Cervical cancer is the fourth most common occurring disease among females across the world. This disease results from the growth of cells in the cervix, which is triggered by persistent infection with high-risk strains of human papillomavirus (HPV). Its high prevalence has made it the leading killer disease among women in the UK. Statistics from Cancer Research UK (2024) show that the disease accounts for over 800 deaths per year in the region. Moreover, studies have revealed that the prevalence of the disease has kept increasing, with peak incidences realized between 2016 and 2018. Human papillomavirus is the primary causative factor for the disease, accounting for approximately 99.7 percent of total cases (Choi et al., 2023). However, other factors such as smoking, immunosuppression, and poor sexual health have recently assumed an increased share in the development of the disease. Understandably, the prevalence of the disease has kept increasing despite the region's introduction of a vaccine against HPV and regular screening programs. Significant disparities are realized in both the incidence and outcomes of cervical cancer, with women under 45 years being one of the most adversely affected groups in the geographical region. These disparities reflect the broader health inequalities that predominantly occur within societies where a particular marginalized group bears a disproportionate share of a specific public health issue.
Choi et al. (2023) explain that peak incidence rates for cervical cancer between 2016 and 2018 were realized among females aged between 30 and 34. Their study links HPV with the highest cause of the disease among the demographic group in their analysis of national cervical cancer data between 1982 and 2006. Foley et al. (2011) find an increasing disease trend among young women. The researchers, however, reveal that introducing the national screening program in 1988 led to a noticeable decrease in the overall incidence of the disease up to the 2000s. The study found a significant fall from 213 to 112 per million person-years. However, a reverse trend of increase was realized among young women between 20 and 29 years old, particularly between 1992 and 2006. Castanon & Sasieni (2018) also point to an alarming increase in cervical cancer for women between the ages of 20 and 24. The study linked the trend to the withdrawal of cervical screening among women of this age bracket.
While favourable trends have been realized in several Western countries, such as Finland and Norway, contrasting statistics have been reported in the United Kingdom. Pimple & Mishra (2022) point to a persistent and gradual increase in the disease's prevalence among younger generations. This unfavourable trend is linked to an escalation of HPV prevalence from changing sexual behaviours. The trend is realized despite a decrease in the overall incidence of the disease across the country due to advancements in screening and prevention measures (Santucci et al., 2020). Prevalence rates of the disease among young women below 45 years differ across different regions of the UK; some areas are more burdened than others. This variation is linked to factors such as socioeconomic deprivation, health education and literacy, and limited access to healthcare services.
There is a multifaceted and deeply linked relationship between socioeconomic status (SES) and the prevalence of cervical cancer among UK women under 45 years. This relationship demonstrates a deep connection with broader social determinants of health. UK socioeconomic status entails income, education, and occupation — factors that collectively impact how women in this age bracket access healthcare resources and services and behave regarding health matters. A study by Qiu et al. (2021) shows a consistent, transparent gradient in cervical cancer cases and death rates for women aged between 24 and 30 across different socioeconomic strata. Findings from the study show that women from lower SES backgrounds experience a disproportionately higher burden of the disease.
A key mechanism through which socioeconomic status impacts cervical cancer prevalence among young women in the UK is access to preventive healthcare services. As in many other areas, the UK displays greater awareness of preventive measures among women from higher SES backgrounds. These women have more access to regular Pap smears and HPV vaccinations, and are better placed regarding access to healthcare facilities offering crucial services such as cervical cancer screening. However, UK women under 45 years from lower socioeconomic backgrounds are exposed to significant barriers that lead to increased prevalence of cervical cancer (Choi et al., 2023). Such barriers include financial limitations, lack of health insurance coverage, and limited access to screening programs. Due to these barriers, this population group is less likely to undergo routine screenings, leading to delayed diagnosis and poorer health outcomes.
Education and health literacy have a significant role in impacting cervical cancer rates among UK women below the age of 45. Education levels immensely shape knowledge about crucial aspects of the disease, such as risk factors and preventive strategies, and inform the importance of undergoing regular screening. Understandably, young women with higher education levels have considerably greater health literacy (Machado, 2023). As a result, they can make informed decisions about their health through measures such as engaging in preventive behaviours, and are better positioned to understand crucial procedures such as cervical cancer screening guidelines — for example, the use of Pap smears and HPV vaccinations, and following recommended screening schedules, which minimizes the risk of developing the disease.
On the other hand, lower education among UK women is linked to limited health literacy. This disadvantaged group is filled with misconceptions about cervical cancer and its preventive measures (Albright & Allen, 2018). They are also disadvantaged in recognizing symptoms and may not understand the necessity of regular screening, and are reluctant to seek cervical cancer diagnosis during the early stages of the disease. Furthermore, lower health literacy levels among this group promote mistrust of healthcare providers and the healthcare system, further impeding access to timely and appropriate care.
