The Global Battle Against Cervical Cancer

Provided by Roche Diagnostics, Global Cervical Cancer Solutions

Every 60 seconds, someone’s mom, wife, sister, aunt or daughter is diagnosed with cervical cancer somewhere in the world. Women in low-income regions are especially vulnerable, as preventive measures to find and treat cervical disease before invasive cancer develops may not be in place or readily accessible.  

Where there is limited access to preventive and early detection measures, cervical cancer is often not identified until it has reached an advanced stage. Access to late-stage cervical cancer treatment – such as surgery, radiotherapy and chemotherapy – can be limited or challenging, resulting in higher death rates in resource-limited countries. 

If cervical cancer is found early, the outlook is good, with an estimated five-year survival rate of 92%. For women with significantly advanced disease, however, the five-year survival rate drops substantially to 17%.¹ That is why global strategies now focus on the prevention of invasive cancer, by not only vaccinating young girls, but also screening women to identify those at risk. With education, HPV vaccination and cervical screening efforts in place, it can be easier to find and treat women with cervical disease (precancerous lesions), before they progress to more serious disease.  

HPV – the root cause of cervical cancer

Human papillomavirus (HPV) is a common sexually transmitted infection predicted to affect over 80% of sexually active men and women at some point in their lifetimes.²  HPV has been detected in more than 99% of cervical cancers, establishing the link between viral infection and disease.  There are more than 150 different types of HPV, yet only some are considered high-risk for cervical cancer.³ Two types of HPV, HPV 16 and HPV 18, account for close to 70% of all cases.⁴ Not every person with HPV will develop cancer, as most of the time the infection is cleared by the body’s immune system. But in some cases the virus persists and can lead to precancer or cancer. ⁵

Globally each year, there are an estimated 600,000 new cases of cervical cancer and 340,000 deaths with the majority occurring in low- or middle-income countries.⁶

Prevention through screening

Cervical cancer screening programs can help decrease the rate of cervical cancer cases and drastically reduce mortality. Since the Pap test was invented early in the 20th century, the mortality rate of cervical cancer has decreased by 70% in those countries where it has been implemented.⁷ 

During the 1980s the link between HPV infection and cervical cancer was identified, which paved the way for both vaccines and new screening tests. Today, HPV vaccination plays a big part in reducing the incidence of cervical cancer.⁸ 

However, cervical cancer will not be eliminated by HPV vaccination alone. Screening and treatment are key factors in controlling the spread of the virus and identifying cervical cancer or precancer earlier.

Compared to the traditional Pap test, an HPV DNA test is a more sensitive indicator of risk for a woman’s future cervical health.  Multiple U.S. and international guidelines recommend HPV primary screening as the test of choice, especially in settings where lifetime access to screening may be limited. In primary screening, HPV testing was proven more sensitive than cytology for detecting cervical disease (lesions classified as  ≥CIN2 and ≥CIN3).⁹ There is an opportunity to identify those at highest risk, since 70% of cervical cancers are caused by HPV genotypes 16 and 18.¹⁰

In some regions where resources are scarce, an alternative option for cervical screening is visual inspection of the cervix after application of acetic acid (VIA), coupled with immediate management of abnormalities by cryotherapy. Sometimes referred to as a “screen and treat” strategy, this method requires adequate facilities and trained health care workers, which are not always readily available. This method is perceived to be cost-effective at the front-end due to its initial low cost. However, it has a number of limitations including difficulty in efficiently scaling-up and screening large numbers of individuals that end up increasing the cost overall.¹¹ Therefore, molecular HPV testing is becoming the preferred recommendation for screening.¹²

Roche’s commitment towards elimination of cervical cancer 

Roche’s portfolio for cervical cancer prevention enables healthcare professionals to screen, triage and diagnose cervical cancer using a combination of molecular, cellular and tissue-based tests. Ensuring access to reliable tests with the potential for automation and high volume processing enables countries to identify women at risk at the scale necessary for their populations. It also allows healthcare providers to catch disease early, when it can be treated more easily and effectively. 

Many of Roche’s diagnostic assay systems, which are used to make critical clinical care decisions, are established and running in centralized testing labs across the world to support HIV and COVID-19 screening. With these programs already online, it can be fairly easy to implement an additional HPV DNA test from Roche into the existing infrastructure, with minimal effort.

The cobas® HPV test is now part of the Roche Global Access Program, a partnership between Roche and national governments, local healthcare facilities, communities and international agencies, to provide increased access to diagnostics at affordable pricing for qualifying organizations in eligible countries with the highest disease burden. Roche is also currently working with the World Health Organization (WHO) to obtain Prequalification Diagnostics Status for the cobas® HPV assays on its molecular diagnostic systems for use in resource-limited settings. Two of the HPV assays have been granted the Abridged Assessment Review Path by the WHO.

