Researchers say expanding current existing interventions like vaccine and screening can help eliminate cervical cancer
Cervical cancer could be eliminated as a public health problem in most countries by the end of the century. This can be done simply with rapid expansion of existing interventions, according to a modelling study published in The Lancet Oncology journal.
The estimates, which are the first of their kind at a global-scale, indicate that combining high uptake of the human papillomavirus (HPV) vaccine and high HPV-based cervical screening rates in all countries from 2020 onwards could prevent up to 13.4 million cases of cervical cancer within 50 years (by 2069). The average rate of annual cases across all countries could fall to less than 4 cases per 100,000 women by the end of the century—which is a potential threshold for considering cervical cancer to be eliminated as a major public health problem.
Under a more gradual scale-up scenario, cervical cancer elimination is expected in countries with very high and high levels of development by the end of the century, but average rates would remain above the threshold in countries with medium (4.4 cases per 100,000) and low (14 per 100,000) levels of development.
Cervical cancer is the second most common type of cancer in females in India. According to the National Health Profile 2017, there were 97909 cases of cervical cancer in 2015. In 2013 the figure was 92,731. It is projected to go up to 104060 by 2020.
Without expanding current prevention programmes, however, the study predicts that 44.4 million cervical cancer cases would be diagnosed over the next 50 years—rising from 600,000 in 2020 to 1.3 million in 2069 due to population growth and ageing.
In May, 2018, the Director General of WHO called for coordinated action globally to eliminate this highly preventable cancer. The findings from this study have helped inform initial discussions of elimination targets as part of the development of the WHO strategy, and future modelling studies will support the development of the final goals and targets for cervical cancer elimination.
Cervical cancer could potentially be eliminated as a major public health problem in 149 out of 181 countries by 2100.
In high-income countries including the USA, Finland, the UK, and Canada, cervical cancer is predicted to be eliminated as a public health problem within 25–40 years.
If high coverage HPV vaccination and cervical screening cannot be achieved globally, over 44 million women could be diagnosed with cervical cancer in next 50 years—two thirds of these cases, and an estimated 15 million deaths, would occur in countries with low and medium levels of development.
WHO has called for urgent action to scale up implementation of proven measures towards achieving the elimination of cervical cancer as a global public health problem (including vaccination against HPV, screening and treatment of pre-cancer, early detection and prompt treatment of early invasive cancers and palliative care). A draft global strategy to accelerate cervical cancer elimination, with goals and targets for the period 2020–2030, will be considered at the World Health Assembly in 2020.
“Despite the enormity of the problem, our findings suggest that global elimination is within reach with tools that are already available, provided that both high coverage of HPV vaccination and cervical screening can be achieved”, says Professor Karen Canfell from the Cancer Council New South Wales, Sydney, Australia who led the study.
He added: “More than two thirds of cases prevented would be in countries with low and medium levels of human development like India, Nigeria, and Malawi, where there has so far been limited access to HPV vaccination or cervical screening. The WHO call-to-action provides an enormous opportunity to increase the level of investment in proven cervical cancer interventions in the world’s poorest countries. Failure to adopt these interventions will lead to millions of avoidable premature deaths.”
Cervical cancer is the fourth most common cancer in women, with an estimated 570,000 new cases diagnosed worldwide in 2018, of which around 85% occur in less developed regions. HPV, a group of more than 150 viruses, is responsible for the majority of cervical cancers. Proven methods are available to screen for and treat cervical pre-cancers, and broad-spectrum HPV vaccines can potentially prevent up to 84–90% of cervical cancers.
Nevertheless, large disparities exist in cervical screening and HPV vaccination coverage between countries. In low- and middle-income countries (LMICs), overall screening rates in 2008 were as low as 19%, compared to 63% in high-income regions; whilst by 2014 less than 3% of females aged 10–20 years in LMICs received the full course of HPV vaccination in 2014, compared to over a third in high-income countries.
The authors analysed high-quality registry data from the International Agency for Research on Cancer to predict future trends in cervical cancer if further action is not taken. They then used a dynamic model to calculate the impact of scaling up HPV vaccination and cervical screening on the cervical cancer burden globally, and in 181 countries of all levels of development, between 2020 and the end of the century.