2020 promises to be a landmark year for cervical cancer and, with World Cancer Day on Feb 4, it is an apt time to reflect on the prospect of elimination. WHO has a highly ambitious plan for elimination: 90% of girls fully vaccinated by age 15 years, 70% of women screened (at ages 35 and 45 years), and 90% of patients with disease receiving care. Two Articles in The Lancet show how achieving these goals would prevent millions of deaths and eliminate cervical cancer as a public health problem in low-income and middle-income countries. They will inform a global strategy for 2020–30, which is slated for adoption at the World Health Assembly in May.
That global elimination is on the agenda at all is a testament to huge medical advances in recent decades. We now have human papillomavirus (HPV) vaccination and screening to prevent cervical cancer, and effective surgery, radiotherapy, and chemotherapy to treat it. Yet, in 2018 there were more than half a million new cases and 300 000 deaths worldwide. The reason is that the burden—including 88% of deaths—falls almost wholly on parts of sub-Saharan Africa and south Asia where there is little or no access to services. This burden is an unconscionable manifestation of health inequities.
Addressing these inequities, and so meeting the elimination goals, presents many challenges. Engagement is needed with the social, political, and economic barriers to accessing services, especially in relation to gender. HPV vaccination needs to be made accessible to all who need it, despite difficulties of supply, cost, delivery, and hesitancy. In some places, screening services need to be set up from scratch. Treatment is required for screening-positive women in countries with little access to chemotherapy or radiotherapy. Cadres of radiographers, physicists, nurses, and surgeons need to be trained. Quality palliative care is scarce.
We have the means to eliminate cervical cancer and we know the health consequences of inaction. The onus now is on governments, civil society, the private sector, and academia to overcome these challenges.
