Every year in the Republic of Moldova, 300–350 women are newly diagnosed with cervical cancer, while another 150–160 lose their lives to the disease. This alarming reality persists despite the expansion of HPV vaccination programmes and intensified cervical cancer screening efforts in recent years.

According to data from the global cancer database GLOBOCAN, managed by the International Agency for Research on Cancer (IARC), these figures are significantly higher than the European Union average, where cervical cancer incidence stands at 10–12 cases per 100,000 women, and mortality at 3–4 deaths per 100,000. This means that women in the Republic of Moldova develop cervical cancer nearly twice as often and die from it two to three times more frequently than women in the EU, while the number of late-stage diagnoses continues to put pressure on the healthcare system.

In Moldova, cervical cancer is the third most common cancer among women and is most frequently diagnosed among women aged 35–55. Against this backdrop, the authorities set targets under the National Cancer Control Programme 2016–2025 to reduce the incidence of several types of cancer, including cervical cancer, by 10%, and to increase the rate of early detection (stages I and II) by 25%. These objectives are supported by international partners and civil society organisations as part of a joint effort to shift the focus from treatment to prevention and early detection.

Diana Valuța, Head of the Cervical Cancer Screening Implementation Coordination Unit at the Institute for Mother and Child, says that one of the major challenges is correctly interpreting the persistently high mortality rates during the first years of an intensified prevention programme:

During the first 3–5 years after screening is intensified, an increase in the number of severe cases detected can be observed. This happens because women who had not previously been screened are diagnosed at this stage, which can create the impression of a peak in advanced cases. However, this is an expected effect seen in prevention programmes: proactive interventions bring to light cases that had previously remained undiagnosed. As more women are screened regularly and precancerous lesions are detected and treated in time, the number of advanced cases and deaths begins to decline. This impact is expected to become visible in the statistics in the coming years, up to 2030.

Indeed, a temporary increase in incidence can be an indication that an organised screening programme is working. Unlike the previous opportunistic screening model, in which women often sought medical care only after symptoms appeared, the new approach involves proactively inviting women for screening based on population registries, covering both insured and uninsured women.

“An organised screening programme is about much more than collecting data—it requires the healthcare system to actively reach out to women. When family doctors invite patients for screening, the number of women tested increases significantly, and cases are detected at earlier stages, when the disease has no symptoms. Cervical cancer does not cause pain or manifest itself until the advanced stages,” Diana Valuța emphasises.

In the Republic of Moldova, the pathway for women participating in cervical cancer screening is regulated by clear standards aimed at early detection and rapid intervention in cases considered high risk. Women with severe abnormalities (ASC-H, HSIL or AGC) are referred for additional investigations, including colposcopy and, where necessary, biopsy, which should be performed within 14 days of receiving the screening result. This allows specialists to assess lesions in detail and confirm the diagnosis.

If cancer is confirmed, the woman is referred to the outpatient department of the Institute of Oncology within a maximum of seven days. Treatment is determined according to the type and severity of the lesion and is not decided by a single doctor, but by a multidisciplinary team of at least three specialists. In complex cases, a second multidisciplinary team may also be convened.

Women are reaching doctors too late: symptoms often appear only when the disease is advanced

The data reveal a contradiction: on the one hand, the system is expanding access to screening and improving early detection; on the other, many women still reach medical care at advanced stages, when treatment options are more limited.

According to the Institute of Oncology, around 4,200 women are currently living with a cervical cancer diagnosis following complex specialised treatment. In 2024, 338 new cases of cervical cancer were registered, of which 203 were detected through screening. However, the distribution by stage remains concerning: only around 47% of cases are detected at early stages (I–II), while more than half are diagnosed at advanced stages (III–IV).

This difference has a direct impact on survival. While the success rate can reach 80–90% in stage I, it drops dramatically to 25–40% in advanced stages.

The explanation largely lies in when women seek medical care. Around 50% of cases are still detected outside the organised screening programme, meaning women seek medical attention only after symptoms appear—such as unusual bleeding or pain. Under these circumstances, the disease is detected reactively rather than in time, when treatment options are limited, more toxic and associated with lower chances of recovery. – Rodica Mîndruța-Stratan, coordinator of the National Cancer Control Programme.

Several factors contribute to this situation: insufficient participation in screening, including the Pap test, limited awareness of prevention, and the tendency to seek medical care only when symptoms appear.

In practice, the greatest challenges arise in late-diagnosed cases. More than half of patients reach advanced stages, when treatment becomes considerably more complex. It may no longer involve surgery, but rather concurrent radiotherapy and chemotherapy, often in cases involving large tumours with local invasion into organs such as the bladder or rectum.

