A structured narrative synthesis published in Frontiers in Medicine has evaluated Cameroon’s operational progress toward implementing the World Health Organization global strategy for cervical cancer elimination, highlighting substantial advances in prevention alongside critical health-system bottlenecks. Synthesizing peer-reviewed publications and official technical documents released between 2015 and 2026, the review examines how Cameroon has introduced innovative primary and secondary prevention initiatives to combat a disease that remains one of the most frequently diagnosed malignancies among Cameroonian women. Although the World Health Organization established ambitious 90-70-90 targets to be reached by 2030—calling for 90 percent of girls to be fully vaccinated against human papillomavirus by age 15, 70 percent of women to undergo high-performance screening at ages 35 and 45, and 90 percent of diagnosed women to receive treatment—the synthesis reveals that national coverage indicators remain substantially below these elimination thresholds.

The biological rationale underpinning these prevention efforts stems from persistent infection with high-risk human papillomavirus genotypes, which serves as the established necessary cause for the development of invasive cervical carcinoma and its precursor lesions. Within low- and middle-income countries, where more than 90 percent of global cervical cancer deaths occur, structural inequities in healthcare access exacerbate disease progression and mortality. In Cameroon, the intersection between human papillomavirus and human immunodeficiency virus represents a profound public health concern, as women living with human immunodeficiency virus experience impaired immune clearance that drives significantly elevated rates of viral persistence, rapid advancement to high-grade cervical intraepithelial neoplasia, and an increased incidence of invasive cancer. Consequently, international guidelines recommend initiating screening at earlier ages and maintaining shorter recall intervals for this priority population. The review underscores that addressing these clinical risks requires robust primary prevention via prophylactic immunization alongside sensitive secondary screening algorithms that detect cellular and molecular abnormalities long before malignant transformation occurs.

National primary prevention in Cameroon commenced formally in October 2020 with the introduction of human papillomavirus vaccination into the routine immunization schedule, though early uptake was hindered by logistical and social obstacles. Programmatic progress improved noticeably following the strategic adoption of a gender-neutral, single-dose vaccination policy coupled with intensified community-level distribution mechanisms. By 2023, national coverage reached approximately 57 percent among eligible girls and approximately 26 percent among boys, marking notable progress while remaining well below the 90 percent World Health Organization elimination benchmark. Structural delivery challenges persist, including difficulties in identifying and vaccinating out-of-school adolescent populations, recurring distribution disruptions across medical supply chains, and the limited integration of immunization campaigns into routine adolescent healthcare platforms. Furthermore, sociobehavioral barriers such as circulating misinformation, low perceived personal risk, and general vaccine hesitancy continue to depress community demand. Overcoming these deficits requires coordinated intersectoral collaboration among the Ministries of Health, Education, and Finance, reinforced by comprehensive electronic vaccination registries that can monitor equity gaps and guide adaptive local outreach.

The Cameroon Baptist Convention Health Services Women's Health Program is the largest cervical cancer screening initiative in the country and provides an important service-delivery platform in the absence of nationwide programme expansion. More recently, decentralized implementation pilots conducted in Dschang, Bafoussam, and Yaoundé demonstrated the feasibility of simplified screen-triage-treat protocols, commonly designated as the Test-Triage-Treat approach.

Decentralization should be considered a core component of national scale-up, using the tiered service-delivery infrastructure already being developed for HIV testing and treatment in Cameroon. Peripheral level-one health centers and intermediate level-two district facilities could be equipped to perform point-of-care human papillomavirus nucleic acid testing and visual inspection triage, while complex cytopathology remains anchored at specialized regional laboratories possessing appropriate technical personnel. Task-shifting represents an essential component of this structural reorganization, transferring routine primary testing, self-sampling guidance, visual triage, and local thermal ablation procedures to trained nurses and certified midwives. The authors stress that delegating these clinical responsibilities requires institutionalizing standardized clinical protocols, formal competency-based instructional curricula, regular supportive supervision, and robust quality-assurance mechanisms. Without standardized tracking mechanisms and continuous oversight, decentralized screening risks generating inconsistent diagnostic assessments or failing to route complex lesions into appropriate tertiary surgical channels, thereby blunting the epidemiological impact of expanded community-level screening.

Integrating cervical screening into routine clinical care for women living with human immunodeficiency virus constitutes another vital strategic opportunity to optimize resource utilization and elevate healthcare equity. Because differentiated service-delivery models are well established in HIV care in Cameroon, projects such as OptiTri are exploring how these platforms can be extended to incorporate cervical cancer screening. In these models, human papillomavirus testing, including self-sampling, can be integrated into routine antiretroviral therapy services, with triage and treatment organized as close as possible to the point of screening. Emerging programme experience suggests that co-location of cervical cancer screening within HIV services can improve uptake, shorten the interval between testing, diagnosis, and treatment, and reduce attrition across the screening cascade. However, scaling this integrated model nationwide demands uninterrupted reagent procurement, clearly delineated clinical handoffs between infectious disease personnel and gynecological specialists, and rigorous tracking of programmatic performance indicators, including screening uptake rates, viral genotype positivity, and long-term retention within routine post-treatment surveillance.

