Women's Health

Cervical cancer is a major global health challenge, disproportionally affecting women in low-income countries and poor women within countries – a disparity all the more unacceptable as it is a preventable disease.

The measures that we know work are contributing to dramatic decreases in the incidence of cervical cancer in high-income countries, but these measures are currently not reaching the regions with the highest burden of disease and thus the greatest need for these services. Cervical cancer was responsible for 342 000 deaths in 2020, the majority of which were women living in poverty, those living in lower-income countries, and women living with HIV. The highest incidence of cervical cancer and associated mortality is found in Africa, with mortality rates in some countries up to 18 times higher than in other regions.

Pillar 2 of the WHO global strategy for cervical cancer elimination calls for at least 70% of women to be screened for cervical cancer using a high-performance HPV test by the time they are 35 years old and again by age 45. Women who are HIV positive should be screened more often due to their higher risk for disease. The current generation of adult women have already been exposed to high-risk HPV strains, so prophylactic HPV vaccination will not benefit them. Despite this strong imperative for screening, just 44% of women in low- and middle-income countries have ever been screened for cervical cancer, compared with screening rates of more than 60% in high-income countries. Screening directly supports the target 30% reduction in mortality by 2030: lives will be saved by combining intensive screening and HPV vaccination prevention programmes, enabling countries with the highest burden of cervical cancer to feasibly achieve the elimination threshold.

Newer, high-performance HPV tests, coupled with self-collection, are amenable to community-based care models that have continued despite pandemic measures. This is supported by a body of evidence showing that self-collection of samples for HPV testing is equally effective in terms of the quality of the sampling compared with healthcare provider collection of samples. Furthermore, studies of women’s preferences have shown that self-collection is both acceptable and indeed preferrable to pelvic examinations conducted by a healthcare provider. This additional choice for women adds flexibility to the design of cervical cancer screening programmes, increasing health service resilience and permitting, where necessary, targeted approaches based on risk – in line with the WHO guidance for screening, which differentiates for example the screening interval for the general population versus women living with HIV.

The COVID-19 pandemic increased the readiness of policymakers and service providers to accelerate the uptake of more convenient HPV screening tools, and leapfrog older methodologies. In addition, many low- and middle-income countries have invested in COVID-19 testing platforms, which also support high-performance HPV testing.

Our cervical cancer strategy supports countries to realize the pillar 2 screening target of the WHO global strategy to eliminate cervical cancer as a public health problem. It achieves this by mobilizing the rapid adoption of HPV-based cervical screening and increasing the understanding of women-centred screening models in low- and middle-income countries, embedded in communities and integrated into primary healthcare services.

Working with partners we will:

• Support community-led approaches to advocacy, education and demand generation for high-performance HPV tools, to help scale up screening
• Accelerate the adoption of women-centric technology
• Increase access to affordable screening tests