Abstract
In 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.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 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.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 This conclusion points global health professionals in the wrong direction for the elimination of cervical cancer. HPV infection is extremely common worldwide. Interventions designed to influence sexual behaviour are not proven to affect cervical cancer incidence. By describing unsafe sex as a cervical cancer risk factor to be addressed through public health programming, the authors risk distracting from evidence-based approaches to eliminate cervical cancer. In August, 2020, the World Health Assembly adopted the Global Strategy for cervical cancer elimination, which includes three evidence-based pillars: HPV vaccination, screening, and treatment of precancer and cancer. Cervical cancer elimination is possible within the next century, but not through sexual behaviour change. I declare no competing interests. A systematic analysis points in the wrong direction for cervical cancer elimination – Author's replyIn 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 Study1 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.1 Full-Text PDF
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