Advancements in molecular diagnostics have introduced sophisticated risk-stratified triage algorithms that balance analytical sensitivity against the clinical hazard of unnecessary surgical intervention. While standard human papillomavirus testing is highly sensitive for cervical precancer, it often detects transient infections that would resolve spontaneously without clinical consequence. Extended genotyping enables clinicians to tailor secondary management according to the distinct oncogenic hazard posed by specific viral variants. The recent World Health Organization classification delineates twelve carcinogenic human papillomavirus genotypes into four distinct risk strata: group 1a consisting exclusively of type 16; group 1b containing types 18 and 45; group 1c comprising types 31, 33, 35, 52, and 58; and group 1d encompassing types 39, 51, 56, and 59. Evidence from Cameroon indicates that resource-adapted algorithms can route women positive for type 16 directly to ablative treatment, while directing those carrying intermediate-risk genotypes to visual or telecytological triage, reserving conservative observational surveillance for lower-risk variants. When extended genotyping of all twelve carcinogenic human papillomavirus types is not feasible, a simplified eight-genotype panel covering groups 1a through 1c may simplify testing while retaining coverage of the types responsible for the largest proportion of cervical cancers.

Complementing molecular triage, digital telemedicine innovations and artificial intelligence applications are being evaluated across Cameroon to bridge severe shortages of specialized medical personnel. Telecytology platforms utilizing whole-slide digital imaging allow remote cytopathologists to examine digitized cervical smears collected at peripheral and district facilities, demonstrating high diagnostic concordance with conventional microscopy while decentralizing specialist expertise. In parallel, investigational computer-aided diagnostic algorithms designed to interpret cervical photographs following acetic acid application and automated digital cytology are being explored to mitigate the known operator subjectivity of visual inspection. Nevertheless, the review urges measured caution, noting that existing artificial intelligence evaluations in Cameroon rely predominantly on small, highly curated image datasets that do not reflect routine screening populations encountered in frontline clinics. The authors assert that artificial intelligence tools remain strictly experimental and must undergo rigorous prospective clinical validation, external verification, cost-effectiveness analyses, and formal regulatory oversight before being integrated into routine national clinical practice.

For patients diagnosed with invasive cervical carcinoma, the national healthcare infrastructure exhibits severe diagnostic and therapeutic deficiencies that compromise curative intent. Effective oncological care requires standardized national staging guidelines supported by reliable histopathology, specialized surgical oncology teams, multimodal chemoradiotherapy, and decentralized palliative care. The therapeutic deficit is especially acute for locally advanced tumors requiring definitive radiation therapy, as functional megavoltage external-beam radiotherapy equipment nationwide remains concentrated exclusively in Douala, creating a severe geographical bottleneck. Furthermore, because a high proportion of Cameroonian cervical cancer patients present with incurable advanced-stage malignancy, palliative care represents an essential clinical requirement; however, palliative services remain largely fragmented, heavily reliant on faith-based charitable organizations, and constrained by restricted community access to oral opioid analgesics.

Sustaining national scale-up ultimately requires establishing robust institutional governance, sustainable health financing, and resilient digital monitoring systems capable of tracking patients across fragmented health jurisdictions. Digital health platforms must provide offline operational functionality to withstand intermittent electrical and internet connectivity, while remaining fully interoperable with national health management databases such as the District Health Information Software 2 platform. Automated text-messaging appointment reminders and digital notification systems can significantly reduce diagnostic loss to follow-up and enhance clinical recall. Methodologically, the authors emphasize that their synthesis represents a narrative review of heterogeneous programmatic reports, observational pilots, and technical documents rather than a systematic meta-analysis, noting that empirical gaps persist regarding longitudinal health outcomes, formal cost-effectiveness, and equitable community uptake. Ultimately, eliminating cervical cancer in Cameroon will depend not on isolated technical innovations, but on sustained political leadership, coordinated domestic financing, structured implementation research, and patient-centered service delivery that respects community trust and addresses the real-world operational constraints of resource-limited healthcare environments.

Subject of Research: Evaluation of implementation progress, pilot innovations, and health-system priorities for cervical cancer elimination in Cameroon

Article Title: Operationalizing the WHO cervical cancer elimination strategy in Cameroon: policy and implementation progress, innovations, and priorities for scale-up

Article References: Vassilakos, P., Petignat, P., Dumps, A., Sando, Z., Mezo, A. F., Debeaudrap, P., Tebeu, P. M., Dongmo, M. M., Thiran, J. P., Fippo Fitime, L., Nkegoum, B., & Djientcheu, V. D. P. (2026). Operationalizing the WHO cervical cancer elimination strategy in Cameroon: policy and implementation progress, innovations, and priorities for scale-up. Frontiers in Medicine, 13, 1968613. https://doi.org/10.3389/fmed.2026.1968613

Image Credits: AI Generated

DOI: 10.3389/fmed.2026.1968613

Keywords: cervical cancer, Cameroon, human papillomavirus, HPV vaccination, cancer screening, WHO elimination strategy, self-sampling, thermal ablation, women living with HIV, extended HPV genotyping, telecytology, artificial intelligence, differentiated service delivery, radiotherapy capacity, health system strengthening, implementation science