Cervical cancer could be effectively eliminated in most countries around the world by the end of the 21st century, according to research. The HPV (human papilloma virus) vaccine, which protects against the virus that causes most cases, has dramatically reduced incidences of cervical cancer wherever uptake has been high.
There are hopes that the jab given to young girls, together with occasional HPV screening, could end the scourge of a disease that kills more than 300,000 women globally every year.
Last year the director general of the World Health Organization (WHO) called for coordinated global efforts to eliminate the disease. The research, published in the journal Lancet Oncology, shows how this could be done by scaling up vaccine coverage and screening.
If nothing happens, 600,000 women will get cervical cancer in 2020, rising to 1.3 million a year by 2069 because the population is increasing and ageing.
But the academics from Sydney, Australia, say 13.4m cases of the disease could be prevented in the next 50 years by implementing high vaccine and screening coverage in all countries.
By the end of the century, that would bring the global caseload down to less than four in 100,000 women – a level at which the cancer could be considered effectively eliminated.
At a slower level of uptake, countries with the highest levels of development would eliminate the cancer by the end of the century, but that countries with medium levels would still have 4.4 cases per 100,000 and those with low levels would have 14 cases in every 100,000, the study says.
Prof Karen Canfell from the Cancer Council New South Wales, who led the study, said: “Our research team has previously estimated that Australia is on track to eliminate cervical cancer by 2035, with rates dropping below four per 100,000 women annually within the next 20 years,” she said.
Very high-income countries, such as England, Finland, the US and Canada, would be able to eliminate it by 2055-59.“Crucially, though, achieving elimination in all countries will depend on sustaining – and hopefully improving – rates of participation in existing HPV vaccination programs and cervical screening initiatives.”
HPV vaccination programmes have run into opposition in some places, however. The virus is sexually transmitted. In some communities, families have opted out on the grounds that the only sexual partner their daughters will ever have is their husband.
Elsewhere the uptake has slumped after the release of documentary films about young girls who apparently became ill after vaccination, with chronic fatigue and pains.
In Denmark and later in Ireland, vaccination rates fell as a result. A review by the European Medicines Agency concluded in 2015 that the vaccines were not responsible for two specific syndromes in young girls with symptoms that may overlap with chronic fatigue syndrome, or ME.
Campaigns to improve take-up have had an effect in Europe, but not in Japan, which suspended “proactive” recommendation of HPV vaccination in the face of public panic – deemed psychosomatic reactions – in June 2013.
The Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine said acceptance rates dropped from over 75% to under 1%.
Heidi Larson, director of the Vaccine Confidence Project, said there were still issues around take-up of the HPV vaccine.
There have been episodes of what appear to be psychosomatic events among groups of girls around the world, such as the 600 girls in various schools across Colombia who were taken to hospital fainting, twitching and unconscious in 2014.
The effects of such episodes spread around the world. Parents look for information about the vaccine which may be arriving in their area and find negative stories.
“We thought all would go well in Armenia, but nobody came,” said Larson. “It is challenging. It takes a lot of work and a lot of engagement. Yet it is one of the best vaccines we have.”
Canfell said the safety of the HPV jab had regularly been confirmed by the Global Advisory Committee on Vaccine Safety, which advises the WHO. “As at 2017, more than 270m doses of HPV vaccines had been administered,” she said.
“Hostility and fear has potential to delay the effective implementation of lifesaving vaccines. We must be very clear about this: millions of women can be spared unnecessary, terrible suffering if HPV vaccines can be effectively deployed and scaled up globally.”
The WHO call to action is crucial, she said. “We should not forget that in some senses the journey towards cervical cancer elimination is only just beginning.
For countries categorised as having high – but not ’very high’ – and medium levels of human development, such as China, Mexico, Brazil and India, the challenges are greater because many of these countries do not yet have major initiatives to support widespread HPV vaccination and cervical screening.
“The challenge is even greater in the world’s poorest countries, which not only have had very limited access to these key innovations, but also have some of the highest rates of cervical cancer in the world.
For some countries in sub-Saharan Africa, cervical cancer is the leading cause of cancer death in women. This is a tragedy, not only for women, but also for their families and broader society.