Abstract

Every 2 minutes somewhere in the world a woman dies of cervical cancer a preventable disease. Cervical cancer is caused by infection with a virus the human papillomavirus, HPV . In addition the precancerous phases are detectable and treatable. It is a cancer which should be effectively prevented by vaccination to prevent infection and screening to detect the easily treatable pre-cancers. Highly safe and effective vaccines that can prevent the majority of HPV infections that cause cervical and other HPV -associated cancers are available. Tests for screening and detection and methods to treat cervical pre-cancerous lesions have been in place for decades in high income countries (HIC) and are proven to reduce cervical cancer incidence. – Combining HPV vaccination at high coverage for adolescents and high coverage of cervical screening for older women, with appropriate treatment, could eliminate cervical cancer as a public health problem. But there are big hurdles for HPV vaccines; they face virulent anti-vaccine activism, they are against a sexually transmitted infection and delivered to young adolescents, an age group unused and often refractory to any medical intervention.

However recent modelling suggests if the current coverage for HPV vaccination and screening is maintained in countries such as the UK and Australia cervical cancer could be almost eliminated by 2050. To achieve this globally, these primary and secondary interventions for prevention will need to be expanded, to include those not currently vaccinated or screened and this means women in low and middle income countries (LMIC). These are big challenges. Broad dissemination of HPV vaccines has been achieved in some low and high resource countries, but needs to be scaled up globally, to reach the majority of age eligible individuals. Strengthening of cervical cancer screening strategies in LMIC has proved hugely difficult in the past 2-3 decades and may be insuperable without economic development in the poorest regions.

Vaccination with high enough coverage could in time make cervical cancer a disease of historic interest only, this is achievable but does require international collaboration, political leadership and a collective will. Allowing women to rot to death from a preventable cancer cannot be tolerated in the 21st century.