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Blog: Why the current state of cervical cancer reveals global inequities

24 May 2021

By Tukiya-Kaunda Mutupa, a Health Consultant at the Commonwealth Secretariat

I am a Black African woman, born and raised in the United Kingdom.

In 2008, when the UK began its vaccination programme against human papillomavirus (HPV), which can cause cervical cancer, my school told my friends and me about the HPV vaccine. I took a keen interest in the programme ever since. After turning 25, I have been routinely called by my doctor for cervical cancer screening tests, and have access to free, high-quality treatment in case needed.

My sisters and my future children will be offered the vaccination and will most likely take it because public promotion has been comprehensive and strong over the last few years.

Now, imagine if I had grown up in a low-resource setting, my journey would have been very different.

In 2018, the World Health Organization (WHO) reported that nearly 90 per cent of the 311,000 cervical cancer deaths across the world occurred in low and middle-income countries. The death rate is high because of the lack of adequate screening in low-resource settings and the dearth of HPV vaccines.

Therefore, in 2020, the WHO’s 194 member states committed to a resolution on eliminating cervical cancer. They further agreed on specific targets under a WHO-led global strategy to eliminate the disease as a public health problem by 2030.

Cervical cancer in the Commonwealth

The Commonwealth accounts for one-third of the world’s population, but 40 per cent of global incidences and 43 per cent of mortality from cervical cancer. So the recent creation of a team to guide the Commonwealth’s response to cervical cancer is a timely initiative.

Last week, Commonwealth health ministers met to discuss, among other priorities, ways to sustain health gains made towards eliminating diseases like cervical cancer that are now at risk due to the COVID-19 pandemic.

I am proud to have helped establish the International Taskforce on Cervical Cancer Elimination in the Commonwealth which will support the 54 member countries in achieving the targets outlined in the WHO global cervical cancer elimination strategy.

The way forward

In this piece, I will share three recommendations explored by our Taskforce on cervical cancer elimination from the perspective of a young woman and her family.

First, access to HPV vaccines is key to immunity. It should start with girls aged 9 to 13 years old. The WHO calls for 90 per cent of girls to be fully vaccinated by the age of 15 because vaccines are the most effective preventive measure for reducing the risk among girls developing cervical cancer when they become women.

Second, we need integrated person-centred services that meet the full needs of women, built on the foundation of primary health care and universal health coverage. Integrating cervical cancer services with HIV services, child and maternal health and other vaccination services will ensure that every medical appointment is an opportunity to meet the holistic needs of a woman.

COVID-19 offers the opportunity to build back better with an ‘integration of services’ model. Women living with HIV are six times more likely to develop cervical cancer than their HIV-negative peers. So women who are being screened for HIV should also be screened for HPV and cervical cancer at the same time. We cannot have women, who courageously manage to live with HIV, go on to die from cervical cancer, a potentially preventable and curable disease.

Offering screening in a ‘screen and treat’ approach is vital. It offers the chance to spot pre-cancerous cells and the opportunity for women to overcome cancer early, especially important, if they did not have access to the vaccine.

Data shows numerous women in poor settings are presenting with late stage cancer at health care services. Hospitals often do not have the cancer services to treat them and they are sent home to die. There is much innovation in self-sampling which can address stigma and ensure more women are screened on time.

Finally, expanding national cancer plans, ensuring they cover cervical cancer, will prioritise cancer and women. Strengthening plans will mean investing in developing population-based cancer registries and digital health technologies to ensure the collected data supports greater decision-making, planning and tracking, to find which communities are not left behind and to explore how governments can reach high-risk groups.

When I recently spoke with some trailblazers who overcame cancer, Nadia Jamil and Dr Pintos Egesimba, they stressed addressing stigma to ensure women are empowered, never ashamed of having cancer and aware of the available services.

They emphasised the need for more investment. Women are dying unnecessarily. The WHO estimates every dollar invested in cervical cancer elimination will generate $3.20 in economic benefits. But looking at the benefits society will reap, the figure increases to $26. Investment is not just the right thing but also the smart thing to do. We are nine and a half years away from the 2030 target, if we continue prioritising cervical cancer, elimination is within reach.