HPV causes 15% of cancers worldwide and 7% of cancers in Europe. But experts and patient advocates believe Europe could dramatically reduce the number of women affected by cervical cancer – a disease caused by human papillomaviruses (HPV).
However, this will only be achieved if every country catches up with the top performing countries that are hitting key targets for prevention, detection and care. Where HPV vaccine uptake is strong, countries are already recording major declines in pre-cancers.
An online conference, Europe’s path to eliminating cervical cancer, hosted by the European Commission’s Health Policy Platform, looked at how Europe – and the world – could make history by eliminating a common cancer.
- Momentum building behind plans to cut cervical cancer deaths
- WHO strategy targets elimination of cervical cancer as a public health problem
- EU Beating Cancer Plan makes cervical cancer a priority
- Major differences across Europe in number of cases and survival rates
- HPV vaccination, cervical screening, and better treatment could crash rates of disease
In November 2020, the WHO published a Global strategy to accelerate the elimination of cervical cancer as a public health problem. Backed by governments around the world, it sets out the short-term targets needed to achieve the long-term ambition of, in effect, ending the disease.
The WHO says that by 2030, 90% of girls should be fully vaccinated with HPV vaccine by 15 years of age; 70% of women should be screened with high-precision HPV tests by the age of 35 (and again by the age of 45); and 90% of women identified as having cervical cancer should receive treatment and care.
While it would plainly be better to achieve 100% in all three categories, the current reality is that many countries – including in Europe – have a long way to go over the coming decade. In particular, countries in the Baltic and Balkan regions have the highest rates of disease and the worst survival rates for those diagnosed with cervical cancer.
To effectively end cervical cancer as a public health concern, rates of disease need to be less than 4 per 100,000 women. Today, Malta and Switzerland are the only European countries hitting the target (although Sweden and Finland are close).
A preventable cancer
Despite the scale of the challenge, there is a growing sense of optimism that progress can be achieved swiftly using existing tools and technologies.
‘Cervical cancer is the only cancer for which we have two very efficient ways of preventing disease: HPV vaccination and cervical screening,’ said Ursak Ivanus, Institute of Oncology Ljubljana & Association of Slovenia Cancer Societies. ‘I am excited that we are on our way to eliminating a cancer for the first time’
Elena Fidarova, Technical Officer at the World Health Organization (WHO), said eliminating the disease by 2120 would avert 70 million cases. However, while this time horizon may seem distant, much of the gains would be seen within a generation. If all three targets are met, there would be a 34% reduction in deaths by 2030 and a 68% reduction by 2045.
Fidarova said, globally, there are already stark differences between high-income and low-and-middle-income countries (LMIC). Access to HPV vaccination and high-performance testing is essential if this gap is to narrow while moving towards elimination. While death rates are higher in LMIC partly due to late diagnosis, access to treatment for women with early-stage cancer also varies widely.
Addressing this will require investment, she said, but it would be money well spent. WHO estimates that USD$10.5 billion would be required to help LMIC countries hit their 2030 targets. For every dollar invested, there would be a return of $3.2 by 2050 because women would continue to contribute to the workforce and the economy.
Factoring in social benefits, the return on investment is estimated to be $26 for every $1 dollar spent. These calculations cannot capture the immense benefit of children not losing a parent to a preventable disease.
Julie Torode, Director of Special Projects, Union for International Cancer Control (UICC), said this was an ‘exciting moment in time’. ‘Every government can eliminate cancer. We can consign a cancer to the history books for the first time ever. The clock is ticking towards the 2030 targets.’
The conference made clear that the scale of the task was significant, but that success would be a historic achievement. In the end, there is one good reason why Europe should eliminate cervical cancer: because we can.