HPV-related cancer vaccination and screening struggle to show their full impact in Spain

The human papillomavirus is responsible for almost all cervical cancers and contributes to other types of cancer, such as those of the vulva, vagina, anus, penis, and oropharynx. A persistent infection with certain types of this virus can, over time, cause precancerous lesions and progress to invasive cancer. In Spain, type 16 is the most common and accounts for at least 58% of cervical cancer cases.

A vaccine against this virus exists and targets the most dangerous strains. It can prevent up to 90% of cancers attributable to the papillomavirus. However, it does not protect against all carcinogenic strains and does not treat existing infections. Screening therefore remains essential, even for vaccinated individuals.

In Spain, systematic vaccination of adolescent girls began in 2008, and since 2022, 12-year-old boys have also been included. Despite this, vaccination coverage remains below the targets set by the World Health Organization, with significant disparities between regions. Some areas barely reach 20% coverage, while others exceed 80%.

Screening for cervical cancer is shifting towards tests that detect high-risk strains, which are more sensitive than traditional methods. However, their implementation remains uneven across regions, and national data lacks precision. Around 87% of Spanish women aged 25 to 65 report having been screened at least once, but this figure masks significant variations.

In 2020, Spain recorded nearly 2,000 deaths linked to HPV-associated cancers, with half of these being cervical cancer. Other cancers, such as those of the anus, oropharynx, or penis, also represent a significant burden, with more than 5,000 new cases estimated each year.

Several high-income countries have already observed a significant decline in infections, precancerous lesions, and cervical cancers due to vaccination. For example, in Sweden, the risk of invasive cancer dropped by 88% among women vaccinated before the age of 17. In England, vaccination has prevented hundreds of cancer cases and thousands of precancerous lesions.

However, in Spain, no sustained and clear decline in these cancers has yet been observed. Several explanations have been proposed: insufficient vaccination coverage, uneven screening, lack of follow-up after abnormal results, and incomplete epidemiological data. Additionally, the impact of vaccinating boys, introduced only recently, cannot yet be measured.

The development process of cervical cancer is long, often more than ten years between infection and the onset of cancer. The reductions observed in other countries first concern infections and precancerous lesions before affecting invasive cancers. In Spain, the delay between the implementation of prevention strategies and their visible impact on cancer rates could therefore still take several years.

Improving vaccination coverage, standardizing screening, strengthening patient follow-up, and better integrating data at the national level are key steps to accelerate the reduction of these cancers. Without these measures, regional inequalities and gaps in prevention are likely to persist.

Information and Sources

Scientific Reference

DOI: https://doi.org/10.1007/s12094-026-04447-w

Title: HPV-related cancer prevention in Spain: progress and remaining challenges in vaccination, screening, and surveillance

Journal: Clinical and Translational Oncology

Publisher: Springer Science and Business Media LLC

Authors: Alejandro Gallego Martínez; Antonio Gonzalez-Martin; Luis Chiva de Agustin