Risk of cervical cancer and high-grade lesions in vulnerable women in high and upper middle-income countries: systematic review and meta-analysis.

Background: Cervical cancer (CC) is largely preventable but still causes around 300,000 deaths annually, particularly among vulnerable women. Methods: This systematic review and meta-analysis included studies from four databases (MEDLINE, EMBASE, CENTRAL, ISI Web of Science) up to February 2024 (from 2004 for HIV). We examined seven vulnerable groups in middle- and high-income countries: women of low socioeconomic status (WLSES), prisoners, sex workers, women with substance use disorders (WSUD), mental illness (WMI), migrants, and women living with HIV (WLWH). Observational studies on CC and high-grade lesion (HGL) risk, incidence, or prevalence were included. Independent reviewers assessed all articles. The main outcome was CC or HGL risk, measured assessed by incidence rate ratio (IRR), risk ratio (RR), standardized incidence ratio (SIR), or odds ratio (OR). PROSPERO registration: CRD42024535331. Findings: We included 126 studies. Vulnerable women had a significantly higher risk of CC (RR 2.78, 95%CI 2.32-3.32) and HGL (RR 2.51, 95%CI 2.02-3.11), with WSUD, prisoners, and WLWH facing a 2- to 5-fold increased risk. Interpretation: Marginalised women face a higher CC and HGL risk, highlighting the need for targeted policies to improve screening and treatment access. Funding: this systematic review and meta-analysis is funded by the CBIG-SCREEN project (The CBIG-SCREEN project has received funding from the EU Horizon 2020 research and innovation program under Grant Agreement No 964049).