The World Health Organization (WHO) has declared Cervical cancer awareness in January. The month of January has been for the past years designated as the cervical cancer month. According to WHO, Cervical cancer is the fourth most common cancer in women globally, with around 660,000 new cases and around 350,000 deaths in 2022.
The highest rates of cervical cancer incidence and mortality are in low- and middle-income countries. This reflects significant inequities driven by a lack of access to national HPV vaccination, cervical screening and treatment services, and social and economic determinants. Cervical cancer is caused by persistent infection with the human papillomavirus (HPV).
WHO report reveals that Women living with HIV are 6 times more likely to develop cervical cancer compared to women without HIV.
Prophylactic vaccination against HPV and screening and treatment of pre-cancer lesions are effective strategies to prevent cervical cancer and are very cost-effective.
Cervical cancer can be cured if diagnosed at an early stage and treated promptly.
Countries around the world are working to accelerate the elimination of cervical cancer in the coming decades, with an agreed set of three targets to be met by 2030.
According to WHO, Human papillomavirus (HPV) is a common sexually transmitted infection which can affect the skin, genital area and throat.
Almost all sexually active people will be infected at some point in their lives, usually without symptoms. In most cases the immune system clears HPV from the body. Persistent infection with high-risk HPV can cause abnormal cells to develop, which go on to become cancer.
Persistent HPV infection of the cervix (the lower part of the uterus or womb, which opens into the vagina – also called the birth canal) if left untreated, causes 95% of cervical cancers.
Typically, it takes 15–20 years for abnormal cells to become cancer, but in women with weakened immune systems, such as untreated HIV, this process can be faster and take 5–10 years.
Risk factors for cancer progression include the grade of echogenicity of the HPV type, immune status, the presence of other sexually transmitted infections, number of births, young age at first pregnancy, hormonal contraceptive use, and smoking.
Boosting public awareness and access to information and services are key to prevention and control across the life course.
Being vaccinated at age 9–14 years is a highly effective way to prevent HPV infection, cervical cancer, and other HPV-related cancers.
Screening from the age of 30 (25 years in women living with HIV) can detect cervical disease, which when treated, also prevents cervical cancer.
At any age with symptoms or concerns, early detection followed by prompt quality treatment can cure cervical cancer.
As of 2023, there are 6 HPV vaccines available globally. All protect against the high-risk HPV types 16 and 18, which cause most cervical cancers and are safe and effective in preventing HPV infection and cervical cancer.
As a priority, HPV vaccines should be given to all girls aged 9–14 years, before they become sexually active.
The vaccine may be given in one or two doses. People with reduced immune systems should ideally receive two or three doses.
Some countries have also chosen to vaccinate boys further to reduce the prevalence of HPV in the community and to prevent cancers in men caused by HPV.
Women should be screened for cervical cancer every 5–10 years, starting at age 30. Women living with HIV should be screened every 3 years beginning at age 25.
The global strategy encourages a minimum of two-lifetime screens, including a high-performance HPV test by age 35 and again by age 45.
Pre-cancers rarely cause symptoms, which is why regular cervical cancer screening is essential, even if you have been vaccinated against HPV.
Self-collection of a sample for HPV testing may be a preferred choice for women and is as reliable as samples collected by healthcare providers.
After a positive HPV test (or other screening method), a healthcare provider can look for changes on the cervix (such as pre-cancers), which may develop into cervical cancer if left untreated.
Treatment of pre-cancer is a simple procedure and prevents cervical cancer. Treatment may be offered in the same visit (the see and treat approach) or after a second test (the see, triage, and treat approach), which is especially recommended for women living with HIV.
Treatments of pre-cancers are quick and generally painless, causing infrequent complications.
Treatment steps include colposcopy or visual inspection of the cervix to locate and assess the lesion, followed by thermal ablation, which involves using a heated probe to burn off cells; cry therapy, which consists in using a cold probe to freeze off the cells; LEETZ (large loop excision of the transformation zone), which involves removing your abnormal tissues with an electrically heated loop; and/or a cone biopsy, which consists in using a knife to remove a cone-shaped wedge of tissue.
Cervical cancer can be cured if diagnosed and treated at an early stage of disease. Recognizing symptoms and seeking medical advice to address concerns is critical.
Women should see a healthcare professional if they notice: unusual bleeding between periods, after menopause, or after sexual intercourse, increased or foul-smelling vaginal discharge symptoms like persistent pain in the back, legs, or pelvis, weight loss, fatigue, and loss of appetite, vaginal discomfort, swelling in the legs.
Clinical evaluations and tests to confirm a diagnosis are important and will generally be followed by referral for treatment services, which can include surgery, radiotherapy, chemotherapy, and palliative care to provide supportive care and pain management.
Management pathways for invasive cancer care are important tools for ensuring that patients are referred promptly and supported as they navigate the steps to diagnosis and treatment decisions.
Features of quality care include a multidisciplinary team ensuring diagnosis and staging (histological testing, pathology, imaging) take place prior to treatment decisions; treatment decisions in line with national guidelines; and interventions supported by holistic psychological, spiritual, physical, and palliative care.
As low- and middle-income countries scale up cervical screening, more cases of invasive cervical cancer will be detected, especially in previously unscreened populations. Therefore, referral and cancer management strategies need to be implemented and expanded alongside prevention services.
All countries have committed to eliminating cervical cancer as a public health problem.
The WHO Global strategy defines elimination as reducing the number of new cases annually to 4 or fewer per 100,000 women and sets three targets to be achieved by 2030 to put all countries on the pathway to elimination in the coming decades: 90% of girls vaccinated with the HPV vaccine by age 170% of women screened with a high-quality test by ages 35 and 45 90% of women with cervical disease receiving treatment.
Modeling estimates that a cumulative 74 million new cases of cervical cancer can be averted, and 62 million deaths can be avoided by 2120 by reaching this elimination goal.
Explore the cervical cancer knowledge repository for resources from WHO, UN agencies, and other partners: the cervical cancer elimination initiative.