Cervical cancer is the fourth most common cancer in women globally, yet because it most often results from specific strains of the human papillomavirus (HPV) for which a vaccine is now available, it is becoming largely preventable. Addressing a call from World Health Organization (WHO) to eliminate cervical cancer as a public health problem, a team of researchers led by cancer epidemiologist Karen Canfell, DPhil, investigated whether it would be possible to wipe out this disease worldwide by the end of the century. In this interview with i3 Health, Dr. Canfell, Director of Cancer Research at the Cancer Council NSW and Adjunct Professor at the University of Sydney, Australia, discusses the study's results and ramifications.
What led you to research the potential for eliminating cervical cancer by the end of the century?
Karen Canfell, DPhil: I've been involved in cervical cancer research for many years. Our team has been closely involved over the years in supporting policy makers in different countries in their efforts to understand the potential impact and costs of a variety of decisions in cervical cancer control, including the role of HPV vaccines, the impact of HPV vaccination on cervical screening, and the role of HPV DNA testing as a primary screening approach for cervical cancer. In 2012, we set up a collaborative project with the International Agency for Research on Cancer with the specific aim of projecting global cervical cancer incidence rates and burden of disease if vaccination and cervical screening could be massively scaled up in all countries, particularly in low- and middle-income countries. As the project matured, two immensely talented Research Fellows in our team, Dr. Kate Simms and Dr. Julia Steinberg, took the lead on implementing the impact modeling and statistical trends analysis components of the work, respectively, and several other team members made major contributions over many years. When the Director-General of WHO announced a call to action for the elimination of cervical cancer last year, we felt that our research would be very informative in the planning of this endeavor. We are now working with other leading modeling groups to support strategic planning towards elimination.
Could you share your perspective on the significance of the study's findings?
Dr. Canfell: Our findings represent the first estimates of the timeline to global cervical cancer elimination. The study presents predictions at an individual country level so that each country can assess the potential impact of successful delivery of combined high-coverage screening and vaccination programs. When we aggregated our individual country results to categories of countries defined by the Human Development Index (HDI), we were able to project average outcomes for low-, middle-, high-, and very high-level HDI country categories. We showed that on average, all country categories could potentially eliminate cervical cancer by the end of the century. We also showed that most but not all individual countries would achieve elimination by the end of the century if the elimination threshold is <4 per 100,000 women.
Your study mentioned a draft global strategy to accelerate cervical cancer elimination to be considered at the World Health Assembly in 2020. Are the measures being proposed adequate to put us on course to eliminate cervical cancer by 2099?
Dr. Canfell: The challenge is immense, but with the right support, global elimination is within reach. This is why the WHO call to action is so critical: achieving elimination will require massive coordination and partnerships between governments, aid agencies, public and private entities, and civil society.
Do you have any additional thoughts you'd like to share?
Dr. Canfell: These findings are a timely opportunity to reinforce the message that HPV vaccines and cervical screening, taken together, are critical to achieving elimination of cervical cancer as a public health problem. It is very important to work to overcome unfounded fears about vaccine safety: literally millions of lives will be saved if HPV vaccines can be delivered effectively. We estimated that in the next half century, up to 13 million or more cervical cancers could be prevented if combined high-coverage vaccination and screening could be achieved. It is also important to note that HPV causes a proportion of the cancers at other anogenital sites and at sites in the head and neck in both women and men, so effective scale-up of HPV vaccines will prevent many other cases of cancer in men and women.
For More Information
Simms KT, Steinberg J, Caruana M, et al (2019). 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. [Epub ahead of print] DOI:10.1016/S1470-2045(18)30836-2
Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily represent the views of i3 Health.