Kirubarajan et al. (2021) explore the position of healthcare services as a crucial socioeconomic determinant of cervical cancer prevalence among young women. Disparities in access are understood as a pivotal contributor to differential health outcomes in the region. For women between 15 and 35, geographical location plays a significant role in determining access to healthcare services. For young women living in the UK's rural or underserved areas, there are more significant challenges in access to cervical cancer screening and treatment facilities (Bogdanova et al., 2022), given the limited availability of healthcare infrastructure and care providers. As a result, these women are exposed to longer travel times and higher transportation costs — barriers that significantly affect timely screenings and follow-up care.
Moreover, women from disadvantaged socioeconomic backgrounds are more affected by financial barriers. Their inability to raise the required financial resources, such as out-of-pocket costs for screening, further impacts their access to healthcare services. Financial issues also bar women from seeking necessary preventive care or lead to delays in seeking medical attention in the event of symptoms (Greenley et al., 2023). Due to delays in diagnosis and poorer prognosis, the incidence of cervical cancer increases among young women.
The patterns of high prevalence of cervical cancer among young women can be explained using various theories and perspectives. These models provide comprehensive knowledge about the underlying factors that contribute to the trends. Examining these theories offers critical insight into the connection between social, economic, structural, and cultural factors that influence health outcomes, and promotes a deeper understanding of the multidimensional nature of high cancer prevalence among young women. Understanding these perspectives also helps identify potential avenues for the adoption of effective prevention measures and interventions.
The social determinants of health theory is concerned with the non-medical factors that impact an individual's health outcomes. It focuses on the conditions in which people are born, grow, work, or live, giving significant focus to the broader array of forces and systems that influence a person's daily life. The theory is linked to a significant influence on health inequalities (Dean et al., 2013), trying to explain the inequitable and avoidable disparities in health status realized between countries or various demographic groups in a similar location. According to the theory, in areas where income, health, or illness follow a social gradient, a lower socioeconomic state is realized, which worsens overall health.
The theory points to factors such as income and social protection, education, access to affordable quality healthcare services, and unemployment as significant social determinants of health with an immense impact on health equity. These factors can impact health equality either positively or negatively depending on their occurrence in a certain region. Research by WHO (2019) shows that social determinants carry more importance than healthcare and lifestyle choices in impacting health, with the SDH having a 30 to 55 percent influence on health outcomes. It also explains that sectors outside health make more contributions to a population's health than the health sector itself. As a result, appropriately addressing SDH is more crucial to improving health than simply minimizing existing health inequalities.
The social determinants of health theory can be a crucial model for evaluating the high prevalence of cervical cancer among UK's young women. It can be used to understand how non-medical factors influence the vulnerable population's health outcomes, informing how women's birth, growth, and living conditions influence their health conditions in relation to cervical cancer. With respect to the theory, several social determinants — such as socioeconomic status (SES) and access to health services — can be considered. The theory may be used to explain how women from lower socioeconomic backgrounds face greater barriers to accessing preventive healthcare services (Choi et al., 2023), preventing engagement in crucial healthcare practices such as cervical cancer screening. It can also explain how this status exposes women to limited financial resources, which prevent access to regular screenings and timely follow-up care, placing them at higher risk of undetected cervical abnormalities progressing to advanced stages.
Higher rates of cervical cancer among UK women aged below 45 can also be linked to access to healthcare services. Due to the region's disparities in healthcare access, women are exposed to lower screening uptake and delayed diagnoses. For instance, Shariati-Sarcheshme et al. (2024) refer to the impact of limited availability of healthcare providers and long wait times for appointments on cervical cancer care. Young women from underserved areas with inadequate screening facilities are further disadvantaged.
Developed by social psychologists Hochbaum, Rosenstock, and others, the Health Belief Model (HBM) seeks to explain people's failure to engage in disease prevention and detection programs. According to the model, individuals only take steps to prevent illness if they consider themselves vulnerable to a particular condition (Jones et al., 2015), driven by the belief that the condition may have serious consequences and that a particular course of action can reduce their susceptibility or lead to other positive outcomes. Later scholars such as Carpenter (2010) also argued that the model is based on an individual's self-efficacy — the belief that it is possible to successfully complete a certain behavior of interest regardless of perceived barriers.
The model contains several constructs that can be hypothesized in predicting individuals' reasons for engaging in the prevention and control of certain health conditions. For instance, the model points to personal characteristics such as age, gender, and ethnicity as key measures that influence perceptions about perceived susceptibility, severity, or barriers (Al-Ani et al., 2024), as well as an individual's perceived susceptibility and severity of a health condition. The model also cites how environmental cues can influence beliefs about engaging in a disease prevention program, triggering action based on individual perceptions about aspects such as perceived benefits or susceptibility.
