Accelerating the elimination of cervical cancer as a global public health problem
AbstractCervical cancer is a significant public health problem in the WHO South-East Asia Region. In 2018, an estimated 158 000 new cases and 95 766 deaths were reported due to cervical cancer, which is the third most common type of cancer. The Region accords high importance to the prevention of cervical cancer. It is also a priority under the Regional Director's Flagship Programme of “prevention of noncommunicable diseases through multisectoral policies and plans with a focus on best buys”. In 2015, the Sixty-eighth session of the Regional Committee for South-East Asia in Dili, Timor-Leste, adopted a resolution (SEA/RC68/R5) on cancer prevention and control as the way forward in the context of comprehensive NCD prevention and control. Vaccination against human papillomavirus, screening and treatment of pre-cancer, early detection, and prompt treatment of early invasive cancers and palliative care have proven to be effective strategies to address cervical cancer across the care continuum. The roadmap for cervical cancer prevention in the SEA Region is elaborated in the Regional Strategic Framework for the comprehensive control of cancer cervix, a Regional Vaccine Action Plan (2016–2020), and the Action Plan for the prevention and control of NCDs in South-East Asia 2013–2020. Bhutan, Maldives, Sri Lanka and Thailand have introduced the HPV vaccine nationally, and screening and treatment of pre-cancers have been initiated in all Member countries of SEA Region. Current global vaccine shortages and price levels impede HPV vaccine introduction leading to low immunization coverage rates. Limited capacity for screening tests contribute to low screening coverage in the Region and limited availability of quality pathology and treatment services and palliative care is the reality in most settings. At a regional meeting in June 2019, Member States accepted the global elimination threshold of the age-adjusted incidence rate of less than 4 per 100 000 women-years by end of the century. Interim targets accepted by Member States are: 90% of girls are fully vaccinated with the human papilloma virus (HPV) vaccine by 15 years of age; 70% of women are screened with a high-precision test at 35 and 45 years of age, and 90% of women identified with the cervical disease receive treatment and care by 2030. Member States concluded that it is feasible for our Region to achieve these 2030 interim targets outlined in the Global Strategy on the elimination of cervical cancer. It is planned to update the regional implementation guidance on the prevention and management of cervical cancers and strengthen health systems at all levels for the provision of cancer control services through a people-centred approach. It is necessary to include these services in the essential services packages towards universal health coverage to meet the global targets. The attached Working Paper was submitted to the High-Level Preparatory Meeting for its review and recommendations. The HLP Meeting reviewed the paper and made the following recommendations for consideration by the Seventy-second Session of the Regional Committee: Actions by Member States (1) Develop/strengthen national cervical cancer control plans, including appropriate strategies and guidelines for immunization, screening, treatment and care, including palliative care. (2) Strengthen services for screening for early detection, management of precancerous lesions and treatment of cervical cancer. (3) Address the data gaps in cervical cancer prevention and control, including through the establishment of population-based cancer registries. (4) Incorporate cervical cancer screening and management of pre-cancerous lesions in basic and/or essential health services packages. (5) Consider the introduction of HPV vaccine and make applications to Gavi, as appropriate. Actions by WHO (1) Update the regional implementation guidance on the prevention, control and management of cervical cancer and provide technical support to Member States in their efforts to develop and implement policy and strategies, including strengthening data collection and monitoring systems to achieve cervical cancer elimination. (2) Collaborate with global partners and stakeholders for the availability of vaccines at affordable prices. (3) Report to the Regional Committee every two years on the status of progress towards the elimination of cervical cancer. This Working Paper and the HLP Meeting recommendations are submitted to the Seventy-second Session of the WHO Regional Committee for South-East Asia for its consideration.
World Health Organization. Regional Office for South-East Asia. (2019). Accelerating the elimination of cervical cancer as a global public health problem. World Health Organization. Regional Office for South-East Asia. https://apps.who.int/iris/handle/10665/327911