Persistent and divergent cervical cancer burden in Sub-Saharan Africa, 1990–2023.

e22588 Background: Cervical cancer is among the most preventable malignancies, yet sub-Saharan Africa (SSA) bears the highest global burden with substantial sub-regional heterogeneity often obscured by regional aggregates. Sub-regional analyses are needed to guide targeted interventions. Methods: Using Global Burden of Disease (GBD) 2023 data, we analyzed age-standardized incidence (ASIR), mortality (ASMR), and disability-adjusted life years (ASDALYR) per 100,000 people for cervical cancer from 1990–2023 across Central, Eastern, Southern, and Western SSA. Global rates were used as a comparator. Temporal trends were quantified using estimated annual percentage change (EAPC) with 95% confidence intervals. Results: In 2023, SSA maintained the highest global cervical cancer burden, with ASIR 55.9, ASMR 27.1, ASDALYR 1040.9, representing more than two- to four-fold global rates. Eastern SSA had the highest burden in 2023; ASIR increased to 78.7 (EAPC 0.37%; 0.22, 0.52) while ASMR of 37.0, and ASDALYR of 1470.6 were stable. Central SSA burden increased over time, ranking second in 2023 burden, with 2023 ASIR of 63.9 (EAPC 1.48%; 1.19, 1.77), ASMR of 31.4 (1.02%; 0.82, 1.22), and ASDALYR of 1228.9 (1.10%; 0.85, 1.35). Southern SSA, despite the lowest 1990 burden, had the steepest increases, with 2023 ASIR of 46.2 (2.67%; 2.39, 2.94), ASMR of 23.8 (2.19%; 1.93, 2.44), and ASDALYR of 825.3 (2.41%; 2.14, 2.68). In contrast, Western SSA had stable ASIR of 35.7 (−0.10%; −0.35, 0.15) alongside significant declines in ASMR 17.8 (−0.52%; −0.71, −0.32) and ASDALYR to 660.4 (−0.49%; −0.72, −0.26) with the lowest 2023 regional burden. Eswatini, Malawi, and Zambia are countries that had the highest cervical cancer burden and ranked first through third globally (ASIR/ASMR/ASDALYR: 157.6/69.4/2999.1; 135.9/60.0/2598.7; 112.6/55.9/2163.8). South Africa, Malawi, Namibia, the Democratic Republic of the Congo, and Lesotho experienced the largest increases in ASIR (EAPC 1.85−3.19%), ASMR (1.43−2.64%), and ASDALYR (1.48−2.89%); while Rwanda, Mozambique, Madagascar, Comoros, Nigeria, United Republic of Tanzania, and Burkina Faso exhibited the largest declines in ASIR (−0.41 to −1.75%), ASMR (−0.73 to −1.34%), and ASDALYR (−0.71 to −2.00%). Across all SSA regions, all rates showed a post-2020 uptick. Conclusions: Cervical cancer burden in SSA remains the highest globally and is highly heterogeneous, likely reflecting sub-regional differences in HIV burden, HPV vaccination and screening coverage, and health-system capacity. While Western SSA demonstrates progress, rising burden in Central, Eastern, and Southern SSA coupled with post-2020 upticks across regions, underscore persistent gaps in HPV vaccination, screening, and treatment access. Accelerated, region-specific implementation of comprehensive prevention and screen-and-treat strategies is urgently needed to advance cervical cancer elimination goals.