By Dr Poonam Khetrapal Singh, WHO Regional Director for South-East Asia
Today, WHO and its Member States in the South-East Asia Region and across the world mark the second Cervical Cancer Elimination Day of Action. Globally, cervical cancer is the fourth most common cancer among women, with an estimated 604 000 new cases and 342 000 deaths in 2020, of which the Region accounted for 32% and 34%, respectively. Vaccination of girls against human papillomavirus (HPV), screening and treatment of pre-cancer lesions, and improved access to diagnosis and treatment of invasive cancers are critical, cost-effective measures that policy makers should urgently apply to eliminate cervical cancer as a public health problem.
Countries of the Region continue to make steady and sustained progress against cervical cancer, in line with the Region’s Flagship Priority on preventing and controlling noncommunicable diseases, as well as the 2021 Regional Implementation Framework on eliminating cervical cancer as a public health problem. Five Member States – Bhutan, Maldives, Myanmar, Sri Lanka and Thailand – have introduced nation-wide HPV vaccination, which Bangladesh, India and Timor-Leste will soon also introduce. HPV vaccination has been introduced in several provinces of Indonesia, protecting tens of millions of girls.
Almost all countries of the Region continue to carry out population-based cervical cancer screening, and several have also included cervical cancer screening in essential service or universal health coverage packages. In 2017, the Region became the first WHO region to publish a training package for health workers on cervical cancer screening and management of cervical pre-cancers. Amid the COVID-19 response, WHO has continued to carry out Regional health worker trainings in colposcopy and cervical cancer prevention. Ten of the Region’s 11 Member States provide tertiary care services for cancer diagnosis and treatment – including surgical and chemotherapy services – and nine also offer radiotherapy services.
Gaps and challenges nevertheless persist, which if unaddressed, will prevent the Region from achieving the global 90-70-90 targets: that is, by 2030, ensure that 90% of girls are fully vaccinated with HPV vaccine; that 70% of women are screened using a high-performance test by 35 years of age, and again by 45 years of age; that 90% of women identified with cervical disease or precancer are treated; and that 90% of women with invasive cancer are effectively managed.
Today, and in the months and years ahead, WHO is calling for action in several key areas to achieve the elimination target of four or less cases per 100 000 women. First, in all countries of the Region, political commitment must be strengthened, and efforts to eliminate the disease accorded the highest priority at the highest levels, mobilizing domestic, international and global financing. Second, in countries that already provide routine HPV vaccination, coverage must continue to expand, even above the 90% target. Countries which are yet to provide routine HPV vaccination should do so without delay. All countries should shift to HPV DNA testing, strengthen timely management of pre-cancer lesions, and ensure access for all to quality, appropriate and timely diagnosis and care for invasive and advanced cancers, including palliative care.
Third, efforts to eliminate cervical cancer must be better integrated with other key health services and programmes, such as for HIV/AIDS, sexual and reproductive health, family planning and cancer control. Women living with HIV are six times more likely to develop cervical cancer compared to women without HIV, and an estimated 5% of all cervical cancer cases are attributable to HIV. Fourth, national, international and global partners must continue to support national priorities and plans, prevent duplication and fragmentation, and provide adequate, predictable and sustained technical, operational and financial resources.
Delayed and/or inadequate action will cause additional morbidity and mortality. Globally, almost 90% of all cervical cancer deaths occur in low- and middle-income countries – a tragedy for most of the world’s women and girls, and yet another reminder of how global inequities adversely impact health and well-being, and sustainable social and economic development. On this Day of Action, WHO reaffirms its commitment to support all countries of the Region to eliminate cervical cancer as a public health problem, making it a disease of the past, consigned to history.