Today, Monday 20 January marks the start of Cervical Cancer Prevention Week – an annual event established by Jo’s Cervical Cancer Trust.
Cervical cancer accounts for 6.6% of all female cancers . Internationally, it is the fourth most common cancer in women; however, the majority of the burden is in low- and middle-income countries where it is the second most common cancer . Although 93% of all cervical cancers are preventable, it remains the fourth leading cause of cancer death in women worldwide [3, 4]. This article will explore primary and secondary prevention measures that, if adequately implemented, could significantly reduce the burden of cervical cancer.
Primary prevention: Human papillomavirus vaccination
Cervical cancer is caused by human papillomavirus (HPV), a virus that is accountable for 5% of cancers worldwide. At least 14 cancer-causing strains of HPV have been identified; however, 70% of cervical cancers are caused by HPV types 16 and 18 [5, 6]. In 2006, a vaccine by the name of Gardasil, which offers protection against four types of HPV (including types 16 and 18), was developed .
In September 2008, the UK established an HPV vaccination programme, which offers the vaccine to girls aged 12–13 years . It was thought if national coverage reached a minimum of 80% that sufficient herd immunity could be generated to additionally protect girls who had not been vaccinated and boys . Real-world evidence has shown a significant reduction in the high-risk strains of HPV in the population and of precancerous lesions in girls and women, demonstrating the capability of the vaccine to reduce the burden of cervical cancer if coverage is maintained .
In 2018, the Joint Committee on Vaccination and Immunisation decided to roll out the vaccine to boys. This was a result of evidence showing that the HPV vaccine would help protect boys against a number of HPV-related cancers and conditions, including head and neck cancers, penile cancer and anal cancer, and genital warts . The update was implemented by the NHS in 2019 and will also strengthen herd protection, which will help to protect people who have not been vaccinated or who have missed doses of the vaccine .
However, it is concerning that although immunisation coverage has remained above the target threshold of 80% nationally, certain areas, such as London and the south-west of England, have failed to reach this for the last three years . The wide variation of vaccine uptake is in part due to cultural barriers and lack of knowledge, with some parents citing safety concerns and the belief that the vaccine gives permission for sexual activity . This demonstrates the ongoing importance for local authorities to not become complacent and to provide comprehensive education for both parents and children.
Secondary prevention: Cervical screening
The high mortality rate associated with cervical cancer can be attributed to failure to detect the disease early. In 1927, the Pap smear was created; this test involves the microscopic examination of cervical cells to identify any abnormal cells that may indicate the formation of precancerous lesions. However, it wasn’t until 1988 that an effective screening programme was introduced in the UK . This programme recommends that women aged 25–49 should be screened every three years, whereas those aged 50–64 should be invited for screening every five years . In 2018, the guidelines were updated so that cells of the cervix are primarily tested for HPV infection, as this has been shown to be the most accurate identifier for those at risk of developing precancerous lesions. It is estimated that if every eligible woman attended their appointment, 83% of cervical cancer cases could be prevented .
Despite this comprehensive screening programme, 2018 marked a 20-year low in coverage, with 1 in 4 eligible women not attending their appointments . Low screening attendance is due to multiple factors, including lack of knowledge of the risks of cervical cancer, poor understanding of the benefits of cervical screening, and fear. Subsequently, Public Health England launched the ‘Cervical Screening Saves Lives’ campaign in March 2019, which aims to educate and reassure women and encourage them to accept their invitation for screening . This rebranding to make cervical screening a more positive and optimistic experience may be partially responsible for the 0.5% increase in coverage in 2019 . Although this is the first time that coverage has increased in four years, the rate is still lower than that in the years preceding 2018, indicating the importance of continued awareness campaigning .
How you can help
- Raise awareness
- Use multiple types of media to share experiences and knowledge to support women who may be worried about cervical screening or uncertain about the benefits of the procedure.
- Raise awareness of the importance of the HPV vaccine in protecting children from multiple types of cancer in the future.
Get your workplace to sign up to ‘Time to Test’ so that female employees have time to attend their screening appointments. Additionally, join the #SmearForSmear campaign pioneered by Jo’s Cervical Cancer Trust to end the stigma around smear tests and HPV.
Ensure that yourself and your loved ones have had the HPV vaccine. If you are under 25 and you missed your opportunity for vaccination or did not complete the course, contact your GP surgery – you are still eligible for free vaccination.
- World Health Organization. Cervical cancer. Available at: https://www.who.int/cancer/prevention/diagnosis-screening/cervical-cancer/en/. Accessed January 2020.
- Vu M, Yu J, Awolude OA et al. Cervical cancer worldwide. Curr Probl Cancer 2018; 42 (5): 457–
- Centers for Disease Control and Prevention. Cervical cancer is preventable. Available at: https://www.cdc.gov/vitalsigns/cervical-cancer/index.html. Accessed January 2020.
- Torre LA, Islami F, Siegel RL et al. Global cancer in women: Burden and trends. Cancer Epidemiol Biomarkers Prev 2017; 26 (4): 444–457.
- World Health Organization. Human papillomavirus (HPV) and cervical cancer. Available at: https://www.who.int/en/news-room/fact-sheets/detail/human-papillomavirus-(hpv)-and-cervical-cancer. Accessed January 2020.
- National Health Service. HPV vaccine overview. Available at: https://www.nhs.uk/conditions/vaccinations/hpv-human-papillomavirus-vaccine/. Accessed January 2020.
- Public Health England. Human papillomavirus (HPV) vaccine coverage in England, 2008/09 to 2013/14: A review of the full six years of the three-dose schedule. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/774074/HPV_Vaccine_Coverage_in_England_200809_to_201314.pdf. Accessed January 2020.
- BBC News. HPV vaccine: Thousands of girls did not get full dose. Available at: https://www.bbc.co.uk/news/uk-england-46953452. Accessed January 2020.
- Drolet M, Bénard É, Pérez N et al. Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: Updated systematic review and meta-analysis. Lancet 2019; 394 (10197): 497–
- Jo’s Cervical Cancer Trust. The HPV vaccine for boys and men. Available at: https://www.jostrust.org.uk/information/hpv-vaccine/boys-and-men. Accessed January 2020.
- Public Health England. Human papillomavirus (HPV) vaccination coverage in adolescent females in England: 2018/19. Report for England. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/851797/HPV_annual_coverage_report_2018_to_2019.pdf. Accessed January 2020.
- Albrow R, Kitchener H, Gupta N et al. Cervical screening in England: The past, present, and future. Cancer Cytopathol 2012; 120 (2): 87–
- Public Health England. Cervical screening: Programme overview. Available at: https://www.gov.uk/guidance/cervical-screening-programme-overview. Accessed January 2020.
- Public Health England. PHE launches ‘Cervical Screening Saves Lives’ campaign. Available at: https://www.gov.uk/government/news/phe-launches-cervical-screening-saves-lives-campaign. Accessed January 2020.
- Public Health England. Cervical Screening Programme: England, 2018–19. Available at: https://files.digital.nhs.uk/56/6FF6AB/nhs-cerv-scre-prog-eng-2018-19-report.pdf. Accessed January 2020.