New Studies Point to Efficacy of WHO Three-Part Strategy to End Cervical Cancer

The World Health Organization (WHO) has called for immediate action to eliminate cervical cancer as a public health problem, and 2 studies published in The Lancet have developed models to examine what could happen were the WHO to commit to a 3-part strategy to end the disease.

The WHO Cervical Cancer Elimination Modelling Consortium (CCEMC) consists of 3 independent transmission-dynamic models of potential reductions in cervical cancer over time in 78 lower-middle-income countries (LMIC) over standardized base-case scenarios: girls-only vaccination; girls-only vaccination and once-lifetime screening; and girls-only vaccination and twice-lifetime screenings.¹

“Elimination of cervical cancer as a global health issue is within reach for all countries. We know what works, and we know how to prevent and control this disease. This new approach will unite us and help to focus the world’s efforts on protecting the well-being of women and girls,” said Princess Nono Simelela, MD, assistant director of the General for Family, Women’s and Children’s Health at WHO.²

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The projections follow a target, known as 90-70-90, that aims to put all countries on the pathway to complete cervical cancer elimination by 2030. The 90-70-90 method includes the following³:

• 90% of girls fully vaccinated with human papillomavirus (HPV) vaccine by 15 years of age.
• 70% of women screened using a high-performance test, by 35 and 45 years of age.
• 90% of women identified with cervical disease are treated, including 90% of women with pre-cancer treated and 90% of women with invasive cancer managed.

According to the initial WHO report, interventions to meet the 3 targets must be implemented simultaneously and at scale for maximum impact. Achieving this 90-70-90 target by 2030 would mean that the median cervical cancer incidence rate would fall by 10%, 70%, and 90% by 2030, 2045, and 2150, respectively.³

The studies published in The Lancet examine a model based off of the 90-70-90 projection. The first study examined the outcomes should girls aged 9 years be vaccinated, with a catch-up to 14 years of age. The model assumed 90% coverage and 100% lifetime protection against HPV types 16, 19, 31, 33, 52, and 58. Cervical screening involved HPV testing once or twice per lifetime for patients aged 35 years and 45 years.¹

Researchers found that vaccination implementation could reduce the rate of cervical cancer by 89% over the next 100 years, and screening twice in a lifetime could reduce 97% of deaths over the same length of time.^1,4

Cervical cancer is among the most common causes of death for women and nearly 90% of deaths from cervical cancer each year are women living in low- and middle-income countries. It is also among the most preventable and treatable forms of cancer, but requires a comprehensive national strategy with HPV vaccination, screening, and treatment of pre-cancerous lesions, as well as effective management of invasive cancer, according to the WHO.²

The authors of the second study noted that successful implementation of the WHO elimination strategy would reduce cervical cancer mortality by nearly 99% and save the lives of more than 62 million women over the next century.⁴

The researchers concluded that predictions were consistent across the 3 models and suggest that high HPV vaccination coverage can lead to cervical cancer elimination in most LMICs by the end of the century. Furthermore, they explained that screening with high uptake will expedite reductions and will be necessary to eliminate cervical cancer in countries with the highest burden.¹

Additionally, the authors noted that the findings emphasize the importance of immediate action to scale up vaccination, screening, and treatment for pre-invasive and invasive cervical cancer.¹

References

• Canfell, K, Kim, J, Brisson, M, et al. Mortality Impact of Achieving WHO Cervical Cancer Elimination Targets: a Comparative Modeling Analysis in 78 Low-Income and Lower-Middle-Income Countries. The Lancet. Jan 30, 2020. DOI:https://doi.org/10.1016/S0140-6736(20)30157-4. Accessed February 10, 2020.
• WHO Leads the Way Towards the Elimination of Cervical Cancer as a Public Health Concern. WHO website. Published September 2018. https://www.who.int/reproductivehealth/cervical-cancer-public-health-concern/en/. Accessed February 10, 2020.
• Global Strategy Towards Eliminating Cervical Cancer as a Public Health Problem. WHO website. Published December 16, 2019. https://www.who.int/docs/default-source/cervical-cancer/cerv-cancer-elimn-strategy-16dec-12pm.pdf. Accessed February 10, 2020.
• Brisson, M, Kim, J, Canfell, K et al. Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries. The Lancet. Jan 30, 2020. DOI:https://doi.org/10.1016/S0140-6736(20)30068- Accessed February 10, 2020.