Cervical cancer elimination

Cervical cancer is the uncontrolled growth of abnormal cells in the lining of the cervix. The cervix is part of the female reproductive system and is located in the lower part of the womb, forming the opening from the womb to the vagina.[1] Cervical cancer, caused by the human papillomavirus (HPV) and particularly devastating in those living with HIV co-infection, is a growing public health concern.

UICC podcast on cervical cancer

What causes cervical cancer?

Most cervical cancers are caused by Human Papillomavirus (HPV) infections. HPV is a group of viruses that are extremely common worldwide. There are more than 100 types of HPV, of which at least 14 are cancer-causing (also known as high-risk types). Two HPV types (16 and 18) cause 70% of cervical cancers and pre-cancerous cervical lesions. There is also evidence linking HPV with cancers of the anus, vulva, vagina, penis and oropharynx.[4]

Prevention, detection & treatment

Cervical cancer is one of the most preventable and successfully treatable forms of cancer, if it is detected and diagnosed early, and managed effectively. Like many cancers, the earlier cervical cancer is detected, the higher the chances are of survival.

Prevention

HPV vaccines protect against the common cancer-causing types of human papilloma virus (HPV) and can significantly reduce the risk of cervical cancer. 

Detection

Screening for HPV-infection in women aged 30-49 followed by examination of the cervix for pre-cancers ensures early detection to help further prevent cervical cancer.   

Treatment

Precancerous lesions: If screening detects pre-cancers, these can be treated by thermal ablation, cryotherapy or LLETZ, which is a therapeutic intervention to remove the tissue. 

Early stage cervical cancer: When detected and diagnosed early, cervical cancer is usually treated through surgery, with radiotherapy or a combination of both. 

Advanced cervical cancer:  When cervical cancer has developed further, radiotherapy with or without chemotherapy is often used to treat the cancer. In some cases, treatments can have lasting impact, including removal of the womb, premature menopause and infertility.

Palliating cervical cancer: When cervical cancer cannot be cured, there are ways to slow its progression, relieve pain, extend and improve quality of life. 

What does "elimination" mean?

In 2020, the World Health Organization approved a strategy aimed at eliminating cervical cancer worldwide within generations. The Global Strategy identifies the following threshold: cervical cancer would no longer be considered to be a public health problem when all countries reach an annual incidence rate of 4 cases per 100,000 women or less. This should happen within the lifetime of today’s young girls. [5]

The elimination initiative suggests a three-pillar approach:

No one intervention alone will be enough. The strategy requires accelerated action in prevention, screening and cancer management.  

1. 90%  of girls fully vaccinated with HPV vaccine by 15 years
2. 70% of women are screened with a high-performance test by 35 and 45 years of age, pre-cancerous lesions are treated early
3. 90% of women identified with cervical disease receive treatment 

WHO estimates that achieving and sustaining the 90:70:90 targets will avert 74 million new cases of cervical cancer and 62 million deaths in 78 low- and middle-income countries in the coming decades. 

Two articles published in The Lancet show that 62 million women's lives could be saved by 2120 if the World Health Organization (WHO) proposed measures for cervical cancer elimination are implemented.

This analysis in 78 low-income and lower-middle-income countries describes the mortality impact of achieving WHO cervical cancer elimination targets.

17 November marks the Cervical Cancer Elimination Day of Action and the second anniversary of the launch of the World Health Organization’s (WHO) Global strategy to accelerate the elimination of cervical cancer as a public health problem.  

The Global Strategy and its related targets represent a unique opportunity to drive long-term, sustainable advocacy and save lives.