Regional implementation framework for elimination of cervical cancer as a public health problem: 2021–2030
Overview
Cervical cancer continues to be a significant public health problem and a major cause of premature mortality among women, disproportionately affecting the socioeconomically disadvantaged population in low- and middle-income countries (LMICs). In the absence of implementing the known evidence-based, cost-effective interventions, the number of deaths per year is projected to reach approximately 416 000 globally in 2035. It was estimated in 2020 that 32% of incident cervical cancer cases and 34% of cervical cancer deaths in the world occurred in the 11 Member States of the WHO South-East Asia (SEA) Region. In 2020, 190 874 new cases and 116 015 deaths were estimated due to cervical cancer, which is the third commonest cancer in the Region.
Persistent infection with one of the 14 high-risk human papillomavirus (HPV) types is the necessary cause for cervical cancer. HPV16 and HPV18 are the two most oncogenic types and are responsible for 70% of cervical carcinomas reported globally. A small proportion (approximately 10%) of infections can persist for several years, progress to precancerous lesion, and, if left untreated, to invasive cancer over a 10–20-year period. Cervical cancer is a preventable disease. It is also curable if detected early and adequately treated.
Cognizant of the urgency that cervical cancer prevention deserves, Dr Tedros Adhanom Ghebreyesus, Director-General of WHO, made a call to action in May 2018 to eliminate cervical cancer.
The WHO Executive Board in February 2020 and the Seventy-third World Health Assembly in May 2020 adopted a Global Strategy to accelerate the elimination of cervical cancer as a public health problem, urging the Member States to reach the interim goals and targets by 2030 to eliminate cervical cancer as a public health problem. Globally, all countries must work together to bring down the incidence of cervical cancer to below 4 per 100 000 women-years by the end of the century.
To achieve cervical cancer elimination by the end of the century, the Strategy aims to ensure that by 2030 90% of girls are fully vaccinated with the HPV vaccine by 15 years of age; 70% of women have been screened using a high-performance test by 35 years of age and again by 45 years of age; and 90% of women identified with cervical disease are treated. These achievements will contribute to a 30% reduction of cervical cancer deaths by 2030.
The cervical cancer prevention and control strategy follows the critical public health principles of primary prevention, secondary prevention and tertiary prevention in the life-cycle approach. Primary prevention mainly refers to HPV vaccination and age-appropriate information on known risk factors such as tobacco use and safe sexual behaviour, including the age of sexual debut and condom use, which should be made readily available to bring behavioural changes. Secondary prevention involves screening and treating precancerous lesions before they advance to invasive cervical cancer. Tertiary prevention comprises stage-appropriate quality management of invasive cervical cancer to prevent deaths due to cancer, improve survival, and enhance health-related quality of life and palliative care.
