TARGETS SET BY the World Health Organisation (WHO) for reducing cervical cancer will be missed unless countries scale up screening programmes, improve coverage of HPV vaccination and improve access to affordable treatment, a study has found.
There were over 600,000 new cases of cervical cancer and over 340,000 deaths worldwide in 2020, according to an observational study published in The Lancet Global Health journal.
Cervical cancer has decreased in many world regions over the past three decades—notably in Latin America, Asia, western Europe and North America but remains unchanged in many low-income countries.
The study analysed cervical cancer cases between 1988 and 2017, finding that Ireland was among the countries that saw the largest average increases in cases in that time, at 3%.
Latvia (4%), Japan (3%), Sweden (3%), Norway (2%) and Northern Ireland (2%) also had increased incidence rates during the same period.
In 2020, the World Health Organisation (WHO) announced a target to accelerate the elimination of cervical cancer as a public health problem, aiming to reduce incidence below a threshold of four cases per 100,000 women per year in every country by 2030.
Rates of cervical cancer cases in 2020 were 13 per 100,000 women and there were seven deaths per 100,000 women per year.
Incidence rates in 172 out of 185 countries still exceed the threshold for eliminating cervical cancer set by WHO.
Launching the study, Dr Deependra Singh of International Agency for Research on Cancer (IARC), said:
“HPV vaccination and screening technologies mean that cervical cancer is now largely preventable.”
“Our study finds encouraging decreases in some high-income countries following successful implementation of HPV vaccination programmes and screening – such as in Sweden, Australia, and the UK – but globally the burden remains high.
“All over the world, women should be free from the risk of preventable cancer, and with development of effective vaccines and screening over the past 20 years, we have the tools to make this a reality.”
Countries with the largest average declines in incidence rates per year included Brazil (8%), Slovenia (7%), Kuwait (7%), and Chile (6%).
Dr Valentina Lorenzoni, who worked on the study, said, “Cervical cancer cases are much higher than the threshold agreed by the WHO initiative on cervical cancer elimination in most countries, indicating that there is still much work to be done before 2030.”
“While a decrease in screening intensity due to the COVID-19 pandemic might have left a new group of susceptible women, the pandemic also boosted the introduction of self-administered HPV testing, offering new possibilities to increase screening coverage.”
In response to the study, Dr Laura Heavey, Specialist in Public Health Medicine with the National Screening Service said that prior to the introduction of the national cervical screening programme, CervicalCheck, in 2008, cervical cancer incidence was rising in Ireland due to changes in our population.
“The National Cancer Registry of Ireland has projected that without screening we would have had an even greater increase in cervical cancer incidence (see below graphic – the blue line). However, thanks to screening Ireland has reported an overall decrease in expected cases (the orange line).”
Dr Heavey said that when the CervicalCheck programme was introduced in 2008 “there was an expected initial increase in cancer incidence due to the programme successfully detecting early-stage cancers in women before they developed symptoms”.
Since 2009 there has been a steady decrease in incidence of 2.8 % per annum. This has led to the incidence falling from 14 women to 11 women per 100,000. Through Ireland’s Cervical Cancer Elimination work, which combines HPV vaccination, screening and treatment, we are aiming to reduce this further to less than 4 per 100,000 women per year.
In September of this year, the National Cancer Registry Ireland released a report on national trends for cancer in Ireland, which can be read here.
Apology
Last week the Taoiseach apologised to Stephen Teap, who had settled his High Court action with two laboratories that examined his wife Irene’s cervical smear tests.
Irene Teap died of cervical cancer aged 35 in 2017, less than a year before the CervicalCheck scandal was revealed by campaigner Vicky Phelan, who died from cervical cancer last month at the age of 48.
Stephen Teap’s court action was settled in a rare case where two laboratories admitted a breach of their duty of care in misreading CervicalCheck smear tests.
Speaking on the steps of the High Court on Thursday, Teap said: “The blood of my wife and the incredible friends I’ve made who have passed away is on the Government’s hands and those politicians who have failed to listen.”
Micheál Martin said there was “no defence” for what happened with the CervicalCheck controversy, and offered an apology to Teap’s family.
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