The development of a cervical cancer elimination strategy from the World Health Organisation (WHO) could help more than 320 million women in the Eastern Mediterranean region.
Drawing upon Australia’s effective cervical screening program and its successful local elimination strategy, the Australian Centre for the Prevention of Cervical Cancer (ACPCC) and the University of Melbourne are supporting the Eastern Mediterranean Regional Office (EMRO) of WHO in this endeavour.
Research has shown that the human papillomavirus (HPV) vaccination, has cut cases of cervical cancer by 90 per cent. And the vaccination in combination with cervical screening programs can reduce cervical cancer incidence and mortality rates even further.
With nearly all cases of cervical cancer being preventable or treatable, the implementation of this new strategy in countries like Afghanistan, Libya and the Kingdom of Saudi Arabia is set to make big impacts for women and their families in the Eastern Mediterranean region, where Professor Marion Saville says “barriers are particularly acute.”
The Global Elimination 90-70-90 targets for 2030 are to have 90 per cent of girls fully vaccinated by the age of 15 and 70 per cent of women screened with a high performance test by age 35 years and again at 45 years.
The targets also want to see 90 per cent of women with pre-cancer treated and 90 per cent of women with invasive cancer managed.
The EMRO strategy has been developed in collaboration with 20 of its member states, but in many of the countries where war and conflict is significant, such as Yemen and Afghanistan, accessibility can be limited, according to Executive Director of the ACPCC Professor Marion Saville.
“The health sector in Afghanistan is primarily run by non-for-profit organisations which can no longer employ women,” said Professor Saville, adding that “HPV vaccines have been provided through schools in Afghanistan, meaning more than 50 per cent of the target girls will be missed, as currently schooling is banned for girls over the 6th grade– this is a tragedy on a global scale.”
Before the announcement of the cervical cancer elimination strategy, only three of the 20 participating countries had existing national HPV vaccination programs (Libya, Kingdom of Saudi Arabia, United Arab Emirates). The Saud Arabian program had the widest range of people with a cervix targeted– covering those between 15 and 26 years of age.
To increase accessibility to screening, there’s a self-collection method that involves a simple swab.
Professor Saville says this self-collect option helps address one of the main barriers to achieving the global elimination targets, reluctance to screen because of the requirement for a pelvic exam.
“With the stigma around HPV vaccination that still exists even in some high-income countries, and the barriers to accessing healthcare in low-income and war-torn countries, the new self-collection tools are an incredibly important way in which we can still strive to eliminate [cervical] cancer.”
“We estimated through work on EMRO’s elimination strategy that 60 per cent of women in these countries would find self-collection of a HPV sample to be acceptable.”