World Health Organization Outlines Plan to Eliminate Cervical Cancer in Low to Middle Income Countries

February 5, 2020

The World Health Organization has announced a vaccination-based initiative to eliminate cervical cancer as a public health problem in low to middle income countries.

The World Health Organization (WHO) has announced its plans for eliminating cervical cancer as a public health problem among low-income to middle-income countries by fully vaccinating 90% of girls by 15 years old, screen 70% of women between the ages of 35 and 45 and provide 90% of patients with disease receiving care. The organization believes not only will this eliminate cervical cancer in these regions within this century, but also prevent millions of deaths, according to two modeling analyses published in The Lancet.

“Cervical cancer is the second most frequent cancer among women in low-income and lower-middle-income countries (LMICs),” the researchers behind the plan said. “Without further intervention, these inequalities in the burden of cervical cancer are expected to grow, because recent increases in the uptake of human papillomavirus (HPV) vaccination and cervical cancer screening have mainly occurred in high-income countries.”

According to researchers, less than 30% of low to middle income countries have introduced the HPV vaccination that is standard in over 85% of high-income countries. Screening rates show a similar disparity as only 20% of women in low to middle income countries compared to 60% of women that have been screened in high-income countries. In 2018, there was an estimated 570,000 cases of cervical cancer diagnosed — 311,000 women died from the disease.

“To date, vaccine coverage in LMICs has been low overall, with an estimated 3% of the primary targeted population of young girls in less developed regions vaccinated by 2014. By 2016, only 14% of LMICs had established vaccination programs,” explained researchers.

Utilizing data from the WHO Cervical Cancer Elimination Modelling Consortium, researchers looked at three dynamic models: girls-only vaccination, girls-only vaccination and once-lifetime screening, and girls-only vaccination and twice-lifetime screening rates. They also looked at three models of HPV infection, cervical carcinogenesis, screening, and precancer and invasive cancer treatment to determine both the impact of achieving the WHO’s plan on HPV vaccination and cervical cancer screening and its effects on mortality rates.

In 2020, the estimated mortality rate of patients with cervical cancer across all countries identified as low to middle income countries was thirteen to two per 100,000 women. Researchers then projected that if this status quo continued, then by 2030 there would only be a 0-1% reduction in deaths due to cervical cancer.

However, when researchers accounted for the WHO’s plan that included more than just HPV vaccinations, researchers predicted they would avert 300,000 to 400,000 deaths in 2030 and reduce the mortality rate to zero to two women per 100,000 women with cervical cancer.

Moreover, researchers believed that in regions that adopted girls-only vaccination plans, cervical cancer could be eliminated altogether by 2059 to 2102. When accounting for twice-lifetime screening, the elimination period was accelerated by 11-31 years in all regions.

“If this global elimination strategy of combined intensive scale-up of HPV vaccination and cervical screening can be achieved, our results suggest that cervical cancer elimination could be achieved in all countries by 2100,” explained the researchers. “In doing so, cervical cancer incidence would be reduced by 97% and more than 74 million cases would be averted over the next century.”