4 steps to eliminate cervical cancer

Cervical cancer is the fourth leading cause of cancer-related death among women worldwide. Every year, 530,000 new cases are diagnosed, resulting in approximately 270,000 deaths worldwide. Without any intervention, it is estimated that by 2050, the number of patients diagnosed with cervical cancer will increase by one million per year, of which about 90% in developing countries.

So what is being done to minimize cervical cancer deaths? Here are the four major advances of the past year in preventing cervical cancer

Women now have more options for cervical cancer screening: the HPV DNA test to detect high-risk HPV infection; cervical cytology, also called Pap smear or test; and co-test.

Cervical cancer is caused by the human papillomavirus (HPV), and the new HPV DNA test detects the presence of HPV. This test was found to be more effective in detecting cervical cancer before progression and reduces the frequency of screening 26 times with smear 10-fold with the HPV test. Before widespread knowledge of the HPV test as a primary screening method, HPV testing was only performed on patients whose smear specimens were abnormal. The Pap smear has been used as a primary screening method for over 75 years and only detects about 55% of cervical cancer cases.

In 2018, the US Task Force on Prevention Services (USPSTF) released a co-test recommendation, using the Pap smear and the HPV test as a reference. There is consensus that co-testing is slightly more effective than using the HPV DNA test. However, some researchers believe that the co-test does not improve the test's effectiveness; In addition, the procedures and costs badociated with co-screening remain high, placing a financial burden on the health system.

By the end of 2018, a new test for cervical cancer, the epigenetic-based test, was also introduced. Research shows that this test outperforms both smear tests and hHPV tests. Currently, cervical smears only detect a quarter of cervical cancers and the HPV test detects only about half of them. The test based on epigenetics is to examine the chemicals located above the DNA, thus forming its "epigenetic profile". In a study conducted at Queen Mary University in London, all cancers were detected in the group of women participating in the study. The test predicted the development of cervical cancer up to five years in advance and can detect high-grade cervical cancer in its infancy. The introduction of this test will advance the prevention of cervical cancer by identifying the most at-risk individuals, detecting early-stage cervical cancer and reducing the number of screenings. In addition, it is profitable.

A stand-alone approach to cervical cancer screening may prove to be another cervical cancer prevention intervention by increasing screening rates in hard-to-reach women. This self-administered smear has been extensively tested in countries such as New Zealand, India, Uganda and the Netherlands, and has been shown to be effective in increasing screening rates. . It is thought that this approach, if widely implemented, will improve the access of under-screened women, such as low-income women with limited access to medical care. A study conducted by the UK's Jo's Cervical Cancer Trust shows that 72% of survivors of badual violence will not be screened for cervical cancer because of trauma. Screening for cervical cancer is an intimate and invasive process that can trigger memories of badual abuse or abuse among those who have been victimized. Thus, the possibility for women to self-administer could be used more and more.

Vaccination against HPV badociated with cervical cancer screening could allow for the elimination of cervical cancer. Twenty countries have already initiated anti-HPV vaccination in boys and the introduction of gender-neutral vaccination in countries such as Australia has shown that HPV vaccine in boys can provide a collective immunity, protecting boys and girls during the transmission of HPV strains. Countries such as the United Kingdom (Wales has announced HPV vaccination without distinction of bad) and Ireland are now following in the footsteps of Australia by pledging to introduce HPV vaccine to adolescents from 2019.

HPV does not stop at 26 years old. Canada and Australia are two countries where the use of the HPV vaccine is also approved in women aged 9 to 45 years. In 2018, US regulators expanded the use of the vaccine Gardasil 9, Merck's vaccine against cervical cancer, to adults under 45 years of age. Gardasil 9 protects against nine strains of HPV, including 16 and 18, responsible for most HPV-related cancers.

The prospect of eliminating cervical cancer is promising, especially in middle and high income countries. The application of these advances must be pbaded on to the rest of the world, especially low- and middle-income countries, so that we can truly eliminate the disease. For example, the widespread implementation of Pap smears in developed countries has been attributed to the significant decline in cervical cancer rates, while in low- and middle-income countries it has been difficult to carry out tests. Papanicolaou for reasons such as lack of inadequate infrastructure, shortage of qualified pathologists and multiple visits to the clinic. The introduction of the HPV test and the self-administered screening test could increase screening rates in low- and middle-income countries as they address some of the current challenges in screening.

These advances in preventing cervical cancer offer the prospect of eliminating cervical cancer in the next 10 to 15 years. By 2019, artificial intelligence (AI) and technology will be used more to advance the prevention and treatment of cervical cancer to help countries with limited resources. eliminate cervical cancer.

• Written with the contribution of Sakirat Makanjuola-Akinola, general practitioner

The opinions expressed in this article are binding only on the author and not the World Economic Forum.