Investigators have found that implementing the updated World Health Organization (WHO) screening guidelines may effectively reduce the cervical cancer mortality rate in patients residing in low- and middle-income countries, according to two recent studies published by Simms et al and Hall et al in Nature Medicine.
Background
The WHO revealed major revisions to its guidelines to inform the acceleration of the organization’s global strategy to eliminate cervical cancer.
The Australian Government recently announced that a new $12.5 million grant—supported by the philanthropic Minderoo Foundation trust—was awarded to a consortium led by the Daffodil Centre in an effort to reduce the incidence and mortality of cervical cancer in the Indo-Pacific region and related developments in Vanuatu and Papua New Guinea.
Methods and Findings From the New Studies
In the new studies, the investigators focused on screening for the human papillomavirus (HPV) in patients in the general population from 78 countries as well as multiple screening scenarios for patients with the human immunodeficiency virus (HIV), calibrated for Tanzania, where the incidence of the virus is endemic. The investigators then modeled the impact of targeted screening options in low- and middle-income countries to encourage adherence to the WHO’s updated screening guidelines.
“We found that primary HPV screening was the most clinically effective and cost-effective [strategy], reducing mortality by 63% to 67% when offered every 5 years,” highlighted lead study author of the first study Kate Simms, PhD, of the Daffodil Centre at the University of Sydney.
The investigators noted that HPV was responsible for almost every case of cervical cancer and that a shift from Papanicolaou tests to HPV screening in low- and middle-income countries could significantly reduce the rate of cervical cancer mortality through earlier intervention. Further, the investigators found that patients with HIV had a sixfold risk of developing cervical cancer compared with the general population and that coexisting HIV and HPV infections were more prevalent among those who resided in low-to-middle-income countries.
“We modeled several scenarios in relation to outcomes in Tanzania, which has one of the world’s highest HIV infection rates, and found that primary HPV testing with triage compared with no screening would reduce cervical cancer mortality by up to 71%,” stressed lead study author of the second study Michaela Hall, PhD, of the Daffodil Centre at the University of Sydney. “This equated to saving a life for every 38 [patients] screened and referred for precancer treatment—an extremely strong result in relation to the benefits of cancer screening,” she added.
Both of the studies were based on a screening participation rate of 70%, a target that is one of the three pillars of the WHO global cervical cancer elimination strategy.
Conclusions
“Low- and middle-income countries bear most of the world’s cervical cancer burden, so demonstrating the effectiveness of HPV-based screening compared with other approaches is crucial to advocacy to support the WHO strategy and guidelines,” emphasized Dr. Simms.
The investigators hope their new findings build on the momentum driving the elimination of cervical cancer in low- and middle-income countries.
“In Australia, we’re on track to be the first country in the world to eliminate cervical cancer by 2035, but in many countries, it is a leading cause of cancer death—and [results in] huge inequities and impacts on entire communities. Yet, it is the only cancer that can be eliminated using technology that’s already well-established and available if there is sufficient funding and community support,” underscored senior study author Karen Canfell, PhD, Director of the Daffodil Centre at the University of Sydney.
“By leveraging in-country partners and Australian technical expertise, [the Eliminating Cervical Cancer in the Western Pacific project] has set Vanuatu on a path to be the first low- [and] middle-income country in the world to eliminate cervical cancer—while [Papua New Guinea] is also taking important steps towards the elimination goal. The Australian Government’s $12.5 million dollar grant to fund the parallel [the] Elimination Partnership in the Indo-Pacific for Cervical Cancer will further expand this approach, informed by the evidence. These two major new studies … strengthen the evidence base for action to guide and expand this work and accelerate the elimination of cervical cancer worldwide,” she concluded.
Disclosure: For full disclosures of the study authors, visit nature.com and nature.com.
