Cervical Cancer: the Solutions

Graphic courtesy of the World Health Organization

The means to prevent and treat cervical cancer are effective and affordable, and with sufficient political and financial support, scaleable to levels that can end this disease for all time.

In 2020, the World Health Organization launched its Global Strategy to Accelerate the Elimination of Cervical Cancer as a Public Health Problem, built on three primary pillars:

Elimination Pillar 1: Vaccinate 90% of girls against human papillomavirus (HPV) by age 15

Elimination Pillar 2: Screen 70% of women at ages 35 and 45 for precancerous cervical lesions

Adult women need to be screened regularly, no matter where they live. More widespread implementation of HPV DNA tests can improve the accuracy of screening in low-resource settings as the technology becomes more affordable. Further, such tests can be performed on samples gathered by women in the privacy of their own homes. New innovations, such as Automated Visual Evaluation (AVE) to detect cervical cancer through a photograph using machine learning, have the potential to bring cutting-edge screening to even the most challenging environments.

Elimination Pillar 3: Ensure that 90% of women in need receive treatment for cervical disease.

The World Health Organization recommends same-day screening and treatment to reduce the risk that women in need of treatment will not receive it. Wider uptake of thermal ablation in low-resource settings will let health workers remove lesions safely and quickly without the need for large gas canisters required for alternate treatment tools; the battery-powered thermal ablation devices are easily moved.

Women with more advanced lesions, or lesions entering the endocervix, need better access to Loop Electrosurgical Excision Procedure (LEEP) and other treatments, which are usually only located in district or regional hospitals.

Meeting these three goals will only be achievable through collaborative integration with other women's health services and innovation to add more effective cervical cancer interventions to enhance providers' ability to provide appropriate care:

Create essential pathways to cancer care.

Integrate cervical cancer prevention services into HIV/AIDS and reproductive health programs.

Women living with HIV develop cervical cancer at 6 times the rate of HIV-negative women, so it’s critical to screen them regularly and treat them for precancerous lesions. It only makes sense that large HIV programs, which spend billions to identify women living with HIV and get them into treatment, don’t let them die of a completely preventable disease.

It is also important to integrate cervical cancer prevention and reproductive health services. Treating women’s health holistically makes sense, and it makes sense to screen for cervical cancer during family planning services. We’ve also learned that cervical cancer prevention has an impact on keeping child mortality rates low, since healthy mothers are more likely to raise healthy children.

Support research toward and approval of more effective diagnostic and treatment tools.

The effective tools we already have can make a big difference, but research is needed both to develop faster, better, less expensive tools as well as to find the best ways to integrate them into health service offerings. Additional research is needed to make HPV vaccines as effective as possible – both scientifically and programmatically. Cheaper HPV DNA tests and screening technologies utilizing artificial intelligence need to be scaled up. Finally, approval for the use of new thermal ablation devices and lower-cost, easier-to-use LEEP machines needs to be fast-tracked so allow rapid implementation in the field.

Cervical Cancer: the Solutions

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