CERVICAL CANCER EPIDEMIOLOGY IN A METROPOLIS WITHOUT AN ORGANIZED SCREENING PROGRAMME

Abstract

Cervical cancer is largely preventable, yet its burden remains high where screening is predominantly opportunistic. A population-level assessment in a large city is essential for designing an organized earlydetection programme. Materials and Methods. The study retrospectively analysed official statistics and population-based cancer registry data for Kyiv in 2015-2024. It assessed age-standardized incidence and mortality, the mortality-to-incidence ratio, temporal trends, age and stage distributions, five-year survival, histological and genotype profiles, and territorial variation across ten administrative districts. Results. Kyiv had an age-standardized incidence of 15.6 and mortality of 6.4 per 100,000 women, with a mortality-to-incidence ratio of 0.41. These indicators were close to national values and three to four times higher than in countries with mature organized programmes. Screening coverage remained 28-32%. Early stages accounted for 71.2% of cases, while advanced stages represented 28.8%, and five-year survival was 58.3%. Survival showed a strong stage gradient, ranging from 98-99% for stage IA to 28-40% for stages III-IV. The integrated earlydetection organization index varied substantially between districts, with a coefficient of variation of 34.2%; 28.3% of examinations were performed outside the district of residence. Squamous cell carcinoma predominated histologically. High-risk human papillomavirus prevalence was 28.9%, with genotypes 16 and 18 predominating. Conclusions. Kyiv has a high and territorially unequal cervical cancer burden, a substantial proportion of advanced disease, and insufficient survival. The findings support transition to an organized, registry-based, and territorially balanced screening programme.