A global movement to eliminate cervical cancer: Action and innovation 

Cervical cancer elimination day of action is a powerful global initiative dedicated to eradicating cervical cancer as a public health issue. Observed annually on November 17, this day raises awareness and encourages collective action to prevent, detect, and treat cervical cancer early.  

With nearly all cases caused by persistent HPV infection, the focus is on vaccination, regular screening, and timely treatment. On this day, healthcare providers, communities, and policymakers unite to support World Health Organization‘s goal of reducing cervical cancer rates worldwide, advocating for equitable healthcare access and aiming to build a future where cervical cancer is no longer a threat to women’s health. 

The preventable tragedy of cervical cancer 

Cervical cancer is both preventable and curable when detected early and managed effectively. Despite this, it remains the 4th most common cancer among women globally, claiming the lives of nearly 350,000 women in 2022. The disease starkly reflects global inequities, with 94% of these deaths occurring in low- and middle-income countries. These regions bear the greatest burden due to limited access to public health services and inadequate screening and treatment for the disease. 

A concerted strategy for elimination 

In May 2018, the WHO Director-General issued a global call to action to eliminate cervical cancer, underscoring renewed political will and urging all stakeholders to unite behind this common goal. Responding to this call, the Director-General established the flagship Cervical Cancer Elimination Initiative to develop a comprehensive global strategy. In August 2020, the World Health Assembly adopted the Global Strategy for Cervical Cancer Elimination. 

Key targets for elimination 

To eliminate cervical cancer, all countries must reach and maintain an incidence rate of below 4 per 100,000 women. Achieving this goal rests on three key pillars with corresponding targets: 

• Cervical cancer awareness: The need for regular awareness campaigns on cervical cancer is crucial. 

• Vaccination: 90% of girls fully vaccinated with the HPV vaccine by age 15. 

• Screening: 70% of women screened using a high-performance test by age 35, and again by age 45. 

• Treatment: 90% of women with pre-cancer treated and 90% of women with invasive cancer managed. 

Each country should aim to meet the 90-70-90 targets by 2030 to set the path for eliminating cervical cancer within the next century. 

Colposcopy and global challenges 

As per “THE LANCET” report, in high-resource settings, colposcopy remains the preferred procedure after a positive cervical cytology or HPV test. However, colposcopy services are scarce in many low- and middle-income countries. To succeed in global cervical cancer elimination, effective screening and management strategies that can be widely implemented in low-resource settings are essential. 

Insights from the ESTAMPA Study (Latin America) 

The multicentric ESTAMPA study provides valuable data on the feasibility and accuracy of quality-assured colposcopy in diverse economic backgrounds. The study involved 4,499 HPV-positive women across 12 centers in Latin America. Key findings include: 

• Follow-up: Good follow-up at 18 months with 75.2% of HPV-positive women. 

• Predictive value: A positive predictive value of 23.1% for CIN3+ lesions and consistent sensitivity of 91.2%. 

• Biopsies: Taking 2-3 biopsies doubled the yield of precancer cases compared to one biopsy. 

• Training and monitoring: Enhanced performance of precancer detection through colposcopy training and close follow-up. 

Future Directions 

While the ESTAMPA study highlights the complexity of triaging screen-positive women, continuous training and monitoring are crucial for high-performance colposcopy. However, implementing this approach widely, especially in settings without organized screening programs, remains challenging. Molecular markers associated with HPV testing as primary screening or aiding cervical visual evaluation offer promising solutions to simplify the screening and management process. 

Cervical cancer in India: A significant burden in India 

Cervical cancer is the second most common cancer in India, particularly affecting women aged 50-74, with the highest incidence in the 65-69 age group. According to a study by the Indian Council of Medical Research (ICMR)-National Centre for Disease Informatics and Research (NCDIR), Bengaluru, the burden is significantly higher in the northeastern and central regions of the country. The study, published in BMC Reproductive Health, emphasizes the need for comprehensive cervical cancer control programs tailored to regional needs. 

