Study indicates that up to 13.4 million cases of cervical cancer could be prevented within 50 years if intervention strategies are scaled-up by 2020
Cervical cancer could be eliminated as a public health problem in India within the next 60 years by making existing prevention programmes such as the human papillomavirus (HPV) vaccine and cervical screening more accessible, according to a Lancet study. The study indicates that up to 13.4 million cases of cervical cancer could be prevented within 50 years if intervention strategies are scaled-up by 2020. 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.
For countries with medium levels of development, including India, Vietnam, and the Philippines, this could be achieved by 2070-79, according to the study published in The Lancet Oncology journal. The study, led by researchers at the Cancer Council New South Wales in Australia, showed that 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 US, Finland, the UK, and Canada, cervical cancer is predicted to be eliminated as a public health problem within 25-40 years.
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. “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,” said Karen Canfell from the Cancer Council New South Wales. “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,” Canfell said.
However, rates of less than 4 cases per 100,000 would not be achieved by the end of the century in all individual countries in Africa (eg, Kenya, Tanzania, and Uganda) even if high coverage vaccination and twice lifetime cervical screening could be achieved by 2020. In May, 2018, the Director General of WHO called for coordinated action globally to eliminate this highly preventable cancer. 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. These include 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. “The WHO call-to-action provides an enormous opportunity to increase the level of investment in proven cervical cancer inter ventions in the world’s poorest countries. Failure to adopt these interventions will lead to millions of avoidable premature deaths,” said Canfell.
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 per cent 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 per cent of cervical cancers.
Results showed that rapid vaccination scale-up to 80-100 per cent coverage globally by 2020 using a broad-spectrum HPV vaccine could prevent 6.7-7.7 million cases but more than half of these would be averted after 2060. If, in addition, cervical screening were scaled-up to high coverage by 2020, an additional 5.7-5.8 million cases of cervical cancer may be prevented globally in the next 50 years, and substantially speed up elimination.