Cervical cancer may get completely eliminated by 2079, claims Lancet study

Cervical cancer could be eliminated as a public health problem in India within the next 60 years by making existing prevention programmes such as the human papillomavirus (HPV) vaccine and cervical screening more accessible, according to a Lancet study published Wednesday.

The study, led by researchers at the Cancer Council New South Wales in Australia, showed that cervical cancer could potentially be eliminated as a major public health problem in 149 out of 181 countries by 2100.

Will India be cervical cancer free?
The estimates, which are the first of their kind at a global-scale, indicate that up to 13.4 million cases of cervical cancer could be prevented within 50 years if intervention strategies are scaled-up by 2020.

The average rate of annual cases across all countries could fall to less than four cases per 100,000 women by the end of the century — which is a potential threshold for considering cervical cancer to be eliminated as a major public health problem.

For countries with medium levels of development, including India, Vietnam, and the Philippines, this could be achieved by 2070-79, according to the study published in the Lancet Oncology journal.

In high-income countries including the US, Finland, the UK, and Canada, cervical cancer is predicted to be eliminated as a public health problem within 25-40 years.

Does this mean cases of cervical cancer will drop?
No, this does not mean cervical cancer cases will decrease.

Without expanding current prevention programmes, however, the study predicts that 44.4 million cervical cancer cases would be diagnosed over the next 50 years — rising from 600,000 in 2020 to 1.3 million in 2069 due to population growth and aging.

“More than two-thirds of cases prevented would be in countries with low and medium levels of human development like India, Nigeria, and Malawi, where there has so far been limited access to HPV vaccination or cervical screening,” Canfell said.

However, rates of less than 4 cases per 100,000 would not be achieved by the end of the century in all individual countries in Africa (eg, Kenya, Tanzania, and Uganda) even if high coverage vaccination and twice lifetime cervical screening could be achieved by 2020.

What actions have been taken to eliminate this highly preventable cancer?
In May 2018, the Director General of WHO called for coordinated action globally to eliminate this highly preventable cancer.

WHO called for urgent action to scale up implementation of proven measures towards achieving the elimination of cervical cancer as a global public health problem.

These include vaccination against HPV, screening, and treatment of pre-cancer, early detection and prompt treatment of early invasive cancers and palliative care.

A draft global strategy to accelerate cervical cancer elimination, with goals and targets for the period 2020-2030, will be considered at the World Health Assembly in 2020.

“The WHO call-to-action provides an enormous opportunity to increase the level of investment in proven cervical cancer interventions in the world’s poorest countries. Failure to adopt these interventions will lead to millions of avoidable premature deaths,” said Canfell.

Deadly facts on cervical cancer
1. Cervical cancer is the fourth most common cancer in women, with an estimated 570,000 new cases diagnosed worldwide in 2018, of which around 85 per cent occur in less developed regions.

2. HPV, a group of more than 150 viruses, is responsible for the majority of cervical cancers. HPV types (16 and 18) cause 70 per cent of cervical cancers and precancerous cervical lesions worldwide.

3. More women in India die from cervical cancer than in any other country. Rural women are at higher risk of developing cervical cancer as compared to their urban counterparts.

4. The highest estimated incidence rates for cervical cancer are in sub-Saharan Africa, Melanesia, Latin America and the Caribbean, south-central Asia and south-east Asia.

5. Other epidemiological risk factors for cervical cancer are early age at marriage, multiple sexual partners, multiple pregnancies, poor genital hygiene, malnutrition, use of oral contraceptives, and lack of awareness.

How HPV infection leads to cervical cancer
Although most HPV infections clear up on their own and most pre-cancerous lesions resolve spontaneously, there is a risk for all women that HPV infection may become chronic and pre-cancerous lesions progress to invasive cervical cancer.

It takes 15 to 20 years for cervical cancer to develop in women with normal immune systems. It can take only five to 10 years in women with weakened immune systems, such as those with untreated HIV infection.

HPV vaccines can prevent cervical cancer
Proven methods are available to screen for and treat cervical pre-cancers, and broad-spectrum HPV vaccines can potentially prevent up to 84-90 per cent of cervical cancers.

Results showed that rapid vaccination scale-up to 80-100 per cent coverage globally by 2020 using a broad-spectrum HPV vaccine could prevent 6.7-7.7 million cases–but more than half of these would be averted after 2060.

If, in addition, cervical screening were scaled-up to high coverage by 2020, an additional 5.7-5.8 million cases of cervical cancer may be prevented globally in the next 50 years, and substantially speed up elimination.

How can cervical cancer be diagnosed?
If any of your screening tests (Pap test, VIA, HPV test) are found to be positive, further testing may be necessary to determine whether the changes in the cervix are cancerous.

A colposcopy may be performed and/or a small sample of tissue (biopsy) will be obtained from the cervix.

Colposcopy: A procedure in which a colposcope (a lighted, magnifying instrument) is used to check the vagina and cervix for abnormal areas.

Biopsy: If abnormal cells are found in a Pap test, the doctor may do a biopsy. A sample of tissue is cut from the cervix and viewed under a microscope by a pathologist to check for signs of cancer.

Source: https://www.indiatoday.in/health/story/cervical-cancer-elimination-by-2100-india-study-1460753-2019-02-20

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