A ray of good news for women in these troubled times: the world is close to eliminating a cancer for the first time. “Cervical cancer can not only be stopped; it could become the first cancer to be eliminated,” the chief of the United Nations global health agency said.
Every year, over 350,000 women die from cervical cancer and another 660,000 are diagnosed with the disease.
“Using existing tools, some high-income countries are already close to eliminating cervical cancer, meaning fewer than four cases per 100,000 women,” Tedros Adhanom Ghebreyesus, chief of the World Health Organization (WHO) said.
Unlike most other cancers, almost all cases and deaths can be averted. “We have powerful vaccines that can prevent infection with the human papillomavirus (HPV) that causes cervical cancer; we have diagnostics to detect it early; and we have treatments for those it strikes,” he explained.
Since many low- and middle-income countries do not have access to the necessary treatment, 94% of cervical cancer deaths occur there.
A WHO-led global strategy agreed by all its 194 member states in 2018 is already underway to eliminate this form of cancer. It calls for countries to achieve three targets by 2030: 90% of girls should be fully immunized; 70% of women should receive timely screening; and 90% of those found with precancer or cancer should get access to treatment easily.
So far, more than 60 countries have introduced the HPV vaccine into their immunization programs, bringing the total to 144 countries that are routinely protecting girls from cervical cancer in later life but the numbers must be greatly increased.
With recent scientific advances, immunization can be achieved with just a single dose. About 60 countries are now doing this with the help of GAVI, a global vaccine alliance, which is the largest provider of HPV vaccines to low- and middle-income countries.
WHO and GAVI plan to vaccinate 120 million girls between now and 2030 but require sustained financial investments and support from manufacturers to prevent supply shortages that held back progress in the past.
The impact of the rapid scale-up in vaccinating girls is not seen for decades until they become adults, when cervical cancer typically appears. So, effective screening and treatment are vital.
Decades ago, as more women gained access to pap smears in rich countries, the mortality associated with cervical cancer dropped rapidly. Today, even better high-performance HPV tests are available, which need to become accessible in poorer nations.
In Australia – which is on track to become one of the first countries in the world to achieve elimination – more than a quarter of all screening tests involve women collecting their own samples for HPV testing. Similar procedures would greatly improve screening and cut death rates in developing nations.
Several countries are also investigating the use of artificial intelligence to improve the accuracy of screening in poorer settings. When women are found with precancerous lesions, many are now treated with portable battery-powered devices that are usable in remote locations.
Tedros called for moving beyond opportunistic testing by investing in organized screening programs using the latest means for high coverage for the whole population.
Advanced cases need to be referred for surgery, radiotherapy and palliative care but women with cervical cancer often die in poor countries because the treatments used in richer countries are not available. For instance, if radiotherapy equipment is broken women have to wait in vain even as their tumors grow.
No woman should have to travel abroad in search of a cure or die waiting, when the equipment to cure her is installed in her own country but is not usable.
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