Cervical cancer elimination: are targets useful?
Authors: Vivien Davis Tsu
Journal: The Lancet (2020)

Cervical cancer is the most common cause of cancer-related deaths in women in 42 low-income and lower-middle-income countries (LMICs), 1 Bray F Ferlay J Soerjomataram I Siegel RL Torre LA Jemal A Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68: 394-424 Crossref PubMed Scopus (50356) Google Scholar with the highest age-standardised incidence rates (40 cases per 100 000 women-years) occurring in 15 countries in sub-Saharan Africa. 2 Arbyn 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)30482-6 Summary Full Text Full Text PDF PubMed Scopus (1404) Google Scholar The gross disparity of the burden of this highly preventable disease, whereby 290 000 (51%) of the 570 000 new cases estimated to occur annually befall women in LMICs, 1 Bray F Ferlay J Soerjomataram I Siegel RL Torre LA Jemal A Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68: 394-424 Crossref PubMed Scopus (50356) Google Scholar has led many people to call attention to the need for urgent action. In fact, valuable new tools have been developed in the past 20 years to make prevention more feasible, even in low-resource settings: the human papillomavirus (HPV) vaccine, 3 de Sanjose S Brotons M LaMontagne DS Bruni L Human papillomavirus vaccine disease impact beyond expectations. Curr Opin Virol. 2019; 39: 16-22 Crossref PubMed Scopus (31) Google Scholar HPV testing, 4 Wentzensen N Arbyn M HPV-based cervical cancer screening-facts, fiction, and misperceptions. Prev Med. 2017; 98: 33-35 Crossref PubMed Scopus (37) Google Scholar the use of self-collected samples for HPV testing, 5 Arbyn M Smith SB Temin S Sultana F Castle P Collaboration on Self-Sampling and HPV TestingDetecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses. BMJ. 2018; 363k4823 Crossref PubMed Scopus (298) Google Scholar thermal ablation for treating cervical pre-cancer, 6 Randall TC Sauvaget C Muwonge R Trimble EL Jeronimo J Worthy of further consideration: an updated meta-analysis to address the feasibility, acceptability, safety and efficacy of thermal ablation in the treatment of cervical cancer precursor lesions. Prev Med. 2019; 118: 81-91 Crossref PubMed Scopus (40) Google Scholar the use of mobile phones to improve follow-up after screening, 7 Erwin E Aronson KJ Day A et al. SMS behaviour change communication and eVoucher interventions to increase uptake of cervical cancer screening in the Kilimanjaro and Arusha regions of Tanzania: a randomised, double-blind, controlled trial of effectiveness. BMJ Innov. 2019; 5: 28-34 Crossref PubMed Scopus (23) Google Scholar , 8 Huchko MJ Saduma I Blat C Oketch S Bukusi EA How providing cervical cancer screening results via cell phone affects patient follow-up rates in western Kenya. J Glob Oncol. 2019; 5: 1-8 PubMed Google Scholar and machine learning to improve visual assessment. 9 Hu L Bell D Antani S et al. An observational study of deep learning and automated evaluation of cervical images for cancer screening. J Natl Cancer Inst. 2019; 111: 923-932 Crossref PubMed Scopus (138) Google Scholar These developments have raised the possibility that we can now have a substantial impact in preventing cervical cancer, if these advances are scaled up and applied judiciously. We also finally have political momentum and a global champion in Dr Tedros Adhanom Ghebreyesus, Director-General of WHO, who sounded the call in 2018 to eliminate cervical cancer as a public health problem. 10 WHOWHO Director-General calls for all countries to take action to help end the suffering caused by cervical cancer. https://www.who.int/news-room/detail/18-05-2018-who-director-general-calls-for-all-countries-to-take-action-to-help-end-the-suffering-caused-by-cervical-cancerDate: May 18, 2018 Date accessed: January 18, 2020 Google Scholar Dr Tedros's call to action has spurred WHO to convene expert consultations and develop a consensus definition of elimination (four cases per 100 000 women-years) 11 Canfell K Towards the global elimination of cervical cancer. Papillomavirus Res. 2019; 8100170 Crossref PubMed Scopus (90) Google Scholar and draft targets, known as the triple intervention strategy: 90% coverage of the HPV vaccine, 70% coverage of twice-lifetime screening of women at the ages of 35 years and 45 years, and 90% delivery of treatment needed for cervical cancer and precancer by 2030. 12 WHODraft: global strategy towards eliminating cervical cancer as a public health problem. https://www.who.int/docs/default-source/cervical-cancer/cervical-cancer-elimination-strategy.pdf?sfvrsn=8a083c4e_0Date: Dec 16, 2019 Date accessed: January 18, 2020 Google Scholar Mortality impact of achieving WHO cervical cancer elimination targets: a comparative modelling analysis in 78 low-income and lower-middle-income countriesThese findings emphasise the importance of acting immediately on three fronts to scale up vaccination, screening, and treatment for pre-invasive and invasive cervical cancer. In the next 10 years, a one-third reduction in the rate of premature mortality from cervical cancer in LMICs is possible, contributing to the realisation of the 2030 UN SDGs. Over the next century, successful implementation of the WHO elimination strategy would reduce cervical cancer mortality by almost 99% and save more than 62 million women's lives. Full-Text PDF Open AccessImpact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countriesPredictions were consistent across our three models and suggest that high HPV vaccination coverage of girls can lead to cervical cancer elimination in most LMICs by the end of the century. Screening with high uptake will expedite reductions and will be necessary to eliminate cervical cancer in countries with the highest burden. Full-Text PDF Open Access