The Health Belief Model can also offer critical insight into the high rates of cervical cancer among young women in the UK, through examination of the demographic population's perceptions and beliefs concerning disease prevention and detection programs in the region. Referring to the theory, women's engagement in preventive behavior is driven by their perceptions of susceptibility to cervical cancer. With many misconceptions about cervical cancer prevalence in middle age, many young women in the UK may thus fail to perceive their high risk of being affected by the disease (Ogbonna, 2017). Ogbonna's research explains how women living in developed countries may be exposed to misconceptions that make them exclude themselves from the risk of developing cervical cancer. As a result of these myths and misconceptions, women's perceptions of susceptibility and severity are influenced, leading to an underestimation of risk and, consequently, higher rates of the disease among this group.
Additionally, the model underscores the role of perceived benefits and barriers in influencing individuals' decisions to participate in preventive behaviors. Young women in the UK occasionally evaluate the perceived benefits of cervical cancer screening against the barriers (Waller et al., 2009) — for instance, weighing the importance of early detection against fear of receiving a positive diagnosis. If perceived barriers outweigh the benefits, women become less motivated to engage in crucial practices such as regular screening, resulting in increased prevalence of the condition among the population group (Lemmo et al., 2022). Given the number of women who report fear of receiving a positive cancer diagnosis, this behaviour can be linked to the high statistics of cervical cancer among the demographic group.
The high rates of cervical cancer among the UK's young women below 45 years present the region with both challenges and opportunities for public health policy and practice. Understanding these dynamics makes it possible to develop appropriate strategies for addressing the issue. The need for early detection and diagnosis is one of the major challenges — when symptoms are overlooked or disregarded by patients and healthcare providers, delayed diagnosis and poorer outcomes result. Public health policies should therefore focus on increasing awareness of the disease's symptoms and signs among women and healthcare providers (Romli et al., 2024), and stakeholders should be informed about the importance of early detection through regular screening programs.
Access to healthcare can also be considered a major challenge affecting UK public health policy and practice with respect to young women with cervical cancer. While the UK's NHS can be commended for providing considerably universal access to health services, concerns can be raised about barriers affecting the young population (Kirubarajan et al., 2021) — for instance, long waiting times to see specialists and limited access to specialized services. Consequently, UK public health policies should focus on addressing these barriers by improving young women's access to cervical cancer care, with one crucial intervention being investment in specialized services for young cancer patients.
Furthermore, addressing the unique risk factors that promote cancer prevalence among this demographic group presents a significant challenge. Young women have unique risks that differ from older populations, including lifestyle behaviors and reproductive factors that occur selectively in young women. While developing public health policies, it is crucial to consider the diversity of these risks to achieve effective mitigation of the public health issue.
Despite these challenges, the high prevalence of cervical cancer among young women also presents various opportunities for public health policy and practice, offering a chance to make a positive impact on cervical cancer among this vulnerable population. For example, there is an opportunity for advancement in screening technologies and diagnostic methods. Through these technological advancements, the sector is offered a chance to improve the potential for earlier detection and more accurate diagnosis of cervical cancer among the UK's younger women (Foran & Brennan, 2015). Policies should thus prioritize research and innovation in cervical cancer screening and diagnostics, with research on new technologies focused on developing sensitive, specific, and minimally invasive diagnostic tests.
Additionally, the UK's National Health Service (NHS) has an opportunity to adopt digital health technologies to improve cancer prevention among young women. As a measure of addressing the problem, public health policy can introduce digital technologies such as mobile health applications and telemedicine platforms, which can be crucial in facilitating remote monitoring and providing access to educational resources (Kanjak et al., 2022). Through these technologies, the sector can also support women's self-management of cancer risk factors and symptoms. Public health policies should ensure that the technologies developed and implemented are accessible, user-friendly, and evidence-based.
The impact of social determinants on cervical cancer inequalities among UK women aged below 45 years cannot be overlooked. Factors such as socioeconomic status, education, and access to healthcare have proven to have significant effects in shaping cervical cancer incidence, diagnosis, and outcomes among the UK's young population. The most affected are young women from disadvantaged backgrounds, who are barred from accessing preventive screenings and receiving adequate treatment, exposing this demographic group to a higher prevalence of cervical cancer and increased mortality rate. These patterns can be explained using related theories and models, such as the social determinants of health theory and the Health Belief Model, which present crucial insight into the link between social, economic, structural, and cultural factors that shape health outcomes. Moreover, the high prevalence of cervical cancer among young women presents significant challenges and opportunities for the United Kingdom's public health policy and practice. By leveraging these challenges and opportunities, public health policies in the region can achieve a significant step towards addressing the root causes of this health issue.