Evidence for the path to cervical cancer elimination
Authors: Afsan Bhadelia
Journal: The Lancet Global Health (2019)

Elimination of cervical cancer is at the forefront of the global health agenda with the launch of the WHO Initiative for the Elimination of Cervical Cancer in 2018.1WHOZero Draft, Global strategy toward the elimination of cervical cancer as a public health problem.https://www.who.int/cancer/cervical-cancer/cervical-cancer-elimination-strategyDate: 2019Date accessed: November 24, 2019Google Scholar Human papillomavirus (HPV) vaccination is expected to be a priority agenda item on health for the 2020 G20 Summit in Riyadh following the 2019 commitment to universal access to vaccination in the G20 Osaka Leaders' Declaration2G20 Osaka Summit 2019G20 Osaka Leaders' Declaration.https://g20.org/en/documents/final_g20_osaka_leaders_declaration.htmlDate accessed: November 24, 2019Google Scholar and the Okayama Declaration of the G20 Health Ministers.3G20 Osaka Summit 2019Okayama Declaration of the G20 Health Ministers.https://g20-meeting2019.mhlw.go.jp/health/g20_hmm_session_outcome.htmlDate accessed: December 2, 2019Google Scholar This political momentum should be coupled with the latest evidence to pinpoint outstanding areas for action and to implement responsive strategies. Cervical cancer is one of the top five cancers with the greatest proportion of avoidable cancer mortality—premature deaths resulting from health system failures that could otherwise be avoided on the basis of existing medical advancements and with access to high-quality health care.4Knaul FM Arreola-Ornelas H Rodriguez NM et al.Avoidable mortality: the core of the global cancer divide.J Glob Oncol. 2018; 4: 1-12PubMed Google Scholar As evidenced by the importance of quality markers in health care, including the effectiveness and timeliness of care,5Kruk ME Gage AD Arsenault C et al.High-quality health systems in the Sustainable Development Goals era: time for a revolution.Lancet Glob Health. 2018; 6: e1196-e1252Summary Full Text Full Text PDF PubMed Scopus (606) Google Scholar an immense opportunity exists to bridge the gap in what can be achieved and what is achieved on the prevention and treatment of cervical cancer. Fundamental to any response is reliable assessment of the global burden of cervical cancer. In their Article in The Lancet Global Health, Marc Arbyn and colleagues6Arbyn M Weiderpass E Bruni L et al.Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis.Lancet Glob Health. 2019; (published online Dec 4)https://doi.org/10.1016/S2214-109X(19)30482-6Summary Full Text Full Text PDF PubMed Scopus (499) Google Scholar present the latest estimates of cervical cancer incidence and mortality worldwide, using the International Agency for Research on Cancer's GLOBOCAN data from 2018 and updating a similar analysis done in 2008.7Arbyn M Castellsagué X de Sanjose S et al.Worldwide burden of cervical cancer in 2008.Ann Oncol. 2011; 22: 2675-2686Summary Full Text Full Text PDF PubMed Scopus (765) Google Scholar Arbyn and colleagues estimated that approximately 570 000 cases of cervical cancer and 311 000 deaths from the disease occurring worldwide in 2018. The annual age-standardised incidence (ASI) worldwide of cervical cancer was estimated to be 13·1 per 100 000 women-years, with an approximate range of less than 2 to 75 per 100 000. Overtime comparison of global patterns revealed that cervical cancer shifted from being the third most common malignant tumour to the fourth most common. However, despite global progress on primary and secondary prevention, Arbyn and colleagues' updated analysis indicated that about 84% of cervical cancer cases occur in low-resource countries (defined as countries with a human development index [HDI] value lower than 0·80), a minimal change in distribution of the burden from a decade ago when this proportion was 85%. Additionally, Arbyn and colleagues found an inverse trend between both the ASI and the age-standardised mortality rate and the level of human development, as derived from the HDI. These data show the ongoing presence of the global cancer divide—disparities in morbidity and mortality within and between countries that are concentrated among the poor.8Knaul MF Gralow JR Atun R Bhadelia A Closing the cancer divide: an equity imperative. Harvard Global Equity Initiative, Boston2012Google Scholar The younger age profile of the disease compared with that of most other types of cancer, with cervical cancer being among the top three cancers in 146 (79%) of 185 countries in women younger than 45 years, provides further cause for concern.6Arbyn M Weiderpass E Bruni L et al.Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis.Lancet Glob Health. 2019; (published online Dec 4)https://doi.org/10.1016/S2214-109X(19)30482-6Summary Full Text Full Text PDF PubMed Scopus (499) Google Scholar Especially as, according to the CONCORD 3 study, the global 5-year cervical cancer survival ranged between 50% and 70% over the time period of 2000–14.9Allemani C Matsuda T Di Carlo V et al.Global surveillance of trends in cancer survival 2000–14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries.Lancet. 2018; 391: 1023-1075Summary Full Text Full Text PDF PubMed Scopus (1214) Google Scholar The situation is starker in specific areas of the world. In eastern, middle, southern and western Africa, Arbyn and colleagues reported that cervical cancer was the leading cancer among women in 2018, highlighting these geographical areas as a pressing priority for the ambitious WHO cervical cancer elimination initiative. In 2008, cervical cancer was also the leading cancer among women in central America, south-central Asia, and Melanesia;7Arbyn M Castellsagué X de Sanjose S et al.Worldwide burden of cervical cancer in 2008.Ann Oncol. 2011; 22: 2675-2686Summary Full Text Full Text PDF PubMed Scopus (765) Google Scholar however, persistent efforts have yielded health gains in these parts of the world. Arbyn and colleagues have made the GLOBOCAN data more accessible and strengthened the existing analysis of global disparities in cervical cancer. The authors have substantiated the grave impetus to ensure that cervical cancer remains a public health priority and called governments and the international community to task to accelerate progress on cervical cancer prevention and treatment alongside the broader aim to achieve universal health coverage. As the cervical cancer elimination movement moves forward, all valued health goals should be pursued. Previous findings on the burden of serious health-related suffering, which could be ameliorated with adequate palliative care that is insufficient in much of the world today, estimated that 80% of individuals who have serious health-related suffering live in low-income and middle-income countries and that nearly a quarter of this burden is associated with cancer, including cervical cancer.10Knaul FM Farmer PE Krakauer EL et al.Alleviating the access abyss in palliative care and pain relief—an imperative of universal health coverage: the Lancet Commission report.Lancet. 2018; 391: 1391-1454Summary Full Text Full Text PDF PubMed Scopus (315) Google Scholar The alleviation of suffering with access to care throughout the care continuum must be a priority in the quest for better health for all initiatives, including disease-specific ones. Moreover, the disaggregation of data to examine health inequities (such as the burden of cervical cancer) among the most marginalised is necessary, to protect the needs of the populations most at risk, including indigenous communities, refugees and immigrants, and individuals in the lesbian, gay, bisexual, transgender, queer or questioning, and intersex community. In this era of misinformation and anti-immunisation campaigns, as well as persistent stigma surrounding cancer in various parts of the world, various challenges stand on the path to elimination of cervical cancer. Improved cancer surveillance and continued evidence-based public awareness activities can serve to counter some of these challenges. This online publication has been corrected. The corrected version first appeared at thelancet.com/lancetgh on Dec 13, 2019 This online publication has been corrected. The corrected version first appeared at thelancet.com/lancetgh on Dec 13, 2019 I declare no competing interests. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysisCervical cancer continues to be a major public health problem affecting middle-aged women, particularly in less-resourced countries. The global scale-up of HPV vaccination and HPV-based screening—including self-sampling—has potential to make cervical cancer a rare disease in the decades to come. Our study could help shape and monitor the initiative to eliminate cervical cancer as a major public health problem. Full-Text PDF Open AccessCorrection to Lancet Glob Health 2019; published online Dec 4. https://doi.org/10.1016/S2214-109X(19)30523-6Bhadelia A. Evidence for the path to cervical cancer elimination. Lancet Glob Health 2019; published online Dec 4. https://doi.org/10.1016/S2214-109X(19)30523-6—In this Comment, “eradication” should read “elimination”. These corrections have been made as of Dec 13, 2019. Full-Text PDF Open Access