New research, led by the Daffodil Centre and published in the journal Nature Medicine, shows cervical cancer death rates in low-to-middle-income countries could be reduced by more than 63% through implementation of World Health Organisation screening guidelines.
The findings were published in two landmark papers focused respectively on screening for human papillomavirus (HPV) in the general population in 78 countries and multiple screening scenarios for women with human immunodeficiency virus (HIV), calibrated for Tanzania, where HIV infection is endemic.
The studies, to model general population and targeted screening options in low- and lower-to-middle-income countries, were conducted to support a major revision of WHO guidelines to inform the acceleration of the WHO global strategy to eliminate cervical cancer.
Their publication follows the recent announcement of a $12.5 million Australian Government grant to a consortium led by the Daffodil Centre to support the elimination of cervical cancer in the Indo-Pacific region and related developments in Vanuatu and Papua New Guinea supported by philanthropic trust the Minderoo Foundation.
A lead author of the first study, Dr Kate Simms, said HPV caused almost all cervical cancers and that a shift from Pap tests to HPV screening in low-and-middle-income countries could significantly reduce mortality rates through earlier intervention.
“Low-and lower-middle-income countries bear most of the world’s cervical cancer burden, so demonstrating the effectiveness of HPV-based screening compared with other approaches is crucial to advocacy to support the WHO strategy and guidelines,” Dr Simms said.
“We found that primary HPV screening was the most clinically effective and cost-effective, reducing mortality by 63-67% when offered every five years.”
Lead author of the second study, Dr Michaela Hall, said women with HIV had a sixfold risk of developing cervical cancer compared with the general population and that co-existing HIV and HPV infection were more prevalent in low-to-middle-income countries.
“We modelled several scenarios in relation to outcomes in Tanzania, which has one of the world’s highest HIV infection rates, and found that primary HPV testing with triage compared with no screening would reduce cervical cancer mortality by up to 71%,” Dr Hall said.
“This equated to saving a life for every 38 women screened and referred for pre-cancer treatment – an extremely strong result in relation to the benefits of cancer screening.”
Both studies were based on a screening participation rate of 70%, a target which is one of the three pillars of the WHO global cervical cancer elimination strategy.
Daffodil Centre Director Professor Karen Canfell, who led modelling analysis that informed the WHO strategy and is senior author on both studies, said the findings should add to the momentum driving the elimination of cervical cancer in low-to-middle-income countries.
“In Australia, we’re on track to be the first country in the world to eliminate cervical cancer, by 2035, but in many countries it is a leading cause of cancer death – and causes huge inequities and impacts on entire communities,” Professor Canfell said.
“Yet it is the only cancer that can be eliminated, using technology that’s already well-established and available, if there is sufficient funding and community support.”
Professor Canfell said the $8.64 million Eliminating Cervical Cancer in the Western Pacific (ECCWP) project, funded by the Minderoo Foundation, was showing what could be achieved in low-to-middle-income countries by supporting the WHO triple strategy.
“By leveraging in-country partners and Australian technical expertise, ECCWP has set Vanuatu on a path to be the first low-to-middle-income country in the world to eliminate cervical cancer – while PNG is also taking important steps towards the elimination goal.
“The Australian Government’s $12.5 million dollar grant to fund the parallel EPICC [Elimination Partnership in the Indo-Pacific for Cervical Cancer] will further expand this approach, informed by the evidence.
“These two major new studies, notably in the prestigious Nature Medicine journal, strengthen the evidence base for action to guide and expand this work and accelerate the elimination of cervical cancer worldwide.”
