SYSTEMATIC REVIEW ON CERVICAL CANCER SCREENING IN SAUDI ARABIA

Abstract

Background: Cervical cancer is largely preventable through high-coverage screening and early treatment. However, uptake remains low in many countries, including Saudi Arabia, where no national screening program is currently in place. Understanding current coverage, determinants, and trends is vital to guide future policy.

Objectives: This systematic review aimed to synthesize evidence from 2000 to mid-2025 on cervical cancer screening uptake, associated predictors, and population-level outcomes among women in Saudi Arabia.

Methods: Following PRISMA 2020 guidelines and Cochrane/JBI methodological standards, we searched PubMed, Scopus, Web of Science, EMBASE, and IMEMR from 1 January 2000 to 30 June 2025. Eligible studies included observational or interventional designs reporting on screening utilization, knowledge, or outcomes. Two reviewers independently screened and extracted data, and risk of bias was assessed using the Newcastle–Ottawa Scale. Narrative synthesis was used due to heterogeneity.

Results: Six studies (n = ~4 000 women) met the inclusion criteria. Reported lifetime Pap-smear uptake ranged from 8.3 % to 26 %, with a weighted mean of ~22 %. Higher uptake was associated with older age, higher education, multiparity, and prior provider recommendation (OR up to 6.16). Knowledge levels were generally low, with fewer than 20 % of women achieving adequate awareness scores. Registry data indicated a rise in localized cancer diagnoses from 24 % in 2005 to over 40 % in 2019, suggesting modest screening impact. All included studies were observational; two had low risk of bias.

Conclusions: Cervical cancer screening coverage in Saudi Arabia remains well below WHO elimination targets. Knowledge deficits and lack of provider-initiated screening are major barriers. Organized, HPV-based screening with integrated public education and provider engagement is urgently needed to accelerate progress toward national and global goals.