Women living in the Newly Independent States (NIS) who develop cervical or breast cancer are likely to have their cancers diagnosed much later than in other European countries, and cases are on the rise.
This is the finding of a review of population-based cervical and breast cancer statistics produced by cancer registries in the 10 countries of Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Republic of Moldova, Russian Federation, Ukraine
and Uzbekistan.
“Our results confirm that current breast and cervical cancer early detection practices in the NIS are far from optimum,” says Dr Ariana Znaor from the Cancer Surveillance Section of the International Agency for Research ln Cancer (IARC), who
led the team of researchers. “High incidence plus late diagnosis is taking its toll on the women of this region, and a radical shift is needed towards efficient rapid diagnosis of symptomatic cases, and population-based, quality-assured, human
papillomavirus (HPV)-based screening programmes. HPV vaccination is also key to prevent cervical cancer.”
Cervical cancer affects 69 000 new women each year in the WHO European Region. NIS countries have among the highest incidence rates of cervical cancer in the Region, particularly among the Central Asian countries where cervical cancer incidence ranks
second in frequency just after breast cancer. The study found that the trends in stage-specific incidence rates of cervical cancer varied across the 10 countries.
- The proportion of late stages were either stable (stage III) or increasing (stage IV) in Belarus and Ukraine.
- The proportion of cancers diagnosed at late stages (III–IV) in Armenia (63%) and the Republic of Moldova (51%) were particularly high. They can be compared with other countries in the Region, such as Czechia (37%), Norway (20.3%), and the United Kingdom of Great Britain and Northern Ireland (21%).
- Furthermore, in Armenia, Kazakhstan, Kyrgyzstan, Republic of Moldova, Russian Federation and Ukraine, the incidence of cervical cancer was 4 to 5 times the threshold incidence rate set by WHO’s Global Strategy for Cervical Cancer Elimination launched on 17 November 2020.
Breast cancer is the most frequent cancer for women in the Region, affecting 563 000 new women each year. The study found the following.
- The proportion of late stage breast cancers (stages III–IV) varied from 18% in Kazakhstan to 44% in Azerbaijan. This compares with the proportions in western Europe, such as 14.1% in 2012 in the United Kingdom and 17.3% in 2014–2016 in Czechia.
- In Azerbaijan, Georgia, Kyrgyzstan, Republic of Moldova and Uzbekistan, more than 35% of breast cancers were diagnosed at a late stage.
- In Belarus, a country where mammography screening was not at all available during the period covered by the study, less than 25% of breast cancers were diagnosed at a late stage. This set up a benchmark for countries to reach – to invest in early diagnosis before investing in costly mammography screening programs.
- The proportions of metastatic cancers exceeded 11% in 6 out of the 10 NIS countries compared to 5.6% in England and 6.6% in Czechia, showing that early diagnosis programmes are urgently needed.
The study was partly funded by WHO/Europe, the Ministry of Health Ukraine, and through an award to Dr Znaor and Dr Rizhov from the Union for International Cancer Control. In a commentary published in the journal Cancer Epidemiology in August 2021, the
study’s authors call for a radical shift in national policies on cervical cancer – away from opportunistic screening and towards HPV vaccination and population-based, quality-assured, HPV-based screening programmes. Both HPV vaccination
and efficient screening programs are urgently needed to put NIS on the path to cervical cancer elimination.
“Progress in cervical cancer prevention in these countries has been too limited in the last decade,” says Dr Marilys Corbex from WHO/Europe. “Unlike most other regions of the world, the mortality rates of cervical cancers are increasing
in many NIS, and opportunistic cytology screening – often using outdated cytology methods such as Romanowsky/Giemsa staining – remains common practice.”
WHO now recommends a shift to the HPV-DNA based test; such a shift could really make a difference in some countries. This said, improving the quality of care for women screened positive, meaning the treatment of precancerous lesion and invasive cancers,
is also highly needed to achieve any result.