Improving women’s healthcare in Africa

On November 17, 2020 the WHO launched the global strategy to accelerate the elimination of cervical cancer as a public health threat. This is a first ever event, with a call to action for all countries to reach target goals for elimination by 2030.¹³

To ensure proper cervical cancer treatment and follow-up, the WHO is urging every country to implement and scale-up HPV screening for women.¹⁴ There are three key target pillars for focus:¹⁵

• 90% of girls fully vaccinated by 15 years of age; 
• 70% coverage of screening with a high-performance test once by the age of 35 and again by 45 years;
• 90% of women who are identified with cervical disease receive treatment (90% of women with pre-cancer treated; 90% of women with invasive cancer managed).

Roche supports the efforts of healthcare agencies, policymakers and funding institutions to bring rapid, scalable and clinically-validated HPV screening tests for cervical cancer prevention to those countries most in need, with the highest cervical cancer disease burden. 

Many African countries with high incidences of cervical cancer also report high rates of coinfection with HIV. Women living with HIV are six times more at risk of developing cervical cancer than those who are not.¹⁶ Therefore, it is vital that these regions take the appropriate actions to ensure proper healthcare screening measures are put in place. 

The Roche Global Access Program, founded to address the need for HIV monitoring, strives to increase access for countries seeking aid in more rapid progress against other diseases, beyond HIV and HPV. Tuberculosis (TB), as well as hepatitis B and C (HBV and HCV) are also included.

Kenya and Nigeria – committed to the battle against cervical cancer

With some of the world’s highest incidences of cervical cancer, which affects the woman, her family and entire communities, both Kenya and Nigeria have made a concerted effort to change policies and guidelines, increase awareness among healthcare providers and patients and implement improved HPV screening and treatment programs. The steps these two countries are taking serve as success stories in the progress being made to eliminate cervical cancer globally.

In 2019, Unitaid and Clinton Health Access Initiative (CHAI) launched a $33 million project to develop innovative screening tools and introduce new technologies for the detection and treatment of cervical cancer. The 2.5-year project was to begin in seven countries, including Kenya and Nigeria.¹⁷

Nigeria

• 50.3 million women aged >15 years, at risk for cervical cancer

• 14,943 new cases annually

• 10,403 deaths estimated per year¹⁹

With new recommendations and policies focused on HPV screening now in place at the global and local level, Roche has begun working with Unitaid, CHAI, and UNICEF through the Global Access Program to deliver reliable and clinically-validated molecular HPV diagnostic tests and cervical cancer screening tools to both Kenya and Nigeria.

Kenya’s Ministry of Health (MOH) released a set of national cancer screening guidelines to help combat the disease, recommending molecular HPV testing as the primary screening method for cervical cancer.²⁰ If not available, VIA-based methods can be used. Kenya also launched a national immunization initiative to provide HPV vaccines free of cost through partnerships with Gavi, UNICEF and WHO.^21,22 Furthermore, Kenya instituted in 2020 a national guide on eliminating cervical cancer with the objective to scale up screening, prevention and treatment with sustainable solutions.²³ 

Nigeria’s Federal Ministry of Health also provided guidance on cervical cancer screening for early detection with the goal of implementing HPV DNA testing as well as VIA.²⁴ In 2019, the Nigerian government made a plan for HPV vaccines to be part of the national routine immunization protocol as well as invest in prevention and treatment programs with the objective of controlling and eliminating cervical cancer.²⁵ Additionally, Nigeria and WHO are planning a national strategic plan to support cervical cancer interventions, research and training throughout the region.

A global call for healthcare infrastructure

Countries like Kenya and Nigeria are developing a road map for the elimination of cervical cancer that other countries can follow. Even small steps based on the implementation of high-precision screening solutions will contribute to improvements in women’s health, decrease the burden on healthcare systems and promote a more sustainable healthcare infrastructure. 

Through the Global Access Program, Roche is supporting the efforts of Ministries of Health, healthcare agencies and funding institutions to develop sustainable solutions to strengthen local healthcare capacity and run rapid, scalable and clinically-validated screening programs for cervical cancer.

As the world continues to battle multiple ongoing public health crises, including the COVID-19 pandemic, Roche is committed to improving access to innovative products and services to customers, communities and patients in those countries that need them most.

Do you think it’s time we all took action towards worldwide cervical cancer elimination? Join the movement and sign up to the campaign today. We’d also love to hear your feedback on this story, so please post your comments to us below. You’ll also find us on all the usual social channels. With widespread global coverage of the HPV vaccination and dedicated cervical screening programs, it will be possible to eliminate cervical cancer for future generations.

