Cervical cancer in the Arab world: knowledge gaps, health system and cultural barriers, and the path forward

BACKGROUND: Human Papillomavirus (HPV) is a sexually transmitted virus that infects the genital tract. High-risk HPVs are responsible for nearly all cervical cancer (CC). In the Arab world, uptake of CC screening by women is low. This study aims to investigate the key factors influencing the uptake of CC screening among women in Arab countries. METHODS: Search strategy for the systematic review was registered in PROSPERO: CRD420251034400 and followed PRISMA guidelines. PubMed, Embase, Web of Science, Cochrane, and Scopus databases were searched. NOS was used for quality assessment. FINDINGS: The search resulted in including 34 studies. The data totals 42,781 participants, including surveys and interviews conducted across 22 Arab countries. Data displayed low knowledge and awareness about HPV, its vaccine, and CC. Saudi Arabia, awareness is poor, with only 14% of women knowing HPV causes CC and 9.8% aware of the vaccine. Similarly, in Oman, Kuwait, Sudan, and Morocco, vaccine uptake remains low due to safety concerns, lack of awareness, and socio-cultural barriers. While some populations show willingness to vaccinate (55% of Saudi parents, 63% of Lebanese mothers), misinformation and conspiracy beliefs hinder acceptance. Vaccination uptake ranged from 4.6% to 18.9%. Healthcare providers played a crucial role in educational interventions in Saudi Arabia and Morocco that have improved HPV knowledge. Media, especially social media, is a key source of information, although reliance on healthcare providers remains low. INTERPRETATION: Overall, improving awareness, addressing misinformation, and strengthening healthcare provider engagement are critical to enhancing HPV vaccination and CC screening uptake.