The World Health Assembly now has a global strategy to expedite the eradication of cervical cancer as a public health issue.
Cervical cancer, though preventable and curable, took the lives of over 300,000 women in 2018. It is the fourth common cancer affecting women around the world. It is also the most common cancer in women who are living with HIV, who are six times more vulnerable to the disease.
The prevalence of cervical cancer in low and middle-income countries reveals that cervical cancer is linked to global inequity. In places where public health services are limited, screening and successful treatment for cervical cancer occur infrequently.
90% of all deaths related to cervical cancer around the world were in low and middle-income countries. In contrast, the proportion of women in high-income countries who die from this disease is as low as 30%.
The World Health Organisation’s Director-General Dr. Tedros Adhanom Ghebreyesus predicts that women’s lives lost to cervical cancer will go up by approximately 50% by 2040.
The cause of cervical cancer has been identified as the human papillomavirus (HPV). The vaccine against HPV has proven to be a safe and effective way to protect women. Despite its success, the HPV vaccine has been introduced in less than 25% of low-income countries yet over 85% of high-income countries now have the HPV vaccine in their national immunisation schedules. Similarly concerning are the rates of screening, which correspond to the availability of the HPV vaccine in low-income and high-income countries.
All countries around the world must reach an incidence rate of less than four cases of cervical cancer per 100,000 women in order to eradicate cervical cancer. The WHO’s strategy to reach this goal involves three key elements: cancer prevention through HPV vaccination, which offers women long-term protection from cervical cancer; reliable screening and treatment of precancerous lesions, which can prevent cancer from developing; and timely treatment of cancer cases as well as pain-minimising palliative care for invasive cervical cancer.
Each of the three key elements of the strategy contain specific targets and milestones for each country. The strategy aims to meet these numbers by 2030, and immediate implementation will save lives in the present day. If the strategy is successful, cervical cancer may be eradicated by the end of the century.
The targets can be understood as 90-70-90: 90% of girls 15 years of age and younger will be vaccinated against HPV; 70% of women will be screened by 35 years of age and again by 45 years of age; 90% of women who have cervical disease will receive treatment. Of the 90% of women with cervical disease, 90% of women with pre-cancerous lesions will be treated and 90% of women with cancer will be managed.
If the 90-70-90 targets are met by 2030, the median rate of the incidence of cervical cancer will go down by 10%. By 2120, 70 million cases of cervical cancer could be prevented and about 62 million deaths by cervical cancer avoided.
The WHO asserts that tools like the HPV vaccine and improved technology can become widely available around the world. With strong monitoring systems and cancer registries based on each individual country’s population, speedy progress towards the elimination of cervical cancer can be made. Careful tracking of progress is essential as such practices help to ensure that mistakes are corrected as they occur.
The eradication of cervical cancer also has positive economic and societal implications. If, by 2030, 250,000 women around the world can remain a part of the workforce, their participation in work and the benefits of good health can add approximately US $28 billion to the global economy.
According to the WHO, successful elimination of cervical cancer is possible, even as the COVID-19 pandemic disrupts regular medical practices. Though the pandemic is clearly disruptive, the WHO is adamant that access to medical treatment that can save lives is of critical importance.
