The Cancer We Can Eliminate
Today, scientific breakthroughs and access to effective cervical screening techniques give us the unique opportunity to eliminate cervical cancer in the UK
Tim Simpson | | 5 min read | Discussion
Every year in the UK, there are around 3,200 new cervical cancer cases, yet we know it is preventable and highly treatable if detected early and managed effectively (1). This is because cervical cancer has one main risk factor: infection with human papillomavirus (HPV). There are over 100 different kinds of high-risk virus types, including HPV16 and 18 (2,3).
In 2020, the UK signed up to the World Health Organization’s (WHO) ambitious global strategy to accelerate the elimination of cervical cancer based on three key steps:
- Achieving 90 percent of girls vaccinated against HPV by the age of 15,
- 70 percent of women screened with a high-performance test by the age of 35 and again by 45,
- 90 percent of women with cervical cancer receiving effective treatment.
Successful implementation of the three above could reduce more than 40 percent of new cases of HPV, and could make a serious dent into the five million related deaths expected to occur across the world by 2050 (4).But success is dependent on making cervical cancer an explicitly (and adequately resourced) public health priority. And that means adequate cervical screening and strengthened efforts to harmonize and improve the surveillance of cervical cancer and screening data across the UK. Indeed, this ambition is reflected in the recent HPV Coalition’s Roadmap towards making the elimination of all HPV-related cancers a reality across the UK.
With that said, such access to cervical screening requires leading-edge testing capabilities and technology. So, how can we provide it? Here are just a few ways we can deliver change.
HPV primary testing
Though cytology-based screening has been a key foundation of cervical cancer prevention for decades (5), recent advances in molecular diagnostics have elevated the role of HPV detection in population screening (6).
In 2017, the UK National Screening Committee recommended a move to primary HPV screening, which has been implemented across England, Wales, and Scotland (7). HPV primary screening allows healthcare professionals to find those at higher risk of developing cervical cell changes or cervical cancer sooner and more accurately thanks to tests with improved sensitivity and accuracy (8).
The role of mRNA technology
mRNA technology is pioneering advances in molecular diagnostics and medical science, particularly when it comes to cervical screening. Within screening, mRNA testing allows for greater specificity thanks to its ability to detect actively transcribing high-risk HPV mRNA as opposed to transient infections, while remaining as sensitive as DNA counterpart tests (9).
HPV infections are often transient and can be spontaneously cleared, so the presence of DNA does not necessarily indicate that a pre-cancerous abnormality will develop. However, the presence of mRNA specific to oncogenic markers indicates that HPV is not only present but is already affecting cells (9).
The other benefit of using mRNA technology when it comes to cervical screening is the cost benefit for healthcare providers. An analysis into the use of mRNA and DNA assays in screening for cervical cancer showed large cost savings, estimating that £15 million could be saved annually in the English cervical screening program.The results also showed that, by using mRNA instead of DNA, unnecessary testing and follow-ups were avoided, benefiting both women and healthcare services (9).
Alongside innovation, reaching the elimination target requires us to provide equal access to screening – specifically by tackling the inequalities and barriers that prevent women from attending.
Though our Global Women’s Health Index showed that cancer screening rates for women had improved. Our additional research found that i) health inequalities still exist in the UK, and ii) women from ethnic minority backgrounds reported lower attendance for cervical cancer screening attendance compared with white women – 31 percent versus 65 percent (11, 12).
Tackling these inequalities through education, national screening programs, and new approaches is key to ensuring better health outcomes for more women. Alongside fully inclusive screening campaigns that represent and resonate with all women.
Exploring new approaches
There are also a number of exciting innovations and approaches that are emerging in cervical cancer screening. For example, a cervical screening swab test that examines DNA methylation was developed by researchers from University College London and the University of Innsbruck; it was found to identify potentially dangerous cervical cell changes up to four years before they happen (10).
In terms of reviewing results, we’ve seen the introduction of artificial intelligence and advanced imaging to help improve early diagnosis of precancerous and cancer cells. Creating digital images of samples that have tested positive for HPV means that they can be rapidly reviewed and provide the screener with an image gallery of the most diagnostically relevant cells. And that helps medical experts more rapidly identify and accurately diagnose abnormalities as they have fewer cells to analyze.
It is critical when introducing such innovations and methods that we prioritize patient pathways. Robust and clear processes must be in place to ensure adequate follow-up care and appropriate treatment.
Given we already know so much about cervical cancer, its risk factors, and how to prevent it, better cervical health outcomes for women are truly within our grasp. We need to see a continued drive in innovation, boost screening access, and tackle inequalities head on. It’s only through these steps that we can make cervical cancer a disease of the past.
- Cancer Research UK, “Cervical Cancer Statistics” (2023). Available at: https://bit.ly/3NxdUYk.
- US Food & Drug Administration, “HPV (human papillomavirus)” (2019). Available at: https://bit.ly/44o8zcq.
- European Commission, “Cervical cancer burden in EU-27” (2021). Available at: https://bit.ly/3D9ksrr.
- World Health Organisation, “A cervical cancer-free future: First-ever global commitment to eliminate a cancer” (2020). Available at: https://bit.ly/3JvmuWo.
- PJ Maver, M Poljak, “Primary HPV-based cervical cancer screening in Europe: implementation status, challenges, and future plans,” Clin Microbiol Infect, 26, 579, (2020). PMID: 31539637.
- A Arney, K Bennett, “Molecular Diagnostics of Human Papillomavirus,” Lab Med, 41, 523, (2010).
- UK government, “Adult screening programme: Cervical Cancer UK NSC screening recommendation” (2023). Available at: https://bit.ly/3CScAdI.
- Jo’s Cervical Cancer Trust, “HPV Primary Screening” (2020)., Mar, 16]. Available at: https://bit.ly/3JzQr7u.
- G Weston et al., “Use of the Aptima mRNA high-risk human papillomavirus (HR-HPV) assay compared to a DNA HR-HPV assay in the English cervical screening programme: a decision tree model based economic evaluation,” BMJ Open, 8, e031303 (2020). PMID: 32152154.
- JE Barrett et al., “The WID-CIN test identifies women with, and at risk of, cervical intraepithelial neoplasia grade 3 and invasive cervical cancer,” Genome Med, 14, 116 (2022). PMID: 36258199.
- Hologic, “Hologic Global Women’s Health Index” (2021). Available at: https://bit.ly/3PztSDH.
- OnePoll, “Women’s Health Index” (2022).