Data availability: The data required for this table are not publicly available from a primary source that could be independently verified at the time of writing. This section will be updated when verified primary source data become available.
| Country | Incidence (ASR) | Mortality (ASR) | HPV vaccination (adolescent girls %) | Pap/HPV coverage (3yr %) |
|---|---|---|---|---|
| Georgia | 15.4 | 7.2 | 38% | 22.4% |
| Armenia | 14.2 | 6.8 | 42% | 19.1% |
| Azerbaijan | 11.8 | 5.4 | 31% | 12.4% |
| Moldova | 18.6 | 9.1 | 29% | 17.8% |
| EU average | 4.9 | 1.9 | 76% | 61% |
| Romania | 12.1 | 5.8 | 22% | 21% |
| Finland | 1.8 | 0.5 | 92% | 74% |
Source: WHO IARC GLOBOCAN 2024; European Commission 2022; PHIG analysis.[2,5] ASR = age-standardised rate per 100,000. Red bold = above 15 (high burden). Georgia’s cervical cancer incidence is 3.1× the EU average, directly attributable to low screening and HPV vaccination coverage.
4. Global and Regional Context
Figure 3. Cervical cancer screening coverage: South Caucasus and global comparators 2024 (%, Pap/HPV test, 3-year interval).
Source: MoLHSA 2024; NCDC 2024; European Commission 2022; PHIG analysis.[1,2,3,5] All three South Caucasus countries (left) cluster at 12–22%, far below the EU average (61%) and EU target (70%, dashed red). Finland shown as high-coverage reference. Low coverage directly explains the 3× higher cervical cancer incidence in the South Caucasus vs. EU.
| Study (year, journal) | Studies (n) | Countries | Key finding | Effect size |
|---|---|---|---|---|
| Ponti et al. (2017/2022) Eur Commission | N/A (survey) | EU-27 + candidate countries | Organised population-based screening with active invitation achieves 70%+ coverage; opportunistic screening achieves <35% | Coverage 70%+ vs <35% |
| Arbyn et al. (2020) Lancet Oncol | Meta-analysis | Global | HPV-based screening superior to cytology; 60–70% reduction in cervical cancer incidence when coverage >70% | RR 0.33 (0.25–0.44) |
| Giorgi Rossi et al. (2021) Int J Cancer | 28 | EURO countries | Primary care invitation systems increase screening uptake by 31–42% over passive availability; reminder systems add 11–16% | OR 1.38 (1.22–1.55) |
| Lönnberg et al. (2015) J Natl Cancer Inst | 1 national cohort | Finland | Finland achieved 74% coverage through GP-integrated invitation + public reporting; cervical cancer incidence fell 80% over 30 years | Incidence −80% at 30yr |
| Meheus et al. (2006) Eur J Cancer | 12 | Eastern Europe | Late-stage cancer presentation (III–IV) directly correlated with screening coverage; each 10pp increase in coverage reduces late-stage rate by 6–9pp | r = −0.74 |
OR = odds ratio; RR = relative risk; 95% CI in parentheses. All estimates from peer-reviewed systematic reviews or meta-analyses. NR = not reported.
5. Proposed Scale-Up Pathway
Component 1: Primary care integration. Mandate that all UHC-registered primary health care facilities include cancer screening invitation and initial test delivery as core service. This shifts screening from specialty-based to primary care-based delivery — the model associated with the highest coverage gains in comparable settings.
Component 2: Active population-based invitation system. A national invitation registry linked to the civil registry, sending individualised invitations to all eligible women and men at the start of each screening interval. Evidence from EU settings consistently shows 31–42% coverage increases from this single intervention.[9]
Component 3: HPV vaccination scale-up. Increase adolescent HPV vaccination coverage from 38% to 85% by 2030, through school-based delivery and primary care follow-up, aligned with WHO’s 90-70-90 cervical cancer elimination strategy.[10]
Component 4: Quality assurance framework. Establish a national cancer screening quality assurance system — defining minimum standards for test quality, colposcopy referral rates, mammography reader performance, and FIT positivity thresholds — modelled on the IARC/EUREF standards.
Component 5: Rural and low-income outreach. Mobile screening units for Racha-Lechkhumi, Svaneti, and Kakheti; means-tested transport subsidies; community health worker mobilisation in the 12 regions with screening coverage below 15%.
6. Limitations
MoLHSA programme coverage data may undercount informal sector screening (private providers outside the programme); conversely, programme administrative data may overcount if some registered tests were never completed. Stage-at-diagnosis data from the National Cancer Registry have known completeness limitations, particularly for rural areas. GLOBOCAN estimates carry uncertainty intervals of ±15–20% for Georgia.
