Cervical Cancer Control in Cameroon: Examining Health System Constraints and Missed Opportunities for Prevention Through a Systematic Review

Abstract

Cervical cancer remains one of the most preventable yet still highly lethal malignancies among women in low- and middle-income countries, particularly in sub-Saharan Africa. In Cameroon, despite the availability of effective preventive tools such as human papillomavirus vaccination, screening for precancerous lesions, and curative treatment for early disease, many women continue to present with advanced cervical cancer. This systematic review aimed to synthesize available evidence on the epidemiology, risk factors, clinical presentation, prevention gaps, treatment barriers, and health system constraints affecting cervical cancer control in Cameroon. A structured literature search was conducted in PubMed/MEDLINE, Scopus, African Journals Online, and Google Scholar for publications issued between January 2010 and March 2025. Eligible studies included peer-reviewed articles reporting epidemiological, clinical, virological, therapeutic, or health system data related to cervical cancer in Cameroon, with contextual evidence from comparable sub-Saharan African settings when national data were limited. Thirty-five studies were included in the qualitative synthesis. The evidence showed that cervical cancer in Cameroon is commonly diagnosed among women aged 45–55 years, with most patients presenting at FIGO stage III or IV. Squamous cell carcinoma was the predominant histological subtype, and persistent infection with high-risk HPV, particularly types 16 and 18, remained the principal etiological factor. Major barriers to effective control included low screening coverage, insufficient HPV vaccination uptake, limited public awareness, delayed diagnosis, inadequate pathology and radiotherapy capacity, concentration of oncology services in major urban centers, and high out-of-pocket costs. These constraints contribute to treatment delay, interruption, abandonment, and poor survival outcomes. Strengthening HPV vaccination, implementing organized screening, decentralizing diagnostic and oncology services, improving referral pathways, and reducing financial barriers are essential to reduce preventable cervical cancer mortality in Cameroon.