President-Elect, Mirza I. Rahman, MD, MPH, FACPM
Cervical cancer is the fourth most common cancer among women globally, with an estimated 604,000 new cases and 342,000 deaths in 2020, per the WHO. About 90% of the new cases and deaths worldwide in 2020 occurred in low- and middle-income countries. In the U.S., according to the American Cancer Society (ACS), it is expected that there will be about 14,000 new cases of cervical cancer and about 4,300 deaths will occur from this disease this year.
January is cervical health awareness month, and it is a time to raise awareness about cervical cancer – namely HPV disease, the importance of getting vaccinated against HPV, screened for HPV infection, and screened for cervical cancer. While just 4% of all healthcare research and development is focused on women's health issues, and women remain under-represented in nearly all clinical trials, preventing cervical cancer is one area where improving women’s health should not be so difficult.
It has been 95 years since Dr. George Papanicolaou discovered in 1928 that he could determine the differences between normal and malignant cervical cells by viewing samples under a microscope. The pap smear is inexpensive, simple to perform, and remains the most widespread screening tool for cervical cancer. Additionally, more than 30 years have passed since the first studies using HPV testing began in clinical settings, and currently, it is used in both primary cervical cancer screening and abnormal pap management.
Yet cervical cancer screening is underutilized in the U.S., with about 20% of eligible women still not getting screened appropriately, per Healthy People 2030. Moreover, in many low- and middle-income countries, women often lack access to any type of screening tests against cervical cancer.
With respect to vaccines, the HPV vaccine protects against the types of HPV that most often cause cervical cancers. HPV vaccination is recommended for preteens aged 11 to 12 years, but can be given starting at age 9, and it is also recommended for everyone through age 26 years, if they are not vaccinated already. According to the ACS, while cervical cancer incidence rates were already declining in the US because of screening, the HPV vaccine accelerated this progress. Among women ages 20 to 24, cervical cancer incidence rates declined by a total of 33% from 2005-2012 and by 65% from 2012 through 2019.
In essence, HPV vaccination has the potential to virtually eliminate cervical cancer, but there are great disparities in the proportion of people who are vaccinated across the country and globally. We can and must do better as a country and globally!
In 2020, all WHO Member States endorsed the Global Strategy towards the Elimination of Cervical Cancer at the World Health Assembly - the first elimination strategy for a cancer in WHO’s history. The WHO’s strategy outlines three measurable global targets to prevent and treat cervical cancer:
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By 2030, 90% of girls should be fully vaccinated with HPV vaccine by 15 years of age;
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70% of women should be screened using a high-performance test by age 35, and again by age 45;
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90% of those identified with cervical disease should receive appropriate treatment.
This is an area where the ACPM and Preventive Medicine specialists can actively engage in, to further this laudable goal. There is much that the ACPM and its members can do, to collaborate with the WHO to increase awareness, disseminate, use, and scale-up of these recommendations to try and improve equity, increase access to services, and improve the health of women, and play a significant role in eliminating cervical cancer in countries around the world. Let’s get started!