Countries must scale up cervical cancer screening programmes if they are to reach the World Health Organization 2030 elimination target, experts say today.
Improved coverage of HPV vaccination and improve access to affordable treatment are also needed to help prevent the disease, according to the study by the International Agency for Research on Cancer (IARC) and WHO in France.
In 2020 there were more than 600,000 new cases of cervical cancer and more than 340,000 deaths worldwide.
While the past 30 years has seen a significant reduction in cases in Latin America, Asia, western Europe and North America, there remains a high burden in many low- and middle-income countries.
In 2020, the WHO set a target to eliminate cervical cancer as a public health problem and reduce incidence below a threshold of four cases per 100,000 women per year in every country by 2030.
This observational study, led by Dr Deependra Singh and published in The Lancet Global Health, examines the progress made on cervical cancer rates and identifies the countries and regions where more work is needed to reach those WHO targets.
“HPV vaccination and screening technologies mean that cervical cancer is now largely preventable,” said Dr Singh.
“Our study finds encouraging decreases in some high-income countries following successful implementation of HPV vaccination programmes and screening, such as in Sweden, Australia, and the UK, but globally the burden remains high.
“All over the world, women should be free from the risk of preventable cancer, and with development of effective vaccines and screening over the past 20 years, we have the tools to make this a reality.”
The study examined IARC’s GLOBOCAN 2020 database to estimate the burden of cervical cancer incidence and mortality rates in 185 countries. It also analysed the relationship between cervical cancer cases and deaths in relation to national levels of socioeconomic development and examined data from 1988 to 2017 to identify trends.
In 2020, rates of cervical cancer cases were 13 per 100,000 women per year and there were seven deaths per 100,000 women per year. Incidence rates in 172 out of 185 countries exceeded WHO’s four cases per 100,000 women per year threshold for elimination.
Case rates ranged from two cases in Iraq to 84 cases in Eswatini per 100,000 women per year, and mortality rates ranged from one death in Switzerland to 56 deaths in Eswatini per 100,000 women per year.
Higher rates observed in countries with lower socioeconomic development.
When the authors examined the data from 1988 to 2017, they found significant declines in cases in some Latin American countries, including Brazil, Colombia, and Costa Rica.
A similar pattern was observed in Asia in India, Thailand, and South Korea, as well as in Eastern Europe in Poland, Slovenia, and Czechia.
However, there were increases in cases in Eastern Europe, in Latvia, Lithuania, and Bulgaria, and Eastern Africa in the past decade, as well as in The Netherlands and Italy.
The authors said increased prevalence of HPV among the younger generations of women and lack of effective screening programmes might be among the reasons for the increase.
Dr Valentina Lorenzoni, Scuola Superiore Sant’Anna, Italy, said: “Cervical cancer cases are much higher than the threshold agreed by the WHO initiative on cervical cancer elimination in most countries, indicating that there is still much work to be done before 2030.
“While a decrease in screening intensity due to the Covid-19 pandemic might have left a new group of susceptible women, the pandemic also boosted the introduction of self-administered HPV testing, offering new possibilities to increase screening coverage.
“Other new advancements, such as thermal ablation for treating cervical pre-cancer, the use of mobile phones to improve follow-up after screening, and machine learning to improve visual assessment, can also be used in low resource settings to lower cervical cancer rates.”
Singh D, Vignat J, Lorenzoni V et al. Global estimates of incidence and mortality of cervical cancer in 2020: a baseline analysis of the WHO Global Cervical Cancer Elimination Initiative. The Lancet Global Health 15 December 2022
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