The 17th of November marks two years since the world came together for a global day of action toward eliminating cervical cancer. One woman dies of cervical cancer every two minutes
Cervical cancer is the fourth most common cancer among women globally. It is a preventable disease. It is also curable if detected early and adequately treated. Yet it remains one of the most common cancers and causes of cancer-related death in women across the globe. Nine in ten cervical cancer deaths worldwide occurred in low-and-middle income countries. Women living with HIV are six times as likely to develop cervical cancer compared to women who are HIV negative.
Achieving the 90-70-90 targets by 2030 would result in over 62 million cervical cancer deaths averted by 2120.
- 90% of girls fully vaccinated with HPV vaccine by age 15 years.
- 70% of women are screened with a high-performance test by 35 years of age and again by 45 years of age
- 90% of women identified with cervical disease receive treatment (90% of women with precancer treated, and 90% of women with invasive cancer managed).
Clearing the path to cervical cancer elimination will require bold strategic actions that are designed to improve community awareness; rapidly expand workforce capacity; strengthen health systems; shape the market so as to lower the prices of life-saving products; accelerate the introduction of affordable technology into screening and treatment algorithms; and nationally scale up organized, population-based prevention and treatment platforms. In order to ensure optimal effectiveness, the strategic actions must be developed in concert with front-line health care policy-makers and providers, advocates, and women themselves
Strategic actions to achieve the 90-70-90 targets should be pursued within the framework of a national policy to eliminate cervical cancer. Scale-up should be incorporated into countries’ national strategic health plans to reach universal health coverage. High-level political commitment and stewardship should drive and guide implementation, supported by collaborative partnerships.
- Primary prevention: HPV vaccination; Vaccination of adolescent girls is the most effective long-term intervention for reducing the risk of developing cervical cancer.
- Strategic actions to achieve 90% coverage of HPV vaccination (1. Secure sufficient and affordable HPV vaccines, 2. Increase the quality and coverage of vaccination, 3. Improve communication and social mobilization, 4. Innovate to improve efficiency of vaccine delivery)
3. Secondary prevention: screening and treating precancerous lesions; The principal goal of secondary prevention is to reduce cervical cancer incidence and mortality by identifying and treating women with precancerous lesions.
4. Strategic actions to achieve 70% coverage for screening and 90% treatment of precancerous lesions. (a. Understand barriers to accessing services and create an enabling environment, b. Understand barriers to accessing services and create an enabling environment, c. Integrate screening and treatment services into the primary care package, d. Promote a screen and treat approach, e. Ensure an affordable supply of quality assured, high performance screening tests and treatment devices, f. Strengthen laboratory capacity and quality assurance programmes)
5. Invasive cancer treatment and palliative care.
Timely assessment and referral of women with suspected or confirmed cervical cancer are crucial for saving lives and preventing disability. Comprehensive management of invasive cervical cancer requires well-equipped, appropriately qualified health providers and access to pathology, medical imaging, surgical, radiotherapy and chemotherapy services.
Management of each case is based on adequate staging of the disease. Early stage cervical cancer is highly treatable by surgery and/or radiotherapy, which can result in long-term survival and/or cure. The five year survival rate for early stage cancer is more than 80% in countries where timely diagnosis and high-quality treatment are available. Surgery and radiotherapy, with or without chemotherapy, are among the cost-effective interventions that WHO recommends for early stage cervical cancer. Even some locally advanced cervical cancers are curable with high-quality concurrent chemoradiation. Palliative care should be integrated into the treatment plan and provided throughout the course of the disease. Currently, very few low- and middle-income countries have palliative care programmes in place. Countries are encouraged to expand the availability of palliative care services, which could readily be extended to other forms of advanced cancers and to non-malignant debilitating disease. Common treatment-related effects experienced by long-term cervical cancer survivors that affect quality of life include bladder dysfunction, bowel dysfunction, sexual dysfunction, lymphoedema and psychosocial problems. Lack of social support, most importantly from spouses, has the greatest adverse impact on quality of life of women cancer survivors in sub-Saharan Africa. In addition to managing pain and other distressing symptoms, care should encompass psychosocial and spiritual support for women and their families.
Together, we are reminding that everyone can contribute, every community matters, and every country can eliminate cervical cancer
Selfless commitments to give back!
November 17, 2022 G.C