Anvita Guttikonda, Alliance Academy for Innovation, Cumming, Georgia, USA
In 2018, the World Health Organization (WHO) set a goal to eradicate cervical cancer, which is the fourth most common cancer in women. In 2018 alone, around 570,000 women contracted the disease worldwide and about 311,000 of those patients passed away (WHO, 2021). With the objective that “no woman should die from cervical cancer”, WHO partnered with multiple organizations and launched a global health strategy to expunge this public health problem. This strategy outlines three targets: vaccination, testing, and treatment protocols (AACC, 2020).
Targets to Carry Out by 2030:
"90% of girls should be fully vaccinated with the HPV vaccine by the age of 15.
Using a high-performance test, 70% of women should be screened by the age of 35 and again at 45.
90% of women should be pre-cancer and invasive cancer treated” (WHO, 2021).
Cervical cancer can only develop in women – specifically in their cervix (located in the lower part of the uterus) (Mayo Clinic, 2021). Around 99% of cases are associated with a high-risk infection of human papillomaviruses (HPV). HPV is a virus that spreads rapidly through sexual contact. Because of the virus, healthy cells develop mutations in their DNA and begin to grow uncontrollably rather than progress through the normal cell cycle. The cancerous cells then invade nearby tissues and accumulate, creating abnormal masses called tumors. Symptoms of this disease include light vaginal bleeding after or between the menstrual cycle, persistent pelvic pain, and increased discharge (Mayo Clinic, 2021). The causes of cervical cancer are not completely known, but scientists have found that HPV plays a vital role. Other factors, such as living conditions and lifestyle choices, influence the development of cervical cancer as well (Mayo Clinic, 2021).
This disease comes in many forms: “the main types of cervical cancer are squamous cell carcinoma and adenocarcinoma”, which are both associated with the HPV virus (American Cancer Society, 2020). Identifying the specific form of cancer is essential to determining the patient’s prognosis and remedy. Squamous cell carcinoma is a rare form of cervical cancer that develops in the epithelium lining of squamous cells. The second type, adenocarcinoma, begins in mucus-producing glandular cells that line the cervical canal (Mayo Clinic, 2021).
However, even with its high mortality and prevalence, cervical cancer is considered the most treatable cancer. With primary and secondary prevention approaches, such as HPV vaccinations and routine PAP tests, precancerous conditions in the cervix can be detected and treated immediately in order to substantially decrease the cancer’s mortality rate. The HPV vaccine is used to reduce the risk of infection that leads to cervical cancer. It is made using a protein from the HPV virus that grows to resemble the virus, but, importantly, does not contain the illness/disease. Routine PAP tests can also help detect precancerous conditions in the cervix to treat any abnormalities immediately (WHO, 2021).
Figure 1: This map visualizes the availability of the HPV vaccine across the globe (WHO, 2014).
HPV vaccinations have been a common practice in many high-income countries, which have resulted in dramatic decreases in HPV infection and cervical diseases (PubMed, 2017). In the United States alone, 49% of adolescents received the HPV vaccine (CDC, 2018). Other developed countries, such as Russia and Australia, started increasing their momentum in vaccination introduction and availability as well (US National Library of Medicine Institutes of Health, 2013).
In low to middle-income countries, many obstacles, including cultural, political, and health systems, have exacerbated the vaccine distribution problem. The greatest death and contraction rates have been found largely in Swaziland and other low-income African countries (World Cancer Research Fund and American Institute for Cancer Research, 2021). In areas where school attendance is already irregular, encouraging girls to be fully vaccinated for HPV, which requires three doses, poses an immense challenge. Furthermore, the lack of routine screenings and treatments has increased the death toll in these countries. In an effort to handle cervical cancer and other communicable diseases, 26 low and middle-income countries participated in piloting activities to test their delivery and roll-out strategies (US National Library of Medicine Institutes of Health, 2013). Through these programs, unintentional barriers can be avoided, and vaccination plans can be set in place.
Hundreds of thousands of lives can be saved with greater prevention approaches and treatments for precancerous lesions. Increasing human and financial support, such as bringing vaccinations to low-income areas and expanding the availability of screenings and PAP tests, are necessary to containing and eliminating cervical cancer once and for all.
References
Aranda, S., Berkley, S., Cowal, S., Dybul, M., Evans, T., Iversen, K., Moeti, M., Osotimehin, B., Peterson, S., Piot, P., Purandare, C. N., Sidibé, M., Trimble, T., & Tsu, V. D. (2017, July). Ending cervical cancer: A call to action. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. https://pubmed.ncbi.nlm.nih.gov/28691327/.
Centers for Disease Control and Prevention. (2018, August 23). More US adolescents up to date on HPV vaccination. Centers for Disease Control and Prevention. https://www.cdc.gov/media/releases/2018/p0823-HPV-vaccination.html.
Cervical cancer (hpv cancer; cancer of the cervix): Myvmc. HealthEngine Blog. (2002, August 10). https://healthengine.com.au/info/cervical-cancer-squamous-cell-carcinoma-of-the-cervix#:~:text=the%20Cervix)%20Treated%3F-,What%20is%20Cervical%20Cancer%20(Squamous%20Cell%20Carcinoma%20of%20the%20Cervix,top%20part%20of%20the%20vagina.
Cervical cancer statistics: World cancer Research Fund International. WCRF International. (2021, May 25). https://www.wcrf.org/dietandcancer/cervical-cancer-statistics/.
A global strategy to eliminate cervical cancer. AACC. (2020, December 17). https://www.aacc.org/cln/cln-stat/2020/december/17/a-global-strategy-to-eliminate-cervical-cancer#:~:text=A%20global%20initiative%20by%20the,by%2045%20years%20of%20age.
Maine, D., Hurlburt, S., & Greeson, D. (2011, September). Cervical cancer prevention in the 21st century: Cost is not the only issue. American journal of public health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3154220/.
Mayo Foundation for Medical Education and Research. (2021, June 17). Cervical cancer. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/cervical-cancer/symptoms-causes/syc-20352501.
Sherris, J., Herdman, C., & Elias, C. (2001, October). Cervical cancer in the developing world. The Western journal of medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071564/.
Stephan, G. (n.d.). Cervical cancer elimination initiative. World Health Organization. https://www.who.int/initiatives/cervical-cancer-elimination-initiative.
Torgovnik, J. (n.d.). Cervical cancer. World Health Organization. https://www.who.int/health-topics/cervical-cancer#tab=tab_2.
What is cervical cancer?: Types of cervical cancer. American Cancer Society. (2020, July 30). https://www.cancer.org/cancer/cervical-cancer/about/what-is-cervical-cancer.html.
WHO HPV Map. World Health Organization. (n.d.). https://www.who.int/reproductivehealth/topics/cancers/HPV-map.jpg.
Wigle, J., Coast, E., & Watson-Jones, D. (2013, August 20). Human papillomavirus (hpv) vaccine implementation in low and middle-income countries (lmics): Health system experiences and prospects. Vaccine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3763375/.
World Health Organization. (2021, July 6). Reaching 2030 cervical cancer ELIMINATION targets - new WHO recommendations for screening and treatment of cervical pre-cancer. World Health Organization. https://www.who.int/news-room/events/detail/2021/07/06/default-calendar/reaching-2030-cervical-cancer-elimination-targets#:~:text=By%202030%2C%2090%25%20of%20girls,disease%20should%20receive%20appropriate%20treatment.
Article Thumbnail: Scientific Animations. (2018, January 30). File:HPV causing cervical cancer.jpg. Wikimedia Commons. https://commons.wikimedia.org/w/index.php?curid=65969733