WHO & HRP launch new guidelines for cervical cancerAugust 7, 2021
WHO and HRP have launched a new guidelines to help countries make faster progress, more equitably, on the screening and treatment of cervical cancer — a disease which is both preventable and treatable.
In 2020, more than half a million women contracted cervical cancer, and about 342,000 women died as a result – mostly in the poorest countries. Quick and accurate screening programmes are critical so that every woman with cervical disease gets the treatment she needs, and avoidable deaths are prevented.
WHO’s global strategy for cervical cancer elimination – endorsed by the World Health Assembly in 2020 – calls for 70 percent of women globally to be screened regularly for cervical disease with a high-performance test, and for 90 percent of those needing it to receive appropriate treatment. Alongside the vaccination of girls against the human papillomavirus (HPV), implementing this global strategy could prevent more than 62 million deaths from cervical cancer in the next 100 years.
“Effective and accessible cervical screening and treatment programmes in every country are non-negotiable if we are going to end the unimaginable suffering caused by cervical cancer,” says Dr Princess Nono Simelela, Assistant Director-General for Strategic Programmatic Priorities: Cervical Cancer Elimination.
The new guideline includes some important shifts in WHO’s recommended approaches to cervical screening.
In particular, it recommends an HPV DNA-based test as the preferred method, rather than a visual inspection with acetic acid (VIA) or cytology (commonly known as a ‘Pap smear’), currently the most commonly used method globally to detect pre-cancer lesions.
HPV-DNA testing detects high-risk strains of HPV which cause almost all cervical cancers. Unlike tests that rely on visual inspection, HPV-DNA testing is an objective diagnostic, leaving no space for interpretation of results.
Although the process for a healthcare provider obtaining a cervical sample is similar to both cytology or HPV DNA testing, HPV DNA testing is simpler, prevents more pre-cancers and cancer, and saves more lives than VIA or cytology. In addition, it is more cost-effective.
More access to commodities and self-sampling is another route to consider for reaching the global strategy target of 70 percent testing by 2030.
WHO suggests that self-collected samples can be used when providing HPV DNA testing. Studies show that women often feel more comfortable taking their own samples, for instance in the comfort of their own home, rather than going to see a provider for screening. However, women need to receive appropriate support to feel confident in managing the process.
Women who are immunocompromised, such as those living with HIV, are particularly vulnerable to cervical disease; they are more likely to have persistent HPV infections and more rapid progression to pre-cancer and cancer. This results in a six-fold higher risk of cervical cancer among women living with HIV.
In recognition of this, the new guideline includes recommendations which are specific for women living with HIV. This includes using an HPV DNA primary screening test followed by a triage test if results are positive for HPV, to evaluate the results for risk of cervical cancer and need for treatment.
The global recommendations also advise that screening start at an earlier age (25 years of age) than for the general population of women (30 years of age). Women living with HIV also need to be retested after a shorter time interval following a positive test and following treatment than women without HIV.