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References

1. United States SEER database (Surveillance, Epidemiology, and End Results) https://www.cancer.org/cancer/cervical-cancer/detection-diagnosis-staging/survival.html May 2021
2. Chesson HW, Dunne EF, Hariri S, Markowitz LE. The Estimated Lifetime Probability of Acquiring Human Papillomavirus in the United States. Sex Transm Dis. 2014;41(11):660–4.
3. Walboomers JMM, Jacobs MV, Manos MM, Bosch FX, Kummer JA, Shah KV, et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathology. 1999;189(1):12–9
4. Sanjose S de, Quint WG, Alemany L, Geraets DT, Klaustermeier JE, Lloveras B, et al. Human papillomavirus genotype attribution in invasive cervical cancer: a retrospective cross-sectional worldwide study. Lancet Oncol. 2010;11(11):1048–56.
5. Holowaty P, Miller AB, Rohan T, To T. Natural History of Dysplasia of the Uterine Cervix. Jnci J National Cancer Inst. 1999;91(3):252–8
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9. Wright TC, Stoler MH, Behrens CM, Sharma A, Zhang G, Wright TL. Primary cervical cancer screening with human papillomavirus: End of study results from the ATHENA study using HPV as the first-line screening test. Gynecol Oncol. 2015;136(2):189–97
10. Li N, Franceschi S, Howell‐Jones R, Snijders PJF, Clifford GM. Human papillomavirus type distribution in 30,848 invasive cervical cancers worldwide: Variation by geographical region, histological type and year of publication. Int J Cancer. 2011;128(4):927–35
11. Holme F, Kapambwe S, Nessa A, Basu P, Murillo R, Jeronimo J. Scaling up proven innovative cervical cancer screening strategies: Challenges and opportunities in implementation at the population level in low‐ and lower‐middle‐income countries. Int J Gynecol Amp Obstetrics. 2017;138(S1):63–8
12. Jeronimo J, Castle PE, Temin S, Denny L, Gupta V, Kim JJ, et al. Secondary Prevention of Cervical Cancer: ASCO Resource-Stratified Clinical Practice Guideline. J Global Oncol. 2016;3(5):JGO006577
13. 73rd World Health Assembly Decisions https://www.who.int/news-room/feature-stories/detail/73rd-world-health-assembly-decisions Accessed May 2021
14. World Health Organization. (2020). Introducing and scaling up testing for human papillomavirus as part of a comprehensive programme for prevention and control of cervical cancer. https://www.who.int/publications/i/item/9789240015166. Accessed May 2021
15. Global strategy to accelerate the elimination of cervical cancer as a public health problem https://www.who.int/publications/i/item/9789240014107 Accessed May 2021
16. Stelzle D, Tanaka LF, Lee KK, Khalil AI, Baussano I, Shah ASV, et al. Estimates of the global burden of cervical cancer associated with HIV. Lancet Global Health. 2020
17. Unitaid and CHAI sign grant to prevent cervical cancer deaths. https://unitaid.org/news-blog/unitaid-and-chai-sign-grant-to-prevent-cervical-cancer-deaths/#en. Accessed October 2020.
18. Kenya, Human Papillomavirus and Related Cancers, Fact Sheet 2018 https://hpvcentre.net/statistics/reports/KEN_FS.pdf?t=1621306000231 Accessed May 2021
19. Nigeria, Human Papillomavirus and Related Cancers, Fact Sheet  2018 https://hpvcentre.net/statistics/reports/NGA_FS.pdf?t=1621306095144 Accessed May 2021
20. Ministry of Health, Kenya. Kenya National Cancer Screening Guidelines Nairobi, November 2018 https://www.health.go.ke/wp-content/uploads/2019/02/NATIONAL-CANCER-SCREENING-GUIDELINES-launched-.pdf Accessed October 2020.
21. Kenya launches HPV vaccine with GAVI support. https://www.health.go.ke/kenya-launches-hpv-vaccine-with-gavi-support/. Accessed October 2020.
22. Kenya introduces cervical cancer vaccine nationally. https://www.gavi.org/news/media-room/kenya-introduces-cervical-cancer-vaccine-nationally. Accessed October 2020.
23. First Lady Margaret Kenyatta launches national guide on elimination of cervical cancer. https://www.president.go.ke/2020/01/30/first-lady-margaret-kenyatta-launches-national-guide-on-elimination-of-cervical-cancer/ Accessed May 2021
24. Nigeria National Cancer Control Plan 2018-2022 https://www.iccp-portal.org/system/files/plans/NCCP_Final%20%5B1%5D.pdf Accessed May 2021
25. Nigeria’s call to action – Time to eliminate cervical cancer in Nigeria https://www.afro.who.int/news/nigerias-call-action-time-eliminate-cervical-cancer-nigeria Accessed May 2021