Things are looking up

No one should die from cervical cancer. Yet every year, we still see more than 600,000 women worldwide diagnosed with the disease, and over 340,000 women losing their lives. Nine in every ten of these women live in low-resource countries.

Cervical cancer is one of the most preventable types of cancer. Human papillomavirus (HPV) – a common virus transmitted through sexual contact – is the source of over 99% of cervical cancer cases.

While the majority of HPV types are low-risk, almost all sexually active people will be infected at some point in their lives, usually without symptoms.

Over the course of the last years, we’ve seen the development and roll out of powerful vaccines to stop the spread of HPV variants. Advanced, high-performance screening tests can now also accurately identify the presence of high-risk strains of HPV.

Together, these interventions mean that when identified early and managed effectively, cervical cancer is one of the most treatable forms of cancer.

Yet recent statistics show that it ranks as the second most frequent cancer among women between 15 and 44 years of age in the United Kingdom. Each year, 1,121 of the 3,791 women diagnosed with cervical cancer in this country die.

This staggering figure reveals significant gaps in education, a widespread lack of awareness and barriers to regular screening – all of which are essential for preventing the cancer through immunisation or early detection.

Recognising the opportunity to have a significant impact on outcomes, the World Health Organization (WHO) has set ambitious targets for cervical cancer elimination by 2030.

These include ensuring that 70% of women have been screened using a high-performance HPV DNA test by age 35, and again by age 45, with 90% of women with pre-cancer treated and 90% of women with invasive cancer managed.

This, along with the target of vaccinating 90% of girls against HPV by age 15, could prevent more than 62 million deaths in the next 100 years.

So, what is behind these overwhelmingly high death rates, even in regions where prevention measures are in place?

A new global survey, commissioned by Roche and conducted by GWI, involved over 8,700 people in 12 countries across Europe (France, Germany, Italy, Spain, UK) and Latin America (LATAM) (Argentina, Brazil, Chile, Colombia, Ecuador, Mexico, Peru).

It showed that half of those polled have either limited or no awareness of the important role that HPV plays in cervical cancer, with nearly one-third being unsure or unaware of the virus altogether. How can we expect individuals to protect themselves from a disease if they lack a fundamental understanding of what it is?

The data revealed that lack of awareness of HPV is a key barrier for screening. It’s interesting to note that there is a higher HPV awareness in regions with less accessible screening, such as in LATAM countries.

One reason for this could be that in regions where healthcare services are more readily available, people feel less of a need to educate themselves on risk factors, and are less motivated to pursue solutions to protect themselves.

What we do know for sure is that education and access to screening must go hand in hand to ensure that women are informed and empowered to prevent cervical cancer.

Other barriers include concerns about the procedure being painful, with on average 21% of women in LATAM and 16% of women in Europe fearful of the pain. Social and economic barriers also play a role in stopping women from being screened.

In LATAM, worries about results and trouble booking an appointment had an impact on women’s willingness to be tested. In Europe, embarrassment and reluctance to undress in front of a stranger had an impact on women’s willingness to be tested.

Other more cultural concerns such as a discomfort about discussing sexual history or sexuality with a healthcare provider were also cited as reasons why women don’t access screening.

These point to barriers beyond the technology itself. Innovative solutions to address all types of implementation barriers are needed to ensure that more women can access the screening that would prevent disease and save lives.

Self-collection is one such solution. Empowering women to take control of their health, it allows them to collect a specimen for testing themselves in private by using a simple device.

This screening method offers a means of mitigating many personal and logistical barriers such as stigma, embarrassment and difficulties in accessing clinical settings.

It offers women a screening option with privacy, reducing the embarrassment and anxiety of an intimate examination, particularly increasing access for those who may avoid these appointments for cultural reasons.

From a pathological perspective, self-collected HPV specimens can be tested with high sensitivity and specificity, similarly to a specimen collected by a healthcare provider – but in a manner that is seen by patients as convenient, swift and user-friendly.

Utilising self-collection could also meet needs associated with access to care infrastructure. Specimens collected by a healthcare provider require a table with stirrups in a private space.

Data from the survey indicates a clear regional disparity that supports this notion – respondents from Latin American countries, where healthcare services are often less accessible than in Europe, show a significantly higher interest in self-collection methods versus European respondents.

This sentiment was echoed by Latin American healthcare professionals and government workers, with 72% agreeing that self-collection is needed in their country versus 48% in Europe.

With more than 70% of respondents in the survey expressing willingness to collect their own samples if such an option were available, self-collection represents a key tool to overcome many of the barriers standing in the way of effective, widespread screening.

By facilitating easier access, self-collection can significantly enhance participation rates and ensure more women are screened in line with World Health Organization (WHO) 2030 cervical cancer elimination targets.

However, for self-collection to be effective, it is essential that the infrastructure is in place for timely and accurate sample testing and the provision of appropriate follow-up care and treatment access.

It is interesting to note that, since the pandemic, global attitudes have increasingly recognised the critical role of diagnostics in supporting public health and lowering healthcare costs – a shift reflected by the adoption of the World Health Assembly (WHA) Resolution to strengthen diagnostics capacity worldwide.

To achieve this and accelerate testing, we must leverage existing testing systems for diseases such as HIV, COVID-19 and hepatitis, as they are often already established and can be applied to HPV testing.

Enhancing workforce capacity and strengthening diagnostics capabilities is also important, as well as understanding current limitations, and taking on board learnings from existing programmes such as HIV, tuberculosis, COVID-19, viral hepatitis and other sexually transmitted infections.

To tackle cervical cancer in the UK, the NHS is spearheading a comprehensive Cervical Screening Programme, inviting all women aged 25–49 for testing.

It implements a 12-month surveillance for women who are HPV-positive, and as part of the NHS national immunisation programme, an HPV vaccine is also available free for all children.

While there are developed and impressive infrastructures in place across a number of countries in Europe, if we were to see low- and middle-income countries scale up cervical screening, more cases of invasive cervical cancer would be detected, especially in previously unscreened populations.

There is a growing need for referral and cancer management strategies to be implemented and expanded alongside prevention services.

By investing in advanced diagnostics and infrastructure, delivering increased large-scale screening capacity and early disease detection, healthcare systems are strengthened.

Eliminating cervical cancer doesn’t require the invention of a new type of vaccine, test or treatment. Those all exist. It requires advocacy, education and will to solve the implementation gaps.

We need to listen to the women being tested, the realities of how they feel about screening and seize any opportunities to improve this experience.

Maximising preventative action and the identification of early-stage cases will ultimately lead to lower treatment costs, fewer cancer cases and deaths, and improved health equity overall.

With strong infrastructure and the provision of education on the value of vaccination and screening in place, combined with the empowerment of women to take their screening into their own hands, no longer should anyone face the threat of this disease.

Joanna Sickler is Vice President, Health Policy and External Affairs, Roche Diagnostics. Go to roche.co.uk