Stamping out cervical cancer is possible. This is the roadmap

Women make up almost 50% of the population in the Asia Pacific; they contribute around 36% to regional GDP and are the beating heart of every health system, comprising 70% of the healthcare workforce.

More needs to be done, however, to support the health needs of these huge contributors to individual families, communities and the economy. Their unique health challenges demand targeted strategies and gender-specific policy interventions. For instance, female cancers, including cervical cancer, continue to be a massive burden to women globally.

Cervical cancer is a global health issue and one of the most common cancers affecting women worldwide, with more than 600,000 new cases estimated in 2020 alone. As a cancer that has existing prevention strategies, the 341,831 annual global deaths from cervical cancer should be considered premature and largely avoidable.

A cervical cancer diagnosis often occurs when women are in the prime of their lives, undermining their personal wellbeing and livelihood, while broader gender equality and economic development take a hit too.

What's positive is that several countries have successfully decreased cervical cancer rates through effective HPV vaccination and screening programmes, such as Australia. However, in many Asia Pacific countries, particularly low-income countries, the HPV vaccine is not included in immunization programmes, mirroring the global challenge of vaccinating young girls – just 13% of 9-14year-olds worldwide were vaccinated against HPV in 2020.

There are also few national screening guidelines or reimbursement policies in the region, leading to low screening rates. From countries studied, Thailand has one of the highest screening rates at just over 50%.

It was only in 2020, however, that 194 countries became signatories to the World Health Organization's global strategy for cervical cancer elimination, drawing attention to the urgency of the issue.

Now, ongoing efforts within the Asia-Pacific Economic Cooperation (APEC) forum provides a path forward.

In 2021, health ministers from across the region endorsed the APEC Roadmap to Promote Sustainable Economic Advancement for Women Through Cervical Cancer Prevention & Control 2021-2025, which sets new goals and highlights globally-recognized best practices in cervical cancer prevention and management for women in APEC economies.

With unanimous endorsement and an official launch in late 2021, the roadmap is critical for APEC to address rising cervical cancer cases in member economies – work ongoing since 2013.

Such a roadmap can facilitate the integration of cervical cancer prevention and control approaches into existing health systems across economies with different resource levels, substantially impacting public health, the workforce and the broader global economy, with the ultimate goal of eliminating cervical cancer in two ways:

- Strengthening policies that centre the elimination of cervical cancer.

- Improving access to cervical cancer prevention and treatment.

To eliminate cervical cancer, governments must adopt the policy frameworks and guidelines recognized as best practices around the world. Doing so will help ensure that the "gold standards" of cervical cancer prevention, screening and treatment are implemented within their domestic health systems.

While the Asia-Pacific region has a diverse healthcare landscape, fostering best practice exchange can help different countries quickly adapt or develop guidelines according to their local needs.

Using the Access Consortium – a coalition of like-minded regulatory authorities working to accelerate approval times of medicines – as a model, a cervical cancer management consortium could likewise study regional nuances and provide tangible recommendations on policy and guidelines.

Additionally, economies with more capacity and expertise in the region could provide support through technical capacity-building and policy decision-making to address barriers to cervical cancer prevention, screening and treatment.

Effective implementation of policies and guidelines requires holistic access to cervical cancer prevention, screening and treatment.

Access has many determinants (Figures 1 and 2) and for cervical cancer prevention and control, access includes the availability and acceptability of HPV vaccines, laboratory capacity to support screening programs and workforce capabilities conducting cervical cancer screening. There are also direct and indirect costs of cervical cancer treatment to the patient, such as accommodation or travel.

Importantly, access also refers to awareness and education about cervical cancer. In some cases, HPV and cervical cancer carry stigma causing discomfort around getting vaccinated and screened. Women can often juggle roles between home and work, so access could mean not having the time to make or keep screening appointments.

Globally, multi-stakeholder campaigns can provide culturally-appropriate information and resources – e.g. providing self-sampling kits or encouraging companies to provide "health days" for screenings – making it easier and less daunting for women to seek care. Rethinking what access means, however, is a particularly challenging aspect to stamping out the disease.

Malaysia's ROSE (Removing Obstacles to Cervical Screening) Foundation is a successful example of a campaign designed for the country's needs that encourages women to get tested via self-sampling kits, helping overcome barriers such as clinic access, travel time and stigma.

The COVID-19 pandemic has impacted access to cervical cancer prevention and management, particularly vaccination and screening rates, which the cancer preparedness in the Asia Pacific report also highlighted. But there has been a positive lesson in the growing recognition that testing is important.

The resources health systems have invested in enhancing capacity could help mitigate an exponential rise in HPV and cervical cancer cases in the near future. Continuing support for prevention and screening programmes, and equitable access to vaccines and treatment could save more lives and reduce long-term healthcare costs.

The first point of call is to accelerate education and policies to stamp out cervical cancer. Countries also, however, need to map out how they will strengthen the resilience of healthcare systems to ensure services like HPV and cervical cancer vaccination, screening and treatment don't suffer again in the event of another pandemic.

This Cervical Cancer Awareness Month, we should, therefore, commit to controlling and eliminating cervical cancer by implementing, issuing and enabling sound policies, guidelines and access.