A global initiative by the World Health Organization (WHO) outlines three targets to end cervical cancer through vaccination, testing, and treatment protocols. This includes a goal to get 70% of women screened by 2030, using a high-performance test by 35 years of age and again by 45 years of age. WHO proposes strengthening laboratory networks, quality assurance, and training and supervision programs to achieve these goals in underserved nations.
“The COVID-19 pandemic has forced us to innovate and improve access to testing services as a whole. Therefore, we should seize this opportunity to reconsider approaches for product selection for cervical cancer screening and diagnosis, so that women will be able to get screened and get diagnosed/treated where and when it suits them best,” WHO said in a statement to CLN Stat.
Global cases of cervical cancer are projected to rise from 570,000 to 700,000 between 2018 and 2030, with annual deaths increasing to 400,000 over the next 10 years. Most affected women are young, poor, and undereducated. “Many are also mothers of young children whose survival is subsequently truncated by the premature death of their mothers,” according to the report’s authors. Incidence and deaths are disproportionately high in low- and middle-income countries. The poorest countries lack access to safe and timely cancer surgery.
“The huge burden of mortality related to cervical cancer is a consequence of decades of neglect by the global health community. However, the script can be rewritten,” said WHO Assistant Director-General Princess Nothemba (Nono) Simelela in a statement. “Critical developments include the availability of prophylactic vaccines; low-cost approaches to screening and treating cervical cancer precursors; and novel approaches to surgical training.”
Through a resolution adopted at the 2020 World Health Assembly, WHO enlisted 194 countries to participate in its Global Strategy to Accelerate the Elimination of Cervical Cancer, to reduce new cases by 40% and prevent 5 million related deaths by 2050 through vaccination, screening, and treatment.
The plan includes meeting three targets by 2030:
- 90% full human papillomavirus (HPV) vaccination of girls by 15 years of age.
- 70% of women screened with a high-performance test by age 35 and again by 45.
- 90% of women identified with cervical disease receive treatment (treatment of 90% of women with pre-cancer and management of 90% of women with invasive cancer).
The 70% screening target offers an important preventive tool for women too old for the prophylactic vaccine, noted Simelela, who favors the idea of a high-precision, self-sampling HPV test that builds on testing platforms developed during the SARS-CoV-2 pandemic. “We know now that developing countries can mount a good laboratory infrastructure. Many of the tests that have been used for COVID-19 are not so different from what is needed to test for HPV infections,” she said in an interview this past summer.
Linking such platforms with self-sampling would give women more choices. They could also choose to self-sample in the clinic, affording them some privacy, she added.
WHO proposed the following activities to support countries in expanding testing services for cervical cancer screening and diagnosis:
- Develop policy and integrate cervical cancer screening and diagnosis services into national laboratory plans and policies.
- Introduce simplified testing strategies for screening and diagnosis, linked to treatment uptake.
- Create demand for screening and diagnosis services for cervical cancer, involve community partners.
- Decentralize specimen collection, leverage existing specimen referral networks such as those for HIV, tuberculosis, viral hepatitis, and other pathology services.
- Streamline procurement, training, and quality assurance across all national testing services.
- Coordinate forecasting efforts for reagents/analyzers/consumables led by national authorities and implementing partners.
- Optimize laboratory network design to leverage the existing screening and diagnosis services, for example, through site selection/optimization, leveraging use of multi-analyte nucleic acid testing analyzers, etc.
- Improve utilization of screening and diagnosis results by clinicians.
Clinical labs can better meet the needs of women by considering the operational and performance characteristics of an analyzer, according to WHO. “For example, if we are serving women in remote settings, selecting tests that can be used near to patient might be ideal,” WHO said in a statement. “But if women are presenting to busy clinical settings, selecting analyzers with high through-put per hour might be more appropriate. In any case, we are likely to have a greater impact on update/demand for screening and diagnosis if testing can be done quickly and accurately.”
The return on investment (ROI) of meeting these targets is $3.20 for every dollar invested through 2050, according to WHO’s estimates. Improving women’s health would contribute to a rise in women participating in the workforce, thus resulting in a larger ROI. Taking into account improved health on families, communities, and societies, the ROI rises to $26 returned to the economy.
“The fight against cervical cancer is also a fight for women’s rights: the unnecessary suffering caused by this preventable disease reflects the injustices that uniquely affect women’s health around the world,” said Simelela. “Together, we can make history to ensure a cervical cancer-free future.”
WHO is urging that all participating countries take necessary precautions to ensure the safe distribution and implementation of vaccination, screening, and treatment interventions during the COVID-19 pandemic.