Towards global elimination of cervical cancer in all groups of women.

Abstract

The study by Kate Simms and colleagues 1 Simms KT Steinberg J Caruana M et al. Impact of scaled up human papillomavirus vaccination and cervical screening and the potential for global elimination of cervical cancer in 181 countries, 2020–99: a modelling study. Lancet Oncol. 2019; 20: 394-407 Google Scholar inspires hope for global elimination of cervical cancer, the burden of which is now predominantly in countries with low and middle Human Development Index (HDI). 1 Simms KT Steinberg J Caruana M et al. Impact of scaled up human papillomavirus vaccination and cervical screening and the potential for global elimination of cervical cancer in 181 countries, 2020–99: a modelling study. Lancet Oncol. 2019; 20: 394-407 Google Scholar However, as the authors note, considerable disparities exist within countries with high HDI. This fact was not considered in their analysis, so findings based on average rates of cervical cancer within a country or HDI category do not imply that elimination will be achieved in all high-risk subgroups within such countries. It is concerning that elimination at a national level might not include high-risk subgroups, such as Indigenous women, who have higher cervical cancer incidence than their non-Indigenous counterparts in countries with high-quality data. 2 Moore SP Antoni S Colquhoun A et al. Cancer incidence in indigenous people in Australia, New Zealand, Canada, and the USA: a comparative population-based study. Lancet Oncol. 2015; 16: 1483-1492 Google Scholar Towards global elimination of cervical cancer in all groups of womenThe excellent study by Kate Simms and colleagues1 proposed a mathematical model to predict the future global incidence and burden of cervical cancer and suggested that successful elimination of the disease will be possible by the end of this century if two major primary prevention strategies—cervical screening and HPV vaccination programmes—are scaled-up to 80–100% coverage over the next 50 years.1 Full-Text PDF Towards global elimination of cervical cancer in all groups of women – Authors' replyOur recent study1 found that if very high global coverage of both human papillomavirus (HPV) vaccination and cervical screening is achieved from 2020, 12·5–13·4 million cervical cancer cases could be prevented globally over the next 50 years, and that even if a low threshold of four cases per 100 000 women is set, most countries could achieve elimination of cervical cancer as a public health problem by 2099. Prabhat Kumar and colleagues propose that achieving this level of coverage would be a “herculean task” for many low-income and middle-income countries. Full-Text PDF Impact of scaled up human papillomavirus vaccination and cervical screening and the potential for global elimination of cervical cancer in 181 countries, 2020–99: a modelling studyMore than 44 million women will be diagnosed with cervical cancer in the next 50 years if primary and secondary prevention programmes are not implemented in LMICs. If high coverage vaccination can be implemented quickly, a substantial effect on the burden of disease will be seen after three to four decades, but nearer-term impact will require delivery of cervical screening to older cohorts who will not benefit from HPV vaccination. Widespread coverage of both HPV vaccination and cervical screening from 2020 onwards has the potential to avert up to 12·5–13·4 million cervical cancer cases by 2069, and could achieve average cervical cancer incidence of around four per 100 000 women per year or less, for all country HDI categories, by the end of the century. Full-Text PDF