At the same time, the patient's pathway through the healthcare system remains fragmented—from the family doctor to the gynaecologist and then to the oncologist—and delays are common. The lack of a uniform system for recalling women after a positive screening result, differences in access between rural and urban areas, and insufficient communication between levels of healthcare further complicate the patient's journey.

The World Health Organization (WHO) has established clear benchmarks for the global elimination of cervical cancer, promoting an integrated approach based on prevention and early intervention. The targets are ambitious but considered achievable—the 90–70–90 targets: vaccinating at least 90% of girls aged 9–14 against HPV; screening 70% of women aged 25–61 every three years; and ensuring that 90% of women diagnosed with precancerous lesions or invasive cancer receive appropriate treatment.

In the Republic of Moldova, authorities, with the support of international partners, have invested in modernising infrastructure, training healthcare professionals, informing eligible women and raising awareness of the importance of screening. The foundations of the National Cervical Cancer Screening Registry have also been established, while the digitalisation of the system has accelerated. These developments are being consolidated through the new National Cancer Control Programme 2026–2030, which places prevention at the centre of public health policy.

Screening and vaccination—the key to reducing cervical cancer mortality

Cervical cancer is one of the few cancers that can potentially be eliminated through two essential tools: HPV vaccination and regular screening. Specialists stress, however, that the two approaches are not alternatives—they complement each other.

HPV vaccination is recommended before the onset of sexual activity, as it is most effective before exposure to the virus. The vaccine helps the body develop antibodies that can prevent subsequent infection with the HPV types targeted by the vaccine.

At the same time, screening remains essential for detecting existing precancerous lesions. In the Republic of Moldova, cytological screening coverage reached 62% in 2025—an important improvement, but still below the optimal level. Even with full screening coverage, vaccination and screening must go hand in hand, together providing more than 90% population-level protection.

HPV vaccination was introduced into Moldova's national immunisation schedule in 2017, with GAVI support. Initially targeting 10-year-old girls, since 2021 the programme has covered girls and boys aged 9–14. Starting in 2025, the vaccination schedule was simplified in line with WHO recommendations: a single dose is considered sufficient to provide long-term protective antibody levels for the 9–14 age group. Vaccination has also been extended to people up to the age of 26, for whom a two-dose schedule is used if they have not been vaccinated previously.

Despite these efforts, vaccination coverage remains below the level needed to significantly reduce the circulation of HPV. Data from the National Agency for Public Health show that only just over 46% of girls aged 10–14 are vaccinated, while coverage among boys is approximately 4%.

The HPV vaccine is available free of charge at all primary healthcare centres across the country, with vaccination provided through the family doctor. Moldova currently uses the four-valent Gardasil vaccine, manufactured in the United States, which protects against HPV types 6 and 11, associated with genital warts, and types 16 and 18, which are responsible for around 70% of cervical cancer cases. The authorities are considering the possibility of introducing the broader-spectrum nine-valent Gardasil vaccine. – Veaceslav Guțu, Deputy Director of the National Agency for Public Health.

To increase vaccination rates, the authorities, together with partners such as UNFPA, UNICEF and WHO, are conducting information campaigns and training for healthcare professionals. Family doctors play a key role, as they are often the main source of health information for the population and the central point through which vaccination is provided.

“Examples show that targeted interventions can have an impact. In the municipality of Bălți, for example, where vaccination coverage was only 7–10%, training healthcare workers helped increase coverage to approximately 22% within a single year. Similar programmes have been implemented in other areas with low coverage, including the Autonomous Territorial Unit of Gagauzia,” Veaceslav Guțu adds.

However, vaccine hesitancy persists. Myths surrounding vaccination—including concerns about infertility and side effects—continue to influence parents' decisions. Specialists stress that these concerns are not supported by scientific evidence: to date, no severe adverse reactions have been reported in Moldova, while globally, the vaccine has demonstrated a strong safety record over more than two decades of use.

In Australia, the first country to introduce nationwide HPV vaccination in 2007, the incidence of HPV infections and precancerous lesions has fallen dramatically, and the country is on track to eliminate cervical cancer by 2035. In the United Kingdom, HPV vaccination has led to a reduction of up to 87% in cervical cancer cases among women vaccinated at ages 12–13.

In the Republic of Moldova, the challenge remains convincing people to get vaccinated. Data show that vaccination coverage increases with age—from just 1.7% at age nine to more than 50% at age 15, suggesting that initial hesitancy can be overcome through accurate and accessible information. In a healthcare system where family doctors are often already overburdened, however, the time available for conversations with patients remains limited—but essential.

In the fight against cervical cancer, prevention is not simply an option—it can be the difference between life and death. The coming years will show the impact of these interventions, but continued efforts will be needed, including further digitalisation, ongoing training for healthcare professionals and targeted information campaigns for the public.