Timely screening and vaccination once or twice in a woman's lifetime can help avert 74 million cases and 62 million cervical cancer deaths over the next century, and reduce deaths by a third by 2030, two new studies published in The Lancet have predicted.
The studies quantify, for the first time, how many cervical cancer cases could be averted and how many women's lives could be saved in 78 low-income and lower-middle-income countries (LMICs), if proposed measures -- proposed in the WHO's draft strategy towards eliminating cervical cancer -- are implemented.
A research paper published in The Lancet Global Health in December last year said that India recorded the highest estimated number of cervical cancer deaths in 2018 -- 97,000 cases and 60,000 deaths.
"For the first time, we've estimated how many new cases of cervical cancer could be averted if WHO's triple intervention strategy is rolled out and when elimination could be achieved," said Professor Marc Brisson from Laval University, Canada, who co-led both the new studies.
"Results suggest that to eliminate cervical cancer by the end of the century, it will be necessary to achieve both high HPV vaccination coverage and high uptake of screening, especially in countries with the highest rates of the disease," Brisson said.
The first study modelled the progress that could be made towards eliminating new cervical cancer cases by introducing or increasing HPV vaccination coverage, or by combining high levels of vaccination with cervical screening once, or twice, in a woman's lifetime.
The second study included cancer treatment in its models alongside other variables and analysed the impact of vaccination, screening and treatment on reducing deaths.
The authors, however, caution that this can only be achieved with considerable international financial and political commitment, in order to scale up vaccination, cervical screening and cancer treatment
The first of the current studies focused on whether and by when it might be feasible to eliminate cervical cancer cases in low-income and lower-middle-income countries according to different scenarios and different definitions of elimination.
The scenarios modelled were HPV vaccination of girls, vaccination combined with a screening of women aged 35, and vaccination combined with screening twice in a woman's lifetime.
The results predict that vaccination alone could reduce the number of cervical cancer cases by 89 per cent over the next century, averting 60 million cases in LMICs.
However, countries with an incidence today of more than 25 cases per 100,000 women could not eliminate the disease with HPV vaccination alone, using WHO's proposed threshold of cervical cancer elimination (four or fewer cases per 100,000 women).
For the second modelling study, the authors analysed the impact of all three elements of the WHO triple strategy on deaths from cervical cancer, modelling the impact of scaling up cancer treatment as well as vaccination and screening.
In 2020, there will be an estimated 13 deaths from cervical cancer per 100,000 women in LMICs. By 2030, the triple strategy could avert around 300,000 deaths, a reduction of 34 per cent.
"By 2070, it could avert 14.6 million deaths, reducing mortality by 92 per cent, compared to a reduction of 62 per cent (4.8 million deaths) with vaccination alone. By 2120, the triple strategy could avert 62 million deaths, reducing mortality by 99 per cent, compared to 90 per cent (45.8 million deaths) with vaccination alone," said the study.
According to Karen Canfell from Cancer Council NSW and the University of Sydney, Australia, "in just 10 years, it's possible to reduce deaths from the disease by a third and, over the next century, more than 60 million women's lives could be saved. This would represent an enormous gain in terms of both quality of life and lives saved".
The findings are set to be presented at the WHO Executive Board at its next meeting from February 3-8.