World Cancer Day, on 4 February, aims to raise awareness of cancer and to encourage its prevention, detection and treatment. Above all, World Cancer Day aims to make the fight against cancer a global health priority. The COVID-19 pandemic has significantly affected cancer management, due to delays in screening as well as interruptions and modifications in the treatment of patients.
During the lockdown period, there were considerably fewer diagnoses than in previous years, and these delays lead to a greater increase in cervical cancer numbers. This particular disease is one of the most common causes of female cancer deaths, despite the fact that is up to 93 percent preventable.
Caused by the most common sexually transmitted disease, cervical cancer is one of the four leading malignant tumours affecting women worldwide. Each year, more than 30,000 new cervical cancer cases are diagnosed in the EU, causing more than 13,000 premature deaths while 300,000 women worldwide die from the disease annually.
This is why eliminating cervical cancer is a global movement, one for which every country and region has a responsibility to convert commitments into action, leaving no one behind. Last November, the WHO formally launched the Cervical Cancer Elimination movement, a global strategy to accelerate the elimination of cervical cancer as a public health problem. This was a historic movement, as the strategy was the first-ever global effort to accelerate the elimination of a specific cancer type.
Some specific elements proposed under this global strategy for eliminating cervical cancer are a vision of a world where cervical cancer is eliminated as a public health problem; a threshold of four per 100,000 women-years for elimination as a public health problem. The following so-called ‘90-70-90’ targets must be met by 2030 in order for countries to be on the path towards these goals.
By the age of 15, 90 percent of girls should be fully vaccinated against HPV; by the age of 35, 70 percent of women should be screened with a high-performance test and again by 45 years of age; 90 percent of women identified with cervical disease should receive treatment (90 percent of women with pre-cancer treated, and 90 percent of women with invasive cancer managed).
Looking to 2030 and beyond, policymakers - including those in the European Parliament - have an important role to play in supporting the elimination of cervical cancer in Europe and in urging Member States to embrace the opportunity behind the elimination movement, in order to translate commitments into action. These targets will not be achieved if we do not act collectively.
Europe’s Beating Cancer Plan, which is the EU’s response to these needs, fully aligns with this direction, aiming to support Member States in meeting these targets. This ambitious plan has, as major commitment, to increase the uptake of the HPV vaccination in line with the WHO Global strategy.
What’s more, during her speech at the Europe’s Beating Cancer Plan conference, European Commission President Ursula von der Leyen admitted that “a woman with cervical cancer who lives in Romania is 16 times more likely to die than a woman who lives in Italy”. This is simply not acceptable. We urgently need to tackle inequalities in access to prevention, treatment and care across Europe.
Cervical cancer is an almost completely preventable disease, but is currently one with gross inequities. Global, regional and national strategies to eliminate cervical cancer will save lives and reduce inequity. In particular, the equitable access to vaccination is critical.
Unfortunately, the availability of the HPV vaccine is inequitably distributed by geography and income. HPV vaccination has been available since 2007, and over half of WHO Member States have introduced vaccination. However, 95 percent of the 100+ million girls vaccinated between 2007 and 2017 lived in high-income countries where immunisation programmes are now routine.
In addition, maximum coverage is the key to impactful screening and early detection. At the moment, only 22 countries - mainly those classified as high income - report cervical cancer screening programmes reaching 70 percent coverage or above (the proportion of women who are screened). The five-year probability of surviving cervical cancer varies across the world, from a low of 37 percent up to 77 percent. Stronger health systems to detect, diagnose and treat cervical cancer are vital to addressing the inequity divide.
Last, a disproportionate number of cervical cancer patients die with poor access to pain relief and palliative care. Supporting equity within a country is an important consideration to eliminating cervical cancer. This includes addressing the geographic barriers to treatment and care that many rural communities face, as well as providing culturally appropriate care.
This is why national and regional strategies are required to reduce inequities, not just in Europe but also worldwide. By addressing cervical cancer, countries also address other critical issues such as poverty, gender inequality and human rights. We are all obliged to protect the women we love, who brought us life. We have no time to lose; we will do the best of our efforts in order to meet the targets of 2030.