Increased HPV vaccination, screening and treatment access in the world’s poorest countries could save over 62M lives in the next 100 years
Australia has led by example and played an integral role in informing this focus on elimination of cervical cancer around the world
The World Health Organisation (WHO) is developing a plan to eliminate cervical cancer globally, and two new studies published today in Lancet estimate the potential benefits. The studies, led by Cancer Council NSW, Université Laval and Harvard University working with the World Health Organisation, have found that over 74 million cervical cancer cases and 62 million deaths could be averted over the next 100 years if 78 of the poorest countries in the world are able to rapidly scale up HPV vaccination, cervical screening and access to cancer treatment services. This follows last year’s Cancer Council NSW paper, which found that global elimination of cervical cancer is possible by the end of the century.
The two studies focus on 78 low and lower-middle income countries (LMIC) which bear the largest cervical cancer burden, located in East Asia & Pacific, Europe & Central Asia, Latin American & Caribbean, Middle East & North Africa, South Asia, and Sub-Saharan Africa. In these countries, combining vaccination of girls with twice-lifetime cervical screening and improved access to invasive cervical cancer treatment was predicted to reduce cervical cancer incidence by 97% and mortality by almost 99%, and avert over 74 million cervical cancer cases and over 62 million deaths in the next 100 years.
These figures rely on three targets being met in these countries by 2030: 90% of girls being vaccinated against HPV, 70% coverage for twice-lifetime cervical screening with HPV testing, and 90% coverage for treatment of preinvasive lesions and invasive cancer.
Adjunct Professor Karen Canfell, Director of Research at Cancer Council NSW and Adjunct Professor at the University of Sydney, who co-led both studies, said, “These results will inform the global strategy to achieve cervical cancer elimination, which is being reviewed by WHO’s Executive Board next week and which will be considered by countries at the World Health Assembly in May 2020.”
“Cervical cancer causes over 300,000 deaths worldwide each year, yet the evidence shows it could be eliminated as a public health issue.”
“Australia has been at the forefront – through being the first country in the world to establish an HPV vaccination program and the shift two years ago to a new National Cervical Screening Program based on HPV testing. It is a great example of the government and nongovernment sectors working together and has positioned Australia to take a leading role globally.
“Our goal is a cancer-free future and this study shows that it can be done, for a cancer that causes hundreds of thousands of deaths each year throughout the world.”
Previously, Cancer Council NSW researchers have found that Australia is set to be the first country to eliminate cervical cancer, by as early as 2035, through successful implementation of a combined approach to vaccination and screening. However, this is not the case elsewhere around the globe. Cervical cancer is still the fourth most common cancer in women worldwide and the leading cause of cancer death in 42 countries, including some of the world’s poorest countries, for example those in sub-Saharan Africa. In 2018, the large majority of the 570,000 new cervical cancer cases worldwide occurred in women living in LMICs.
“While Australia has one of the world’s lowest cervical cancer rates, we still have a long way to go to achieve our elimination goal – globally and in Australia,” Professor Canfell said.
“Given that over 90% of cervical cancer deaths occur in less-developed regions, these countries must be our first priority for implementation of HPV vaccination programs, high coverage cervical screening, and establishing cancer treatment services. This will help alleviate the enormous global inequities with the burden of this devastating disease.
“In Australia, we can build on our successes and further reduce cervical cancer deaths by at least 20%, by supporting the renewed screening program and reaching priority populations – particularly Aboriginal and Torres Strait Islander women and others who screen at low rates and face cultural and economic barriers to services.
“Everyone can get behind our push for a cervical cancer free future, from individuals who can engage in the screening and immunisation programs and health professionals checking their patients are up to date with screening and vaccination, to policy makers and collaborators who can drive this agenda globally.”
You Can access the studies by clicking on the titles below:
Call to Action - Towards the Elimination of Cervical Cancer in the Pacific Islands
C4 CRE team members Marion Saville, Julia Brotherton, Andrew Vallely, and Deborah Bateson met with key organisations in Suva, Fiji on 5-6 December 2019 and agreed to a Call to Action on the global target to achieve elimination of cervical cancer as a public health problem, (below), noting the current high burden of cervical cancer in the Pacific and the current lack of adequate vaccination, screening and treatment there.
