A systematic analysis points in the wrong direction for cervical cancer elimination – Author's reply

Abstract

In their Correspondence, Ashley Jackson raises concern about the inclusion of unsafe sex as a behavioural, potentially modifiable risk factor for cervical cancer in the Global Burden of Disease (GBD) 2019 Study1Tran KB Lang JJ Compton K et al.The global burden of cancer attributable to risk factors, 2010–19: a systematic analysis for the Global Burden of Disease Study 2019.Lancet. 2022; 400: 563-591Summary Full Text Full Text PDF PubMed Scopus (38) Google Scholar and the potential negative implications this framing could have on misdirecting policy makers towards ineffective strategies to reduce cervical cancer burden. We appreciate this feedback and the opportunity to clarify our intentions in the published analysis.1Tran KB Lang JJ Compton K et al.The global burden of cancer attributable to risk factors, 2010–19: a systematic analysis for the Global Burden of Disease Study 2019.Lancet. 2022; 400: 563-591Summary Full Text Full Text PDF PubMed Scopus (38) Google Scholar Cervical cancer is an important contributor to the global burden of cancer,2Kocarnik JM Compton K Dean FE et al.Cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life years for 29 cancer groups from 2010 to 2019: a systematic analysis for the Global Burden of Disease Study 2019.JAMA Oncol. 2022; 8: 420-444Crossref PubMed Scopus (228) Google Scholar and, as noted by Jackson, is linked to persistent infection with high-risk human papillomaviruses (HPVs) that are transmitted through sexual contact. In the GBD study, the risk factor of unsafe sex is used to quantify the risk of having sex with someone that might have an infection that can be sexually transmitted if protection is not used, and is a risk factor associated with HIV, sexually transmitted infections, and cervical cancer as outcomes.3Murray CJL Aravkin AY Zheng P et al.Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019.Lancet. 2020; 396: 1223-1249Summary Full Text Full Text PDF PubMed Scopus (2030) Google Scholar As this exposure can be challenging to estimate, 100% of cervical cancer burden is estimated to be attributable to this risk factor. The terms modifiable and potentially modifiable were used to refer to the risk factors included in this analysis in general and were meant to indicate that the risk-attributable burden of the cancers analysed could theoretically be mitigated through changes to the various risk exposures included. For cervical cancer, these mitigation efforts would include reduction in future persistent high-risk HPV infections through comprehensive prevention strategies encompassing vaccination as well as potentially safer sexual practices.4WHOGlobal strategy to accelerate the elimination of cervical cancer as a public health problem.https://www.who.int/publications/i/item/9789240014107Date: 2020Date accessed: November 2, 2022Google Scholar We agree that vaccination against HPV should be emphasised as a crucial cervical cancer prevention strategy and, in alignment with the WHO cervical cancer elimination initiative,5WHOCervical cancer elimination initiative.https://www.who.int/initiatives/cervical-cancer-elimination-initiativeDate accessed: November 2, 2022Google Scholar that evidence-based strategies towards the elimination of cervical cancer should also include screening and treatment of precancer and invasive cancer. The burden of cervical cancer weighs disproportionately in low Socio-demographic Index settings, and is most likely multifactorial in aetiology and includes disparities in access to high-quality screening and treatment.4WHOGlobal strategy to accelerate the elimination of cervical cancer as a public health problem.https://www.who.int/publications/i/item/9789240014107Date: 2020Date accessed: November 2, 2022Google Scholar I declare no competing interests. A systematic analysis points in the wrong direction for cervical cancer eliminationIn August, 2022, the GBD 2019 Cancer Risk Factors Collaborators published a systematic analysis that identified unsafe sex as the second leading risk factor for cancer in women globally.1 This finding was driven by data on cervical cancer, which is linked to persistent infection with high-risk human papillomaviruses (HPVs) that are transmitted through sexual contact. The authors concluded that reducing exposure to unsafe sex and other modifiable risk factors would reduce the global burden of cancer. Full-Text PDF