Tackling cervical cancer in Europe amidst the COVID-19 pandemic
Authors: Marc Arbyn, Laia Bruni, Daniel Kelly, Partha Basu, Mario Poljak, Murat Gultekin, Christine Bergeron, David Ritchie, Elisabete Weiderpass
Journal: The Lancet Public Health (2020)

According to estimates for 2018,1Arbyn M Weiderpass E Bruni L et al.Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis.Lancet Glob Health. 2020; 8: e191-e203Summary Full Text Full Text PDF PubMed Scopus (2114) Google Scholar approximately 33 000 cases of cervical cancer occurred and 15 000 people died from the disease in Europe (see map in appendix). Human papillomavirus (HPV) vaccine coverage is relatively low in countries with the highest incidence and screening performance is heterogeneous among European countries. Cytological screening followed by treatment of screen-detected cervical lesions has resulted in substantial decreases in the burden of cervical cancer in western and northern Europe; but in eastern Europe, cervical cancer incidence and mortality remain comparatively high.2Arbyn M Antoine J Mägi M et al.Trends in cervical cancer incidence and mortality in the Baltic countries, Bulgaria and Romania.Int J Cancer. 2011; 128: 1899-1907Crossref PubMed Scopus (62) Google Scholar Today, new powerful tools are available for primary and secondary prevention of cervical cancer, among which prophylactic HPV vaccines, and screening using validated HPV tests for women—including some tests that can be applied on self-collected samples, a strategy that might be used to reach underscreened populations.3Arbyn M Smith SB Temin S et al.Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses.BMJ. 2018; 363k4823Crossref PubMed Scopus (437) Google Scholar In May, 2018, the WHO Director General launched a call to eliminate cervical cancer by vaccinating at least 90% of girls by age 15 years, by offering screening at least twice in a lifetime to 70% or more of the target age populations and treat more than 90% of women with screen-detected lesions. Recently, a large group of experts from diverse professional societies and cancer organisations supporting WHO's call to eliminate cervical cancer, proposed a series of concerted actions to implement organised integrated HPV vaccination and HPV-based screening, and requested European health authorities to endorse the principles of the WHO elimination initiative, mobilise resources to update evidence-based guidelines, and translate them into quantified and monitored preventive activities.4Kyrgiou M Arbyn M Bergeron C et al.Cervical screening: ESGO-EFC position paper of the European Society of Gynaecologic Oncology (ESGO) and the European Federation of Colposcopy (EFC).Br J Cancer. 2020; (published online June 8.)https://doi.org/10.1038/s41416-020-0920-9Crossref PubMed Scopus (74) Google Scholar However, in the first half of 2020, due to the dramatic COVID-19 pandemic, cervical cancer prevention activities have been disrupted in many European countries. We are concerned and urge the public health community to maintain sufficient resources to sustain HPV vaccination and cancer screening in the future. Importantly, the COVID-19 pandemic might also generate opportunities for more efficient prevention, by promoting more cost-effective, evidence-based protocols, by focusing on women who are at high-risk, extending HPV testing on self-collected samples, and discouraging inefficient policies, such as screening with two tests. We welcome the unprecedented collaborations between the cancer and infectious disease communities, who have been working jointly to tackle the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by applying the experience of HPV test evaluation to protocols for comparing and validating SARS-CoV-2 assays and by bringing modellers together in the COVID-19 and Cancer Taskforce Global Modelling Consortium. This online publication has been corrected. The corrected version first appeared at thelancet.com/public-health on August 5, 2020 This online publication has been corrected. The corrected version first appeared at thelancet.com/public-health on August 5, 2020 MA was supported by Directorate-General for Research and Innovation of the European Commission (RIsk-based Screening for Cervical Cancer, grant number 847845); Belgian Foundation Against Cancer (IHUVAC project) and from the VALCOR project. LB's research unit has received unrestricted research grants from Merck, Sharpe & Dohme and GlaxoSmithKline. MG received travel support and honoraria from Merck, Sharpe & Dohme to be a speaker. DK, PB, MP, CB, DR, and EW declare no competing interests. Where authors are identified as personnel of the International Agency for Research on Cancer or WHO, the authors alone are responsible for the views expressed in this Article and they do not necessarily represent the decisions, policy or views of the International Agency for Research on Cancer or WHO. Download .pdf (.13 MB) Help with pdf files Supplementary appendix 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 Public Health 2020; 5: e425Arbyn M, Bruni L, Kelly D, et al. Tackling cervical cancer in Europe amidst the COVID-19 pandemic. Lancet Public Health 2020; 5: e425—In this Correspondence, the grant project for Marc Arbyn should have read "(RIsk-based Screening for Cervical Cancer, grant number 847845)". This correction has been made as of Aug 5, 2020 Full-Text PDF Open Access