19 August 2020: The World Health Assembly has adopted the global strategy to accelerate the elimination of cervical cancer as a public health problem.
Cervical cancer is a disease that can be prevented and cured, provided it is detected early and managed effectively. But it is the fourth most common type of cancer among women worldwide, and the most common cancer among women living with HIV who have six times the risk of developing cervical cancer. The disease claimed more than 300 000 women's lives in 2018.
Cervical cancer is also a disease that mirrors global inequity. The burden is highest in low- and middle-income countries where there is minimal access to public health facilities and disease prevention and care has not been widely introduced. Nearly 90 per cent of all deaths in low- and middle-income countries worldwide occurred in 2018. Furthermore, in these countries , the proportion of women with cervical cancer who die from the disease exceeds 60%, which is more than twice that in many high-income countries, where it is as low as 30%.
The main cause of cervical cancer is the human papillomavirus (HPV), and the HPV vaccine is a safe and effective way to protect women from HPV infections. Yet by 2020, fewer than a fifth of low-income countries have incorporated the HPV vaccine into their national immunization schedules, with more than 85 per cent of high-income countries doing so. In the establishment of cervical cancer screening programs similar disparities are also observed.
“Most of these women are not diagnosed early enough, and lack access to life-saving treatment,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General, when he issued the Call to Action in 2018. “These women are raising children, caring for their families and contributing to the social and economic fabric of their communities. If we don’t act, deaths from cervical cancer will rise by almost 50% by 2040.” With the elimination strategy’s adoption by the World Health Assembly, Dr Princess Nothemba Simelela, WHO Assistant Director-General for Strategic Programmatic Priorities, said the resolution presents an opportunity for leaders and advocates “to end the inequity and restore women’s dignity.”
The path to eliminating cervical cancer
All countries must hit and sustain an incidence rate of below four per 100 000 women to eradicate cervical cancer. Achieving this goal requires strategic action, and in its global strategy, the WHO outlines the necessary actions, envisioning a world where cervical cancer is eliminated as a public health issue, and keeping the SDGs agenda for 2030 on.
WHO’s strategy of elimination rests on three main pillars:
prevention through vaccination
screening and treatment of precancerous lesions
treatment and palliative care for invasive cervical cancer
All three pillars must be implemented collectively and at scale to achieve the goal of elimination. HPV vaccination offers long-term protection against cervical cancer. Screening and treatment of precancerous lesions can prevent pre-cancer from developing into cancer. For those who are identified with invasive cancer, timely care and treatment saves lives, while palliative care can greatly reduce pain and suffering.
Targets or milestones
Based on the three key pillars of the global strategy, WHO recommends a set of targets or milestones that each country should meet by 2030 to get on the path to eliminate cervical cancer within the century:
90% of girls fully vaccinated with the HPV vaccine by the age of 15;
70% of women screened using a high-performance test by the age of 35, and again by the age of 45; and
90% of women identified with cervical disease receive treatment (90% of women with pre-cancer treated and 90% of women with invasive cancer managed).
Projections show that achieving the 90-70-90 targets by 2030 can reduce the median cervical cancer incidence rate by 10% by 2030, and by 2120, 70 million cases could be averted. Additionally, an estimated 62 million cervical cancer deaths could be averted by 2120. In the meantime, implementing the strategy will save lives today.
A robust monitoring system, including population-based cancer registries, is essential to keep track of the progress and to make course corrections.
Cervical cancer elimination would also result in positive economic and societal outcomes. By 2030, around 250 000 women will remain productive members of the workforce, adding an estimated US $28 billion to the world’s economy: US $700 million as a direct result of increased workforce participation and about US $27 billion as an indirect benefit of good health.
COVID-19 could disrupt efforts to attain the goals set out in the global strategy. Exposure to lifesaving care appears to be critical in the midst of the pandemic. Ensuring that vital health programs continue, with all necessary safety measures in place, is crucial so that no more people die from this preventable illness.
Eliminating cervical cancer is within reach
Cervical cancer stands as one of the greatest public health failures in the world, but elimination is within reach for all countries through strong action and aligned intervention. There is the technology and tools to prevent this disease, together with proven early diagnosis and treatment measures.
“Through cost-effective, evidence-based interventions, including human papillomavirus vaccination of girls, screening and treatment of precancerous lesions, and improving access to diagnosis and treatment of invasive cancers, we can eliminate cervical cancer as a public health problem and make it a disease of the past,” said Dr Tedros.
The time has come for an ambitious, concerted and inclusive strategy to hasten the elimination of cervical cancer as a global public health issue. To bring it to life is our mutual responsibility: policy makers, health care providers, civil society, scientific community, and the private sector all have important roles to play. It's now time to act