The ambitious goal of eliminating cervical cancer as a global public health issue faces significant challenges, with approximately 50,000 pregnant women currently residing in Gaza, according to the United Nations Relief and Works Agency for Palestinian Refugees (UNRWA). The organization emphasizes the critical need for concerted action to address inequalities in vaccination, screening, and treatment, particularly in regions with limited access to healthcare resources.
The World Health Organization (WHO) has outlined a goal of achieving “elimination” of cervical cancer, defined as less than four incident cases per 100,000 women annually. To realize this objective, WHO recommends comprehensive strategies, including vaccinating 90% of girls against human papillomavirus (HPV), screening 70% of women for cervical cancer, and treating 90% of women with cervical disease. However, health inequities pose a formidable barrier to achieving these goals, particularly in countries with inadequate access to essential healthcare services.
While some high-income countries like Australia, England, and the United States have made significant strides toward eliminating cervical cancer, progress is hindered by geographical, socioeconomic, and ethnic disparities. Australia, for instance, is on track for near elimination by 2028, thanks to robust vaccination programs and quality screening. However, the poorest areas in the US are projected to achieve near elimination 14 years after the wealthiest.
England and the US, although meeting WHO’s screening target, are below the recommended vaccination targets, with 77% and 65% of adolescent girls completing their HPV vaccination in 2022. The COVID-19 pandemic has further impacted vaccination efforts, particularly in England, where school-based delivery faced challenges. To address these gaps, experts recommend increasing vaccination locations, simplifying consent processes, and establishing clear vaccination recommendations.
Despite screening targets being met, both England and the US face challenges, with England experiencing a 10-year high in the proportion of unscreened women. Modeling from the US indicates that additional investment in screening could expedite elimination goals. In both countries, efforts are needed to reach underscreened populations, including minorities and low-income households, through patient navigation and validation of HPV self-sampling.
While high-income countries face challenges, the situation is even more dire in low and middle-income countries (LMICs), where resource limitations and insufficient healthcare infrastructure impede progress. These countries bear the brunt of cervical cancer incidence and deaths, with 80% of cases and 90% of deaths occurring in LMICs. Initiatives focusing on equity goals, empowerment of women, and building healthcare capacity are deemed essential for progress in LMICs.
In conclusion, the near elimination of cervical cancer is within reach for high-income countries, but addressing health inequities in vaccination, screening, and treatment is imperative. For LMICs, the timeline for achieving this goal is less foreseeable, highlighting the urgent need for global collaboration and public health initiatives that target the root causes of health inequalities.
