We have all the tools we need for the elimination of cervical cancer, a largely preventable cancer that annually kills more than 300,000 women worldwide—the vast majority in low- and middle-income countries.

In response to the World Health Organization (WHO) Global Strategy to Accelerate the Elimination of Cervical Cancer as a Public Health Problem, countries and communities heavily burdened by cervical cancer are innovating and building momentum toward achieving the ultimate goal. For instance, health care workers in rural Guatemala wear show-and-tell aprons illustrating female reproductive anatomy to educate women on the simplicity of cervical cancer self-sampling for screening. In the Philippines, pop-up tents at a recreation area provide women easy access —and privacy—so they may self- collect samples to be tested for the human papillomavirus (HPV). HPV is the most common viral infection of the reproductive tract and more than 95 percent of all cervical cancer is due to HPV. And, in Burkina Faso, women living with HIV —who have a substantially increased risk for cervical cancer — can be screened for HPV during a visit to pick up their multi-month supply of antiretroviral drugs.

These are just a few of the simple efforts underway to reach more women with prevention and treatment—and ultimately eliminate cervical cancer. It’s challenging, of course, to expand access to, and integrate a new cancer screening technology into health systems burdened by competing priorities and recovering from the COVID-19 pandemic. But it’s essential.

It’s also achievable. The global response to COVID-19 has shown us that resources can be mobilized. Collecting and testing samples, navigating clients, and getting test results to women is possible—but only with real commitment. With similar resolve, we can eliminate a deadly cancer.     

The Importance of Testing

With the observation of World Cancer Day later this week (February 4) we must take the opportunity to sharpen the focus of the global health conversation on international efforts at cervical cancer prevention and treatment, and the continuing inequity therein. Ninety percent of the 341,843 cervical cancer deaths in 2020 occurred in less resourced regions of the world where access to prevention, screening, and treatment services are severely limited.

It’s been two years since, in a much-anticipated announcement, the WHO adopted the aforementioned global strategy. The emphasis on elimination within the new guidance on HPV DNA screening is essential. It is this testing that reveals the presence of human papillomavirus (HPV) types—notably types 16 and 18, two high risk types responsible for 70 percent of cervical cancers.

As a WHO-recommended technique for cervical cancer screening in low- and lower-middle income countries, HPV DNA testing is worth celebrating. HPV DNA testing can help identify women with high risk of developing cervical cancer and offers clinical and operational advantages for population-based screening approaches—such as an opportunity to screen women less frequently.

Self-Care in Cancer Prevention

Through a 4-year project known as Scale Up Cervical Cancer Elimination with Secondary Prevention Strategy (SUCCESS), a Unitaid-funded consortium, Jhpiego is working with Expertise France, the Union for International Cancer Control (UICC), and government and civil society cancer prevention partners in Burkina Faso, Côte d’Ivoire, Guatemala, and the Philippines to implement WHO-recommended secondary prevention models and to develop scaling plans for  HPV DNA testing.

One of the bright spots that bodes well for the scalability of HPV DNA testing is self-collection of samples. Studies show this self-care type approach is accurate, effective, and enthusiastically accepted by providers and clients alike.

Self-sampling counseling engages women in learning about and taking greater control of their own health. Self-sampling allows women to swab themselves in privacy. It’s less invasive than a Pap test or Visual Inspection with Acetic Acid (VIA). It reduces reliance on screening in facility settings and has great potential for community-based instruction and sample collection.

Realizing the potential to scale these promising screening methods depends on their being integrated into existing health services—including HIV care and treatment and primary reproductive health care—as part of a fully optimized health system. Ensuring support for laboratories is critical, so that they can return test results to women within days, not months. We also still need affordable pricing for testing that doesn’t leave low-income countries behind. This problem of cost means that these measures also become inaccessible to middle income countries that do not qualify for reduced rates and still can’t afford to scale up testing.

What’s Still Needed?  

Organizations including the Global Fund to Fight AIDS, Tuberculosis and Malaria; UNAIDS; Unitaid; and the United States President’s Emergency Plan for AIDS Relief are making critical, large investments in cervical cancer elimination. Yet reaching the elimination strategy goals by 2030—screening 70 percent of eligible women around the world regularly for cervical disease with a high-performance test, and treating 90 percent of those who need it—is achievable only with greater investment and attention by the global public health community, funders, and others.

A frank discussion about progress within the global elimination strategy needs to emphasize additional investment as well as highlight barriers preventing the scale-up of advancements proven to be “best-buy interventions,” namely HPV vaccination as a primary preventive, with HPV DNA screening as the secondary preventive, and thermal ablation for treatment of precancerous lesions.

Effectively scaling HPV DNA testing calls for more: more funding, greater optimization of laboratory capacity, and more opportunities for countries to avail themselves to global access pricing either independently or through collective procurement to increase quantities and potentially drive down costs for any one country. It also calls for greater investment in implementation research and—this is critical—ensuring early dissemination of and knowledge-sharing about effective service delivery.

Observing World Cancer Day means honestly assessing what the global health community has learned about achieving elimination—as well as facing the formidable funding and pricing challenges that remain to reach those 2030 targets.

As we look to what is possible in the coming years, we will also do well to amplify what works in scaling high-performance testing and treatment, while continuing to investigate new developments including mRNA testing and a therapeutic vaccine. This requires us to put financing and pricing solutions at the top of the global health agenda. Women need cervical cancer elimination. Women want cervical cancer elimination. Women deserve cervical cancer elimination.