Cervical cancer

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.

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.

Anchored in our programmatic approach, 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.