Today is World Cancer Day. This year’s theme is ‘Closing the care gap’ and it has prompted me to consider the gaps we see in cancer prevention. During my 40-year career in cancer and palliative care, I worked in practice, management, education and research roles, all enjoyable in different ways. There have been so many advances over that timespan in cancer treatment and care, and these could fill a book. Here, however, I focus on the elimination of cervical cancer, currently the fourth most common cancer in women.
Cervical cancer is associated with exposure to the Human Papilloma Virus (HPV), primarily types 16 and 18, which are transmitted sexually and with no symptoms. Other cancers also caused by HPV exposure include those of the head and neck, anus and vulva, and there is also some evidence of its association with prostate cancer. Normally the immune system can clear HPV infection, but vaccination helps by priming the body’s defences to recognise this pathogen. With effective vaccination programmes, it’s now possible to talk about elimination of cervical cancer. Elimination is a term used in an epidemiological sense when the incidence of a specific disease falls below a level that no longer requires public health interventions (WHO consider elimination to be reached at fewer than 4 cases per 100,000).
Elimination is not the same as eradication, a term we use for diseases that have been permanently and globally reduced to zero, such as smallpox. While Australia and Sweden are on track to reach elimination of cervical cancer by 2030, here in the UK, we have settled on 2040 as the target year. A recent report from Scotland confirmed no cases of cervical cancer in women who, since 2008, have received the HPV vaccine at the age of 12 or 13 – evidence that cancer prevention reduces mortality associated with a disease that has taken many lives in the past. Importantly though, for lower and middle income countries, or those with poor vaccination uptake or screening systems, cervical cancer remains a potent threat.
Any cancer nurse who has cared for patients with cervical cancer knows what a devastating diagnosis it can be. Despite radical surgical intervention, including total or partial pelvic exenteration, chemotherapy and radiation therapy, the prognosis for advanced disease is poor. Cervical cancers can arise in all age groups, and detection of pre-cancerous cellular changes can identify those at risk through a Pap smear. An additional benefit of HPV testing when the virus is found in cervical cells is that healthcare professionals know to pay closer attention in patient follow up. Testing for the virus in cervical cells helps makes screening more effective and helps to close the care gap by allowing for earlier treatment.
The European Cancer Organisation’s HPV Action Network aims to ensure that all countries in Europe meet the needs of citizens in terms of cervical cancer prevention through better awareness, vaccination and screening, and by ensuring that treatments are evidence-based. I have been privileged to co-chair this network since 2019 and have spoken in the European Parliament more than once on this topic, with some success: for example, by ensuring that the reduction of HPV-associated cancers was included in the European Beating Cancer Plan. Since then, the network has worked with countries in Eastern Europe to improve access to HPV vaccination and screening. More recently, I attended the launch of the HPV Protect project in the Romanian Parliament. Here, I witnessed the announcement that the vaccine would be made available to boys as well as girls through gender-neutral vaccination, and to young adults up to the age of 25 through a catch-up programme. Interventions to improve HPV vaccination uptake need to work for young people.
My message here is a positive one. The gap between cervical cancer incidence and mortality is closing. It may eventually disappear through vaccination, screening and effective public health messaging. But many other cancers, especially those with a much poorer prognosis, such as pancreatic cancer, lag behind. We must demand equal attention is given to these cancers to close the care gap even further.
Cervical cancer is associated with exposure to the Human Papilloma Virus (HPV), primarily types 16 and 18, which are transmitted sexually and with no symptoms. Other cancers also caused by HPV exposure include those of the head and neck, anus and vulva, and there is also some evidence of its association with prostate cancer. Normally the immune system can clear HPV infection, but vaccination helps by priming the body’s defences to recognise this pathogen. With effective vaccination programmes, it’s now possible to talk about elimination of cervical cancer. Elimination is a term used in an epidemiological sense when the incidence of a specific disease falls below a level that no longer requires public health interventions (WHO consider elimination to be reached at fewer than 4 cases per 100,000).
Elimination is not the same as eradication, a term we use for diseases that have been permanently and globally reduced to zero, such as smallpox. While Australia and Sweden are on track to reach elimination of cervical cancer by 2030, here in the UK, we have settled on 2040 as the target year. A recent report from Scotland confirmed no cases of cervical cancer in women who, since 2008, have received the HPV vaccine at the age of 12 or 13 – evidence that cancer prevention reduces mortality associated with a disease that has taken many lives in the past. Importantly though, for lower and middle income countries, or those with poor vaccination uptake or screening systems, cervical cancer remains a potent threat.
Any cancer nurse who has cared for patients with cervical cancer knows what a devastating diagnosis it can be. Despite radical surgical intervention, including total or partial pelvic exenteration, chemotherapy and radiation therapy, the prognosis for advanced disease is poor. Cervical cancers can arise in all age groups, and detection of pre-cancerous cellular changes can identify those at risk through a Pap smear. An additional benefit of HPV testing when the virus is found in cervical cells is that healthcare professionals know to pay closer attention in patient follow up. Testing for the virus in cervical cells helps makes screening more effective and helps to close the care gap by allowing for earlier treatment.
The European Cancer Organisation’s HPV Action Network aims to ensure that all countries in Europe meet the needs of citizens in terms of cervical cancer prevention through better awareness, vaccination and screening, and by ensuring that treatments are evidence-based. I have been privileged to co-chair this network since 2019 and have spoken in the European Parliament more than once on this topic, with some success: for example, by ensuring that the reduction of HPV-associated cancers was included in the European Beating Cancer Plan. Since then, the network has worked with countries in Eastern Europe to improve access to HPV vaccination and screening. More recently, I attended the launch of the HPV Protect project in the Romanian Parliament. Here, I witnessed the announcement that the vaccine would be made available to boys as well as girls through gender-neutral vaccination, and to young adults up to the age of 25 through a catch-up programme. Interventions to improve HPV vaccination uptake need to work for young people.
My message here is a positive one. The gap between cervical cancer incidence and mortality is closing. It may eventually disappear through vaccination, screening and effective public health messaging. But many other cancers, especially those with a much poorer prognosis, such as pancreatic cancer, lag behind. We must demand equal attention is given to these cancers to close the care gap even further.
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