L-R: Andrew Vallely, Julia Brotherton, Marion Saville, and Deborah Bateson
Meeting Delegates in Suva, Fiji on 5-6 December 2019
Call to Action – Towards the Elimination of Cervical Cancer in the Pacific Islands
Delegates from the following countries and organisations met in Suva, Fiji on 5-6 December 2019 and agreed the Call to Action below:
Delegates from Papua New Guinea, Vanuatu, Solomon Islands, Kiribati, Federated States of Micronesia, Fiji and Samoa together with representatives of the Pacific Society for Reproductive Health, Papua New Guinea Obstetrics and Gynaecology Society, Fiji Obstetrics and Gynaecology Society, Papua New Guinea Institute of Medical Research, Cervical Cancer Prevention in the Pacific, The Pacific Community (SPC), VCS Foundation, Royal Australian and New Zealand College of Obstetricians and Gynaecologists, Kirby Institute at the University of New South Wales, Family Planning Australia, Australian Cervical Cancer Foundation, Fiji Cancer Society, Fiji National University, University of Otago, National University of Samoa and Victoria University. Also present were representatives of the United Nations Population Fund and the United Nations Children’s Fund.
We agreed to the following principles:
- We support the global target to achieve elimination of cervical cancer as a public health problem, noting the current high burden of cervical cancer in the Pacific and the current lack of adequate vaccination, screening and treatment.
- In line with the World Health Organization (WHO) draft targets for 2030, in the Pacific our targets are:
- 90% of girls are fully vaccinated against human papillomavirus (HPV) by 15 years of age.
- 70% of women have had an HPV screening test between 30 – 39 years of age and a second HPV test between 40 – 49 years of age.
- 90% of women identified with cervical pre-cancer and cancer have received appropriate treatment and care
- We support the principles of equity in striving for the elimination of cervical cancer in the Pacific so that no woman or community is left behind.
- We support the principle of meaningful collaboration between Pacific Island nations in planning, procurement and knowledge sharing.
We are committed to the following actions:
- Raising awareness of cervical cancer in the Pacific and its impact on families and communities and strengthening advocacy for elimination.
- Exploring funding options including public-private partnerships for ongoing HPV vaccination in the Pacific.
- Urging Pacific Island governments to include HPV vaccination against HPV onto existing immunization schedules.
- Urging Pacific Island governments to transition to the delivery of effective cervical cancer screening with HPV testing and pre-cancer treatment services.Consideration should be given to self-collection of vaginal samples in order to facilitate scale up and acceptability.
- Urging cooperation between Pacific Island Governments to establish a treatment centre for cervical cancer, including radiotherapy, to act as a referral hub within the Pacific.
- Assisting Pacific Island governments and training agencies to develop an essential workforce for the delivery of HPV vaccination, cervical cancer screening and the management of cervical cancer.
- Assisting in establishing an adequate registry to record information about vaccination, screening and treatment for the prevention of cervical cancer; and with potential linkage to a cancer registry. This will facilitate follow-up of the young with incomplete vaccination and women through the screening pathway. It will also enable robust monitoring and evaluation of vaccination and screening program performance.
For more information, please email/call any of the following:
Professor Alec Ekeroma, HOD, Department of Obstetrics and Gynaecology, University of Otago, Wellington, New Zealand. E: firstname.lastname@example.org
Professor Marion Saville, Executive Director, VCS Foundation, Melbourne, Australia. E: email@example.com
Professor Andrew Vallely, Papua New Guinea Institute of Medical Research, Goroka; and The Kirby Institute, UNSW Sydney, Australia. E: firstname.lastname@example.org
Dr Steven Badman, Public Health Interventions Research Group, The Kirby Institute, UNSW Sydney, Australia. E: email@example.com
Clinical Associate Professor Deborah Bateson, Medical Director Family Planning NSW, Australia. E: firstname.lastname@example.org
Professor Diana Sarfati, Head of Department, Public Health, University of Otago, Wellington, New Zealand. E: email@example.com
 These two tests should be 10 years apart. Clinically validated PCR based tests should be used.
Papillomavirus Research Special Edition
This special collection consists of a series of reviews summarizing some of the key insights presented and discussed at the 32nd International Papillomavirus Conference (IPVC) and Asia-Oceania Research Organization in Genital Infection and Neoplasia (AOGIN) 2018, which was held in October 2018, in Sydney Australia. The conference was held at a pivotal moment for the International Papillomavirus Society, AOGIN and for HPV research: it came hard on the heels of the announcement by the Director-General of the World Health Organization (WHO) that cervical cancer elimination was within reach and that WHO would focus on the development of a draft strategic plan for elimination.
You can find the special edition here.