Long-term trends and post-pandemic deviations in cervical cancer burden in South India, 1990–2023: a Global Burden of Disease 2023 study

Objectives: Cervical cancer remains a major public health challenge in India despite advances in prevention through human papillomavirus (HPV) vaccination and screening. Although national estimates indicate gradual declines, marked regional disparities persist, and coronavirus disease 2019-related disruptions may have affected recent disease trajectories. This study assessed long-term trends, post-pandemic deviations, and progress toward World Health Organization (WHO) elimination targets in South India. Methods: This population-based observational analysis used Global Burden of Disease Study 2023 estimates for women aged 30-69 years in South India from 1990 to 2023. Pre-pandemic trends and counterfactual projections were evaluated, and age-standardized incidence rates (ASRs) were descriptively compared with the WHO elimination threshold of ≤4 cases per 100,000 woman-years. Results: Age-standardized cervical cancer incidence and mortality declined until the early 2010s but remained above national and global rates. Thereafter, declines stagnated and reversed. In 2023, incidence ranged from 26.1 per 100,000 women in Kerala to 65.8 in Telangana; all states exceeded the WHO threshold based on these ASRs. Observed rates exceeded counterfactual projections, but uncertainty envelopes included zero for every location and outcome. Thus, the findings are consistent with possible post-pandemic disruption to cervical cancer services rather than statistically demonstrated excess burden, and this ecological comparison cannot establish causality. Disability-adjusted life-year rates were highest among women aged 50-69 years. Conclusion: South India appears to have experienced a recent loss of momentum in cervical cancer control. Strengthening HPV vaccination coverage, expanding screening, and improving the resilience of cancer prevention services are essential for accelerating progress toward elimination targets.