“We already have everything we need: free school-based vaccination for both girls and boys, free screening for women aged 23 to 70, high-quality data registers and solid research showing this works. And yet, we saw that using these tools would eliminate cancer, but only in 2039. Until then, women would still be getting cervical cancer. So we stepped out of the lab and said: enough is enough. Let’s fully use the tools, and our data to stop this disease as soon as possible.”
Dr. Arroyo Mühr is associate professor, tumor biologist and coordinator at the Center for Cervical Cancer Elimination at the world-renowned Karolinska Institutet in Stockholm. She has spent years researching HPV and cervical cancer, a disease almost always caused by HPV.
“It’s a cancer that kills hundreds of thousands of women every year around the world. Preventable deaths. Because we do have the tools. Let’s use them to stop this cancer from developing in the first place. Even for those who survive, the aftermath can be severe and lifelong.”
Early detection improves treatment outcomes
A cornerstone of Sweden’s action plan is prevention through vaccination and screening. Since 2010, HPV vaccination has been part of school-based programs for girls, and since 2020, for boys too. HPV also causes cancers that affect men.
“Vaccination happens at school, through the school nurse or doctor,” Sara explains. “We want to make it as easy and accessible as possible. Parents need to give consent, and 9 out of 10 do. In just a couple of weeks, we vaccinate nearly all 10- and 11-year-olds in the country.”
“Besides vaccination, we have a population-based screening program. Women between 23 and 70 are invited to undergo free HPV screening. If they are HPV negative, they are called every five years up to age 49, and every seven years after that. Early detection significantly improves treatment outcomes, especially for cervical cancer. If they are HPV positive, we follow them up closely to ensure the immune system clears the virus, and treat if necessary, to prevent the development of serious lesions. And ultimately, to stop cancer before it ever begins.”
“We’ve improved the screening program to make it more convenient and respectful of women’s privacy and bodies,” says Sara, “The test can be done by a healthcare professional or as a self-test. Women receive the self-sampling kit at home, collect the sample themselves in a private and comfortable setting, and then return it by mail within a prepaid envelope. Many women appreciate that self-sampling gives them more control and preserves their sense of intimacy. Two-thirds chose this option.”
Persistence pays off
“Follow-up is key,” Sara stresses. “Every woman gets a personal invitation letter to participate in the screening program. If she doesn’t show up, she’ll get another one the following year — and the next, until she does. Thanks to our IT system, we monitor the process and make sure that no one is left behind. Screening on a large scale is crucial to eliminate cervical cancer.”
Moving faster with targeted catch-up programs
As mentioned, initial models predicted that school vaccination and broad screening could eliminate cervical cancer in Sweden by 2039. “Too slow for us,” says Sara. “So we dove into the data and found that most virus transmission was happening among people below 30. Above that age, the transmission is low because they have fewer sexual partners.”
In Sweden, those below 23 were already fully vaccinated, and therefore protected. Of the ones born between 24 and 30, only around 60% were vaccinated, with an older version of the actual vaccine.”
“In response, we launched a catch-up program in 2021: simultaneous vaccination and screening for women born between 1994 and 1999. We leveraged both covid vaccination centers and screening centers. Today, we have over 3,000 authorized vaccinators across Sweden — GPs, gynecologists, midwives — all playing a vital role.”
“The idea is simple,” says Sara. “We offer vaccination to everyone aged 23 to 30. Vaccination protects against future HPV infections but not against an infection that’s already there. That’s why it is also essential to test for HPV.”
“If they test positive, we follow them up carefully to see if their immune system clears the virus. If not, and a lesion develops, we treat it early — long before it can turn into pre-cancer. Once the infection is gone and vaccination is done, they’re also protected.”
“We have a total of 350,000 women aged 23-30 in Sweden. To succeed and achieve elimination, at least 70% of these women need to be vaccinated. The rest will be protected by the so-called herd immunity. Some regions, like Värmland, Kalmar, Västernorrland and Halland have already surpassed that. Others, like Stockholm, are lagging a bit behind at around 53%. Nationally, coverage is at 60%, and rising.”
