Australia can continue to pave the way for cervical cancer elimination

On 17 November, following the close of the 73rd World Health Assembly, the World Health Organization will officially launch the Global Strategy to Accelerate the Elimination of Cervical Cancer.

The adoption of the strategy was co-led by Australia, who has a history of global leadership in cervical cancer prevention programs, technology and research. The HPV vaccine was developed at the University of Queensland by Professor Ian Frazer and the late Dr Jian Zhou, and in 2007 Australia introduced the world’s first nationwide HPV vaccination program.

Professor Frazer reflects on the progress achieved since the vaccine was first rolled out at scale:  “There is no doubt that we now have both the technology and the public health expertise to provide all girls and women with a cervical cancer free future. What we need now is the commitment from right across society to make this a reality.”

Since 2007, in Australia there has been a 92% decline in the prevalence of infections of vaccine targeted HPV types in females aged 18-35 years[1]. Pre-cancerous cervical lesions also halved in young women aged 20-24 years in Australia between 2006 and June 2017[2].

On 1 December 2017, Australia was the second country in the world to transition its successful National Cervical Screening Program from two-yearly Pap smears to five-yearly HPV tests with greater accuracy. As a result of its world-leading screening and vaccination programs, Australia is well on track to eliminate cervical cancer by 2035.

But in 2020, cervical screening rates are down across the country. The impact of the COVID-19 pandemic has been marked in Victoria in particular, says Professor Marion Saville AM, Executive Director of VCS. “At VCS Pathology, which processes around fifty per cent of all cervical screening tests in Victoria, we saw cervical screening test volumes decline steeply down to approximately thirty per cent of usual volume during mid-April to mid-May during Victoria’s first lockdown. There was a brief recovery to about sixty per cent of usual volume and then a slower decline from early July when we went into the second lockdown.”

“It is safe to visit your health care practitioner, so I’d encourage everyone who is due or overdue for a cervical screening test to make an appointment as soon as possible. If you haven’t had a cervical screening test in the last four years, ask your doctor about self-collection.”

“It is imperative that we offer our support to less well-resourced countries”

For the first time ever, the world has committed to eliminate cervical cancer, by reaching an incidence of <4 per 100,000 women in every country within the next 100 years. The scale up target is 90-70-90 by 2030: 90% of girls to be fully vaccinated with the human papillomavirus (HPV) vaccine by 15 years of age; 70% of women to be screened by 35 and again by 45 years of age using an HPV-based test; and 90% of women identified with cervical disease to receive treatment for precancerous lesions or invasive cancer.

However whilst Australia has one of the lowest cervical cancer incidence and mortality rates in the world, some of the country’s closest neighbours face a heavy burden from the treatable, preventable disease. Cervical cancer is the second most frequent cancer in women in the Solomon Islands, and Vanuatu’s cervical cancer mortality is six times the rate in Australia. Papua New Guinea has one of the highest burdens of cervical cancer globally with an incidence rate of 35 per 100,000, making it the leading cause of death in women in the country.

As Professor Frazer reflected, “Australia continues to play a leadership role in this area and I’m proud to have been a part of that. Let us all step up as scientists, women and men, community groups, politicians, and the private sector, to work together to provide all that is necessary to eliminate cervical cancer not only for our own families here in Australia but for families right across our region.”

As a key development partner for the Pacific, Australia is well placed to lead the way for cervical elimination across the region. The Department of Foreign Affairs and Indo-Pacific Centre for Health Security is already working closely with partner nations on country-specific pandemic response and recovery plans, including health systems preparedness for the COVID-19 vaccine rollout.

Australia has an opportunity to build upon these public health frameworks, and the relationships built with local governments, local community organisations and health care providers to support our neighbours to eliminate other vaccine-preventable diseases.

“It is imperative that we offer our support to less well-resourced countries to scale up HPV vaccination and cervical screening,” says Professor Saville. “Solutions must be locally driven to ensure they are acceptable to and suitable for local populations and health systems. Australia can offer assistance by providing technological expertise and sharing knowledge.”

“There is no doubt that the COVID-19 pandemic is going to hamper the global health community’s efforts to make HPV vaccination and HPV-based screening available to all girls and women. We have to find innovative ways to overcome this new challenge. Self-collected samples and rapid point of care testing will be crucial to provide safe and cost-effective screening.”

One of the myriad of challenges faced in fighting cervical cancer in the region is that many of the successful techniques used in high-income countries such as Australia are difficult to transfer to low- income countries. Unitaid is one organisation investing in game-changing innovations that are accurate, easy to use and affordable. These include portable thermal ablation devices that destroy precancerous cells on the cervix and are designed for use in remote clinics, and the future use of artificial intelligence to detect cervical or precancer within seconds using a common cellphone camera.

Unitaid has already made significant progress towards its goal of delivering screening and treatment for less than US$1 per woman, with Thermal Ablation devices now available for less than US$900, representing an average price reduction of 50%. With these more affordable devices, it is almost ten times cheaper to treat a woman than using cryotherapy, the previously-used treatment. Unitaid’s investments have also resulted in HPV testing prices coming down by a third.

Chair of Unitaid’s Executive Board, Marisol Touraine said: “No woman or girl – irrespective of where they are born, or where they live – should fall prey to cervical cancer. We cannot see cervical cancer as a death sentence because it is one of the most preventable and treatable cancers”.

Ultimately, prevention will always be better than a cure. The HPV vaccine remains a highly effective prevention measure with the potential to reduce cervical cancer globally by as much as 90%. But not all countries can afford to purchase this vaccine. It was a major step forward when Gavi, the Vaccine Alliance made the HPV vaccine available to lower income countries in 2012 and since that time more than 4.8 million girls have been vaccinated through this Gavi-supported program.

With new innovations, and barriers to accessibility being broken down, the future looks promising. The WHO’s launch of the Global Strategy to Accelerate the Elimination of Cervical Cancer signals a collective ambition and enthusiasm to leave a legacy of a world free of this disease. Australia is well positioned to lead the way.

To mark the launch of Global Strategy to Accelerate the Elimination of Cervical Cancer, Melbourne Town Hall will be lit in teal lighting on November 17. The sign is just one of a host of launch activities planned across the globe to mark this historic moment of solidarity to eliminate cervical cancer for all.

END

[1] Hall MT, Simms KT, Lew JB, Smith MA, Brotherton JML, Saville M, Frazer I, Canfell K. The projected timeframe until cervical cancer elimination in Australia. Lancet Public Health 2019;4: e19–27. Published Online October 2, 2018. http://dx.doi.org/10.1016/S2468-2667(18)30183-X

[2] AIHW CSA 2019 report: https://www.aihw.gov.au/reports/cancer-screening/national-cervical-screening-monitoring-2019/contents/table-of-contents

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