Temporal trends and sources of variation in late-stage cervical cancer diagnosis in low- and middle-income countries: a systematic review and meta-analysis.

[OBJECTIVE] Late-stage cervical cancer diagnosis is a key driver of mortality in resource-limited settings. We aimed to synthesize available evidence on late-stage presentation and subsequently analyze the sources of variation and temporal trends across low- and middle-income countries.

[METHODS] We performed a systematic review and random-effects meta-analysis of observational studies reporting stage distribution of invasive cervical cancer in low- and middle-income countries. We searched PubMed, Web of Science, Scopus, and Embase from inception to August 1, 2025. We pooled study proportions using the Freeman-Tukey double-arcsine transformation and DerSimonian-Laird random-effects models. Prespecified sub-group analyses assessed potential sources of heterogeneity. Temporal trends were also examined.

[RESULTS] Analysis of 132 studies (189,716 women) from 37 low- and middle-income countries yielded a pooled late-stage prevalence of 51.2% (95% confidence interval [CI] 48.2% to 54.2%, I = 98.9 %). Meta-regression identified the World Health Organization Universal Health Coverage index as a significant predictor of late-stage presentation (β = -0.0032, p = .002), whereas temporal analysis confirmed diagnostic stagnation over 3 decades (β = 0.003, p = .121). Significant variation was observed by region (Q = 44.90, p < .001), with the highest prevalence in Africa (55.9%, 95% CI 52.1% to 59.7%) and in low-income countries (55.9%, 95% CI 51.2% to 61.4%). Population-based registries reported significantly lower estimates (44.8%, 95% CI 38.4% to 51.2%) than clinical case series (Q = 9.43, p = .009). Sensitivity analyses confirmed that results were robust to study quality (p = .10) and staging frameworks (p = .40).

[CONCLUSIONS] One in 2 women in low- and middle-income countries is diagnosed at an advanced stage, with no significant improvement over time. The strong association between lower Universal Health Coverage levels and late presentation suggests that health-system-level barriers, rather than only individual-level factors, are primary drivers. Strengthening Universal Health Coverage frameworks and equitable screening access are quantitatively supported priorities to shift diagnosis toward earlier, curable stages.