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.
Cervical cancer ranks 4th of all cancers and currently, one life is lost every 2 minutes to this disease. Importantly, it is the leading cause of cancer deaths in women in 42 countries.[2]
In 2020, the global mortality statistics increased to over 340 000 women and these are likely to continue to grow, particularly in underprivileged and vulnerable communities. Current data suggests that 90% of all cases occur in low- and middle-income countries, due largely to poor access to screening and early detection and treatment of both pre-cancers and cancer. [3]
Diagram showing stage 1B cervical cancer
Author: Cancer Research UK - CC BY-SA 4.0
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]
Virologist Harald zur Hausen discovered how cervical cancer is triggered by virus infections. His work led to the creation of the HPV vaccine which cuts the risk of developing cervical cancer.#WorldCancerDay pic.twitter.com/ZNCQEf5zkV
— The Nobel Prize (@NobelPrize) February 4, 2020
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. For example, in the US, the five-year survival rate for women diagnosed with cervical cancer at an advanced stage is 15%, compared with 93% if diagnosed when the cancer has not spread*. This holds true in lower income settings as well. In India, a study among rural women with cervical cancer found the five-year survival rate to be 9% when diagnosed at Stage IV, which soars to 78% when diagnosed earlier at Stage I.
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 and extend and improve quality of life.
Source: National Health Service: Cervical Cancer Treatment
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.
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]
No one intervention alone will be enough. The strategy requires accelerated action in prevention, screening and cancer management.
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.
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