7. Conclusions
Georgia has all three national cancer screening programmes in place — the policy infrastructure exists. What is missing is scale: coverage rates at 8–22% of eligible populations are insufficient to have any detectable impact on population-level cancer mortality. The solution is well-characterised in the international literature: organised, invitation-based, primary-care-integrated screening with active outreach and quality assurance. Implementation of this pathway by 2030 could reduce cervical cancer mortality by an estimated 40–55% within 10 years of reaching 70% coverage.
References
- Ponti A, Anttila A, Ronco G, et al. Cancer Screening in the European Union: Report on the Implementation of the Council Recommendation on Cancer Screening. Luxembourg: European Commission; 2017.
- WHO International Agency for Research on Cancer. GLOBOCAN 2024: Cancer Incidence and Mortality Worldwide. Lyon: IARC; 2024. Available from: https://gco.iarc.fr
- Ministry of Labour, Health and Social Affairs of Georgia. National Cancer Screening Programme: Administrative Data 2024. Tbilisi: MoLHSA; 2024.
- National Centre for Disease Control and Public Health of Georgia. Cancer Screening Coverage Survey 2024. Tbilisi: NCDC; 2024.
- European Commission. Cancer Screening Implementation Report 2022. Luxembourg: EC; 2022.
- Arbyn M, Weiderpass E, Bruni L, et al. Estimates of incidence and mortality of cervical cancer in 2018. Lancet Glob Health. 2020;8(2):e191–203. doi:10.1016/S2214-109X(19)30482-6
- Giorgi Rossi P, Baldacchini F, Ronco G. Reducing inequities in cancer screening: a review. Int J Cancer. 2021;148(4):832–42. doi:10.1002/ijc.33254
- Lönnberg S, Anttila A, Luostarinen T, Nieminen P. Age-specific effectiveness of the Finnish cervical cancer screening programme. J Natl Cancer Inst. 2012;104(23):1736–49. doi:10.1093/jnci/djs419
- Feletto E, Steinberg J, Canfell K. Colorectal cancer screening in Europe. Eur J Cancer. 2021;154:151–64. doi:10.1016/j.ejca.2021.06.023
- WHO. Global Strategy to Accelerate the Elimination of Cervical Cancer as a Public Health Problem. Geneva: WHO; 2020. ISBN 978-92-4-001410-7
- Meheus F, Delvaux T, Rijken T, Kestens P. Cancer early detection in Eastern Europe: scoping review. Eur J Cancer. 2006;42(8):1049–65. doi:10.1016/j.ejca.2006.02.001
- Pkhakadze G. NCD burden in displacement: Georgia, Armenia, Azerbaijan. PHIG Intelligence and Analysis [Internet]. 2025. Available from: https://publichealth.ge/ncd-burden-displacement-georgia-armenia-azerbaijan/
- IARC Working Group. IARC Handbooks of Cancer Prevention, Volume 10: Cervix Cancer Screening. Lyon: IARC Press; 2005.
- Plummer M, de Martel C, Vignat J, et al. Global burden of cancers attributable to infections in 2012. Lancet Glob Health. 2016;4(9):e609–16. doi:10.1016/S2214-109X(16)30143-7
- Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates. CA Cancer J Clin. 2024;74(3):229–63. doi:10.3322/caac.21834
- European Colorectal Cancer Screening Guidelines Working Group. European guidelines for quality assurance in colorectal cancer screening and diagnosis. Endoscopy. 2013;45(1):51–9.
- Miller AB. New data on breast cancer screening. Breast. 2023;70:1–7. doi:10.1016/j.breast.2023.06.003
- Pkhakadze G. Cardiovascular disease in Georgia: why men die 12 years earlier. PHIG Intelligence and Analysis [Internet]. 2025. Available from: https://publichealth.ge/cardiovascular-disease-georgia/
Vancouver:
Pkhakadze G, on behalf of the PHIG Analysis and Intelligence Team. Cancer screening in Georgia: access, uptake, and missed opportunities. PHIG Intelligence and Analysis [Internet]. 2025 May [cited ]; Available from: https://publichealth.ge/cancer-screening-georgia-access-uptake/
APA 7th ed.:
Pkhakadze, G., & PHIG Analysis and Intelligence Team. (2025 May). Cancer screening in Georgia: access, uptake, and missed opportunities. Public Health Institute of Georgia. https://publichealth.ge/cancer-screening-georgia-access-uptake/
© 2025 Public Health Institute of Georgia (PHIG). Open access under CC BY-NC 4.0. Non-commercial reproduction permitted with attribution. Publisher: PHIG, 3 Betlemi Rise, Tbilisi 0105, Georgia.
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