在 30-49 岁的女性中，有 6.62 亿 (64%) 从未接受过宫颈癌筛查。高收入国家 1.58 亿 30-49 岁女性中，有 1.33 亿 (84%) 一生中接受过筛查，而中高收入国家 4.04 亿女性中，有 1.94 亿 (48%) 接受过筛查；中高收入国家 3,400 万人接受过筛查。中低收入国家 3.97 亿女性中的 9%（9%），低收入国家 7400 万女性中 800 万（11%）。30 至 49 岁的女性中，三分之二从未接受过宫颈癌筛查。在疾病负担最高的低收入和中等收入国家，筛查的普及率非常低。世卫组织消除运动的首要任务应该是提高筛查覆盖率和对检测到的病变的治疗；然而，扩大监测系统在覆盖范围和质量控制方面的努力是实现世卫组织消除目标的主要挑战。