Cervical cancer elimination: The progress made and what more needs to be done

In a world where more than 600,000 women are diagnosed with cervical cancer annually, and approximately half succumb to this preventable disease, urgent action is imperative.

Cervical cancer – which is caused by certain strains of human papillomavirus (HPV) – is the fourth most common cancer in women globally. However, with a comprehensive approach to prevention, screening and treatment, experts predict that the disease can be eliminated as a public health problem within a generation.

It has been three years since 194 countries resolved to eliminate a cancer for the first time and the World Health Organization (WHO) launched the Global Strategy to Accelerate the Elimination of Cervical Cancer.

Today, on Cervical Cancer Elimination Day of Action 2023, we reflect on some of the progress made, the challenges that persist and what can be done to move towards achieving its ambitious goals.

Eliminating cervical cancer, defined by the WHO as fewer than 4 cases per 100,000, has seen commendable strides in developed countries such as Australia, Finland and Sweden.

However, the alarming reality of the impact of cervical cancer persists elsewhere – with 90% of new cases and deaths in 2020 occurring in low- and middle-income countries. Indeed, it is the leading cause of cancer death in women in sub-Saharan Africa.

Cervical cancer is the malignancy with the largest inter-country range of variation in mortality among all cancers. Typically, with early diagnosis and access to high-quality treatment, five-year survival for early-stage cancer of more than 80% can be achieved.

Whereas Australia had a cervical cancer age-standardized (ASR) mortality rate of about 1.6 per 100,000 in 2019, the average mortality rate of the 10 countries with the highest ASR – all of which are based in Africa – is approximately 43 per 100 000 – 27 times that of Australia.

We must also remember that the ramifications of cervical cancer extend beyond its health implications, as the disease can have a profound social impact, causing discrimination and loss of body image, sexual functioning and femininity.

In addition, a recent study in Ethiopia underscored the economic toll, with 45.7% reporting a loss of income and 71% facing financial distress due to medical expenses.

Eliminating cervical cancer therefore becomes not only a health imperative but a critical driver for gender equity and women's empowerment.

The WHO proposes a comprehensive three-pronged approach of vaccination, screening and treatment along with a 90-70-90 strategy:

By achieving the 90-70-90 targets by 2030, the WHO estimates that more than 62 million cervical cancer deaths can be averted by 2120.

Despite being part of the region most affected by the prevalence, incidence and deaths from cervical cancer, several African nations have taken bold steps towards its elimination.

In 2011, Rwanda became the first African country to introduce a national HPV vaccination campaign, and the programme has consistently achieved more than 90% coverage. More than 1.2 million girls and women have been fully vaccinated with two doses.

Meanwhile, in October, Nigeria became the latest country to introduce the HPV vaccine into its routine immunization system, to reach 7.7 million girls “in the largest single round of HPV vaccinations across Africa”.

Zambia, also recognizing the burden, established a National Cervical Cancer Prevention Programme in 2006, demonstrating the importance of community mobilization and health literacy.

The screening programme started with two clinics and has since evolved to now close to 160 clinics screening almost 300,000 women annually.

But challenges persist with limited prioritization, insufficient human resources and inadequate financing hindering progress.

In Africa, just 16 countries have introduced HPV-based screening at the sub-national level, and approximately 70% of the African population lacks access to radiotherapy for treatment – with that number rising drastically to over 85% if you exclude South Africa, Egypt and Morocco.

Further action is therefore urgently needed – both in Africa and beyond. Countries across the world must prioritize cervical cancer, develop comprehensive strategies and ensure patient-centric approaches to hit global elimination targets.

The broader cancer care community, including civil society, academia, non-profit organizations and the private sector, must unite in deeper engagement and coordination to support national strategies.

Public-private collaborations are pivotal in strengthening health systems and optimizing limited resources. Greater coordination among stakeholders is therefore essential to navigate the complexities of cervical cancer control programmes efficiently.

Public-private collaborations are also critical to building and supporting health system resilience, as well as ensuring sustainable and efficient use of limited human capital and financial resources in these challenging ecosystems.

With cervical cancer still the leading cause of cancer deaths in women in 42 low- and middle-income countries worldwide, our collective responsibility is clear.

It is time for the global community to work collaboratively, ensuring that no woman succumbs to cervical cancer. However, the journey to elimination requires unwavering commitment, innovative strategies and a united front against this preventable disease.