Cervical Screening Systems in Eastern Europe and Central Asia: A Comparative Policy Evaluation

<b>Background/Objectives</b>: Cervical cancer remains a major cause of morbidity and mortality in Eastern Europe and Central Asia (EECA), where screening implementation remains fragmented. This study provides a comparative assessment of national cervical screening programs across the region, highlighting structural strengths and policy gaps. <b>Methods</b>: National self-reported data were collected through a standardized UNFPA questionnaire from 18 submissions representing 16 EECA countries and territories. Descriptive analyses compared organized and opportunistic approaches, and an illustrative Program Maturity Index (PMI) was constructed from eight structural and performance indicators aligned with WHO and European standards. <b>Results</b>: Fifteen submissions reported national screening guidelines and seventeen defined intervals, most commonly every three or five years. Organized systems achieved higher participation (median 57.2%) than opportunistic models (15%). Follow-up of screen-positive women was the weakest component, with rates ranging from below 2% to above 90%. The regional mean PMI was 0.73, reflecting intermediate-to-advanced maturity overall, but persistent gaps in monitoring and patient linkage to care. <b>Conclusions</b>: This study offers the first regional comparison of cervical screening systems in EECA. Despite policy progress, weak follow-up and incomplete data systems limit impact. Strengthening electronic registries, financing linkage to outcomes, and regional collaboration are essential to meet the WHO's 90-70-90 elimination targets.