Global Cancer Conundrum: 604,000 Cases Forecasted

The Cervical Cancer Epidemic: A Global Health Crisis

The World Health Organization estimates that globally, cervical cancer is the fifth most commonly diagnosed cancer in women, with 604,000 new cases projected in 2024. This staggering figure underscores the gravity of the situation, as cervical cancer remains the leading cause of cancer death in women in 26 countries, primarily in sub-Saharan Africa and parts of South and Central America, Melanesia, and South-East Asia.

The disparities in access to vaccination, screening, and treatment services are stark, reflecting broader social and economic determinants, including gender inequality and poverty. Women living with HIV are six times more likely to develop cervical cancer compared to the general population, and an estimated 5% of all cervical cancer cases are attributable to HIV.

The culprit behind this epidemic is human papillomavirus (HPV), a common sexually transmitted infection that can affect the skin, genital area, anal area, and throat. While the immune system typically clears the virus, persistent infection with certain carcinogenic types of HPV can cause abnormal cells that may develop into cancer.

The cervix is the most commonly affected site, with persistent HPV infection leading to precancerous lesions that can progress to cervical cancer if left untreated. The process can take up to 15-20 years, but in women with weakened immune systems, such as those living with HIV, the timeline can be significantly shortened to 5-10 years.

Factors that increase the risk of cancer progression include the grade of oncogenicity of the HPV type, immune status, the presence of other sexually transmitted infections, number of births, young age at first pregnancy, hormonal contraceptive use, and smoking.

Boosting public awareness, strengthening health literacy, and improving access to information and services are crucial to prevention and control across the life course. The World Health Organization has licensed eight HPV vaccines, five of which have received pre-qualification and are available globally. All these vaccines protect against high-risk HPV types 16 and 18, which cause approximately 76% of cervical cancers.

Girls should receive HPV vaccination between 9 and 14 years of age, when the immune response is stronger and they have not yet been exposed to the virus. Individuals with compromised immune systems, including those living with HIV, should ideally receive two or three doses.

Other important strategies for preventing HPV infection and reducing the risk of cervical cancer include:

• Women should be screened for cervical cancer with a high-performance test every 5-10 years starting at age 30. Women living with HIV should be screened every 3-5 years, starting at age 25.
• Self-collection of a sample for HPV testing, which may be a preferred choice for women, has been shown to be as reliable as samples collected by healthcare providers.
• Treatment of precancerous lesions is usually quick and may involve limited discomfort compared to other medical procedures.

Cervical cancer can be cured if diagnosed and treated at an early stage of disease. Recognizing symptoms and seeking medical advice to address any concerns is a critical step. Women should consult a healthcare professional if they notice:

• Abnormal bleeding or discharge
• Pelvic pain or pressure
• Unusual vaginal discharge or bleeding

Clinical evaluations and diagnostic tests are essential for confirming cervical cancer. These are generally followed by referral for treatment services, which can include surgery, radiotherapy, and chemotherapy, as well as palliative care to provide supportive care and pain management.

Management pathways for invasive cancer care are important tools to ensure that a patient is referred promptly and supported as they navigate the steps to diagnosis and treatment decisions. Features of quality care include:

• Timely referral and diagnostic testing
• Multidisciplinary care team
• Access to treatment services and palliative care
• Ongoing follow-up and monitoring

As low- and middle-income countries scale-up cervical screening, more cases of invasive cervical cancer will be detected, especially in previously unscreened populations. Therefore, referral and cancer management strategies need to be implemented and expanded alongside prevention services.

All countries have made a commitment to eliminate cervical cancer as a public health problem. The World Health Organization's Global strategy defines elimination as reducing the number of new cases annually to 4 or fewer cases per 100,000 women and sets three targets to be achieved by the year 2030 to put all countries on the pathway to elimination in the coming decades.

Modelling estimates that achieving the elimination goal could avert 74 million new cases of cervical cancer and prevent 62 million deaths by 2120, with additional analyses highlighting the impact among women living with HIV.

Prevention of HPV-associated precancer and cancer is also a key element of the World Health Organization's Global health sector strategy on HIV, hepatitis, and sexually transmitted infections 2022-2030, and the World Health Assembly resolution WHA74.5 (2021) on oral health includes actions on mouth and throat cancers.

17 November is observed as World Cervical Cancer Elimination Day to strengthen global efforts to prevent and treat cervical cancer. The day highlights the importance of HPV vaccination, screening, and treatment, with a focus on supporting women and girls. It encourages countries, the World Health Organization, and partners to collaborate, expand services, and track progress, building on the Global Strategy to eliminate cervical cancer.