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. Or maybe it’s your boss, co-worker, neighbor or friend. Women in low-income regions are especially vulnerable, because preventive measures to find a treatment for cervical disease before invasive cancer develops may not be in place or may not be readily accessible.  

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

If cervical cancer is found early, the outlook is good, data from the US show an estimated five-year survival rate of 92%.¹ For women with advanced disease, however, the five-year survival rate is 17%.¹ That is why global strategies now focus on the prevention of invasive cancer, by screening women to identify those at risk. It is easier to find and treat women with cervical disease (precancerous lesions), before they progress to a stage of more serious disease. 

HPV – the known Root Cause

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. 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.³

Globally there are an estimated 600,000 new cases annually, and 340,000 deaths that occur.⁴

Prevention through screening

Cervical 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 incidence of cervical cancer has decreased by 70% in those countries where it has been implemented.⁵ 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.⁵ However, cervical cancer will not be eliminated by HPV vaccination alone. Screening and treatment are also key factors. 

An HPV DNA test is a more sensitive indicator of risk for a woman’s future cervical health than a Pap test alone.⁶  Multiple U.S. and international guidelines, including the World Health Organization, recommend HPV primary screening as the test of choice, especially in settings where the lifetime access to screening may be limited.⁷

• In primary screening, hrHPV testing was proven more sensitive than cytology for detecting ≥CIN2 and ≥CIN3.⁶
• 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 most limited, visual inspection of the cervix after application of acetic acid (VIA), coupled with subsequent management of abnormalities by cryotherapy, was utilized as a screening method. This is sometimes referred to as a “screen and treat” strategy.¹² This method was perceived to be cost-effective at the front-end due to its initial low cost, but has limitations including difficulty in efficiently scaling-up and screening large numbers of individuals, as well as additional variables increasing the true cost.¹⁴ The implementation challenges associate with VIA includes human resource shortage, issues with the equipment, poor paper based record system, poor follow-up of patients, quality of VIA screening, continuous supervision, non-standardised training curricula, cost for training the man power, high inter-operator variability and low sensitivity among older women with endocervical lesions.¹⁵ Therefore, molecular HPV testing is becoming the preferred recommendation, as part of the WHO global strategy for cervical cancer elimination.⁷ 

Roche’s commitment towards elimination of cervical cancer 

Roche’s portfolio for cervical cancer prevention enables healthcare professionals to screen, triage and diagnose using a combination of molecular, cellular and tissue-based tests. Ensuring there is 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, and allows healthcare providers to catch disease early, when it can be treated more easily and effectively. 

Many of Roche’s systems to run these diagnostic test assays are established and running in centralized laboratories across Sub-Saharan African countries 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.

In June 2023, the cobas® HPV test for use on the cobas^® 6800/8800 Systems was awarded World Health Organization (WHO) prequalification. WHO prequalification expands the availability of this critical HPV screening tool in countries that rely on the global organisation’s list in making purchasing and implementation decisions.⁹

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.^20,21 

Nigeria

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

• 14,943 new cases annually

• 10,403 deaths estimated per year¹⁶

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.⁷ If not available, visual inspection with Acetic acid (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 the World Health Organization (WHO).^{13, 21} 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.¹³ 

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.¹⁷  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.¹⁷ Additionally, Nigeria and WHO are planning a national strategic plan to support cervical cancer interventions, research and training throughout the region.¹⁹

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 was a first ever event, with a call to action for all countries to reach target goals for elimination by year 2030.

To ensure proper cervical cancer treatment and follow-up, the WHO is urging every country to implement and scale-up HPV screening for women.⁷ There are three key target pillars for focus:

• 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.¹¹ 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 as well, beyond HIV and HPV. Tuberculosis (TB), as well as hepatitis B and C (HBV and HCV) are also included.

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. 

As the world continues to address multiple ongoing public health crises, including the addressing of COVID-19 as an endemic public health threat, Roche is making substantial investments in building additional manufacturing capacity to increase production of testing solutions and the instruments on which they are performed. This effort will draw on the strength of Roche’s global network across multiple sites and involve collaboration amongst multiple departments within the organization

Through the Global Access Program, Roche will continue to work towards implementation and expanded access, bringing innovative solutions to customers, communities and patients in those countries that need it 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 data base (Surveillance, Epidemiology, and End Results) https://www.cancer.org/cancer/cervical-cancer/detection-diagnosis-staging/survival.html Accessed 26June2023
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.
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4. https://gco.iarc.fr/today/data/factsheets/cancers/23-Cervix-uteri-fact-sheet.pdf. Accessed 26June2023
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8. Whitlock EP, Vesco KK, Eder M, Lin JS, Senger CA, Burda BU. Liquid-based cytology and human papillomavirus testing to screen for cervical cancer: a systematic review for the U.S. Preventative Services Task Force. Ann Intern Med. 2011; 155:687-697.
9. https://ml-eu.globenewswire.com/Resource/Download/8c0b6b8f-ee09-402c-91d6-31bd71afc0fe Accessed 26June2023.
10. Hariri S, Unger ER, Sternberg M, et al. Prevalence of genital human papillomavirus among females in the United States, the National Health and Nutrition Examination Survey, 2003–2006. J Infect Dis. 2011; 204(4):566-73.  http://www.ncbi.nlm.nih.gov/pubmed/21791659Accessed 26June2023.
11. https://hpvcentre.net/statistics/reports/KEN_FS.pdf. Accessed 26June2023.
12. 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.
13. Ministry of Health, Kenya. Kenya National Cancer Screening Guidelines Nairobi, November 2018. Accessed 21June2023.
14. 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.
15. Lohiya A, Daniel RA, Kumar D, Varghese C, Rath RS, Abdulkader RS, et al. Effectiveness of Visual Inspection with Acetic Acid (VIA) Screening on Cervical Cancer Mortality and Incidence – A Systematic Review and Meta-Analysis. Asian Pac J Cancer Prev : APJCP. 2022;23(2):399–407.https://journal.waocp.org/article_89962_5fa66d6b8fecf591b5f4f01c7844d46f.pdf Accessed 14July2023.
16. https://www.gavi.org/news/media-room/kenya-introduces-cervical-cancer-vaccine-nationally. Accessed October 2020.
17. https://gco.iarc.fr/today/data/factsheets/populations/566-nigeria-fact-sheets.pdf Accessed 26June2023.
18. Nigeria National Cancer Control Plan. Accessed 26June2023.
19. https://www.afro.who.int/news/nigerias-call-action-time-eliminate-cervical-cancer-nigeria. Accessed 26June2023.
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21. https://unitaid.org/news-blog/unitaid-and-chai-sign-grant-to-prevent-cervical-cancer-deaths/#en. Accessed26June2023.