From evidence to practice: leveraging implementation science for transitioning to risk-adapted cervical cancer screening

Population-wide human papillomavirus vaccination has transformed the epidemiology of cervical cancer and accelerated the interest in risk-adapted screening approaches that tailor screening intervals, methods, and triage pathways to an individual's vaccination status and underlying risk. Although modeling studies suggest that vaccinated cohorts may require fewer lifetime screenings and later screening initiation, implementation science provides frameworks, methods, and strategies to guide the translation of these approaches into practice. However, real-world implementation is complex and constrained by incomplete linkages with immunization records, evolving evidence on cross-protection, and persistent inequities in screening participation. By focusing on multilevel contextual determinants that span patients, clinicians, organizations, and policy environments, implementation science can guide the design, testing, and optimization of strategies such as clinical decision support tools, tailored communication, and clinical workflow redesign that are required to translate emerging evidence into practice. We highlight examples from pragmatic and hybrid effectiveness-implementation trials demonstrating how approaches such as self-sampling, participatory co-design, peer advocacy models, and multicomponent strategies improve screening reach, acceptability, and fidelity. As risk-adapted screening becomes the next frontier in cervical cancer prevention, embedding implementation science early can prevent future translational bottlenecks, support equity, and ensure that health systems are prepared to adopt and sustain evidence-based recommendations once epidemiological data mature while guiding a research agenda for implementation of risk-adapted screening worldwide.