Poor cervical screening coverage 

Despite the National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD) initiating cervical cancer screening since 2010, coverage remains extremely poor, with only 1.2% of women aged 15-49 having been screened. This gap is notably wider between urban and rural populations. 

Projected reduction in burden 

The study projected a 3.4% reduction in the cervical cancer burden in India by 2025, based on data from the National Cancer Registry Program (NCRP) collected in 2016. However, the age-standardized incidence rate in 2016 was 12.1 per 100,000 women, three times higher than the elimination target of 4 per 100,000 women. 

Regional disparities in cervical cancer burden 

The study also assessed the cervical cancer burden at national and sub-national levels, projecting the years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) for 2025. States such as Mizoram, Tripura, Arunachal Pradesh, Karnataka, Meghalaya, and Nagaland have higher cervical cancer burdens. The higher burden in northeastern regions is attributed to a lower Human Development Index and unsafe sexual practices, with Mizoram having the highest HIV infection rate at 2.32%. 

Progress and challenges 

India has made progress in reducing cancer-related premature mortality by only 11.5% between 2015 and 2030, which falls short of the sustainable development goal of a one-third reduction. In 2020, India accounted for approximately one-fifth of new cervical cancer cases and nearly one-fourth of deaths worldwide, underscoring its significant contribution to the global burden. 

Moving forward 

India has focused on expanding HPV vaccination, enhancing screening programs, and implementing region-specific cancer control strategies. The burden of cervical cancer in India remains high, but ongoing efforts and targeted interventions are crucial to achieving the goal of cervical cancer prevention. 

In India, routine colposcopy can play a critical role in the fight against cervical cancer. However, to achieve this goal, any program must address the societal realities faced by women in accessing healthcare services. Community cervical screening camps encounter significant barriers such as knowledge gaps, fear, embarrassment, and the influence of social contacts and service models. 

During our extensive field visits at Gyneye, we discovered that many women hold misconceptions about cervical screening. Socio-cultural barriers, geographical challenges, and limited finances are perceived as major obstacles to attending screening centers and follow-up appointments. Additionally, unwarranted reasons such as needing permission from a male partner, fear of cancer, and deep-rooted stigma and prejudices further hinder participation. 

While traditional colposcopes are often bulky and not user-friendly, complicating the diagnostic process and encountering infrastructural challenges, a portable digital solution like the Gyneye portable colposcope has revolutionized diagnostics with its single-sitting approach. This innovation enhances the effectiveness of diagnostic procedures in both remote and advanced healthcare settings. 

Gyneye’s digital smart colposcope delivers high-quality images and helps identify biopsy sites in the hands of community health providers. 

Gyneye significantly reduces the dependency on the operator’s experience and aids in diagnosis with its ability to document the Swede Score for evaluating colposcopic abnormalities. This highly integrated platform boasts various functionalities, easy accessibility, and a lightweight design. It is a smart, single-unit device offering integrated EMR, telemedicine functionalities, and secure operations. 

Built for low-resource settings, Gyneye is rugged and features an extensive 5000 mAh battery life, providing up to 10 hours of use. Its offline capability ensures it functions effectively even in remote areas. Gyneye’s design and comprehensive features make it an ideal solution for all healthcare settings, revolutionizing cervical cancer screening and making it accessible to every woman. 

The global strategy to eliminate cervical cancer underscores the importance of vaccination, the role of colposcopy, and treatment. With a concerted effort and innovative strategies, we can achieve a world free from cervical cancer, transforming the lives of women worldwide. Now is the time to act and make cervical cancer elimination a reality with Cervical cancer elimination day of action 2024. 

References: https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(23)00014-1/fulltext  

https://www.who.int/campaigns/cervical-cancer-elimination-day-of-action

https://www.newindianexpress.com/nation/2024/Aug/03/mizoram-arunachal-karnataka-nagaland-report-highest-cervical-cancer-cases-in-india-icmr