Screening as well as vaccination is essential in the fight against cervical cancer
An estimated one million-plus women worldwide are currently living with cervical cancer. Many have no access to health services for prevention, curative treatment or palliative care. Cervical cancer is a consequence of a long-term infection with human papillomavirus (HPV), and the majority of cervical cancer cases (>80%) occur in low- and middle-income countries.
A safe and effective HPV vaccine exists, which when provided to young girls between 9 and 13 years old protects against HPV, and therefore against cervical cancer. This vaccination has been rolled out in many high-income countries but progress is slower in low- and middle-income countries because of resource constraints. As a member of the Global Vaccine Alliance (Gavi), WHO is working to increase access to the vaccine for girls in Gavi-eligible countries, with the aim of vaccinating over 30 million girls in more than 40 countries by 2020.
WHO’s new guidelines, published in 2014, recommend a vaccine schedule of 2 doses of the HPV vaccine for girls aged between 9 and 13 years old.
Although HPV vaccination for girls reduces the possibility of developing cervical cancer later in life, this approach does not eliminate the need for regular screening later in life. Firstly, the vaccines do not protect against all high risk HPV types. Secondly, if vaccination coverage is low, non-vaccinated girls continue to be at risk as will other women who did not have the opportunity to be vaccinated. To tackle cervical cancer effectively, screening programmes have a vital role in cervical cancer prevention allowing for early detection and treatment.
Cervical cancer screening is testing for pre-cancerous lesions and cancer among women who may have no symptoms and feel perfectly healthy. When screening detects pre-cancerous lesions, these can easily be treated and cancer avoided. Screening can also detect cancer at an early stage, enabling women to receive treatment which is highly effective.
Because pre-cancerous lesions take many years to develop, screening followed by adequate treatment is recommended for every woman aged 30 every 5 to 10 years if the screening test is negative and depending on the screening test used. WHO also recommends that countries ensure that women from 30 to 49 years are screened at least once in their lifetime.
Inequitable access to screening and treatment
Cervical cancer mortality rates have fallen in much of the developed world during the past 30 years, largely due to screening and treatment programmes. During the same time, however, rates in most developing countries have risen or remain unchanged, often due to limited access to health services, lack of awareness and absence of screening and treatment programmes. Rural and poorer women living in low- and middle-income countries, as well as poorer women living in high-income countries are at an increased risk of invasive cervical cancer, because they often do not have access to crucial prevention, screening and treatment services.
We have the technical knowledge to prevent hundreds of thousands of unnecessary deaths of women worldwide. What is needed now is the strengthening of health systems to enable them to implement what we know and give women and girls access to the services they need to stay alive.