ELIMINATION OF CERVICAL CANCER AS A GLOBAL

PUBLIC HEALTH PROBLEM

GROWING INEQUITIES AND PUBLIC HEALTH THREAT OF CERVICAL CANCER (GLOBOCAN 2018)

WHO LIFE COURSE APPROACH TO CERVICAL CANCER CONTROL

Primary Prevention Secondary Prevention Tertiary Prevention

VARIABILITY IN CERVICAL CANCER INCIDENCE RATES BY WORLD REGION

CERVICAL CANCER ELIMINATION: CONCEPTUAL FRAMEWORK

2030 21202020

Cer

vica

l can

cer c

ases

/100

,000

Current vaccination and screening

Intensive vaccinationIntensive screening and vaccinaMon

2060

INCREASING ACCESS TO INTERVENTIONS 2030 VACCINATION, SCREENING & TREATMENT COVERAGE TARGETS

2030 21202020

Cer

vica

l can

cer c

ases

/100

,000

2060

Elimination at 4 / 100,000

Elimination by2085 /2090

Control: Targets of 90/70/90

THE ARCHITECTURE TO ELIMINATE CERVICAL CANCER:

2030 CONTROL TARGETS

The 2030 targets and elimination threshold are subject to revision depending on the outcomes of the modeling and the WHO approval process

90%of girls fully vaccinated with HPV vaccine by 15

years of age

70%of women screened with an

high precision test at 35 and 45 years of age

90%of women identified with

cervical disease receivetreatment and care

SDG 2030: Target 3.4 – 30% reduction in mortality from cervical cancer

VISION: A world without cervical cancer

THRESHOLD: All countries to reach < 4 cases 100,000 women-years

92 Countries included HPV vaccine in the national immunization programme

(Feb 2019)

Reported HPV vaccine coverage of various ages, 2014-201690% coverage is achievable, but most countries are far behind

Source: Brotherton & Bloem, 2017

%

AFR AMR EUR SEAR WPR

0

10

20

30

40

50

60

70

80

90

100

Bot

Mau

Rwa

Sey SA Ug

Arg

Bar

Bel

Bra

Can

Chi

Col

Ecu

Hon

Mex Pan

Par

Per

Sur

USA Uru Au

tBe

lD

en Fin

Fra

Ger

Hun Ic

e Ire Ita Lat

Mac

Mal

Net

Nor Po

rSl

oSp

aSw

eSw

iU

K

Bhu

Aus

Bru

Coo Fij

Mal Nzl Pal

Cervical cancer screening : proportion of womenbetween 30 – 49 screened for cervical cancer at least once

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0%

Benin (2015)Pakistan (2013)

Timor-Leste (2014)Egyp t (2017)

Sudan (2016)Ethio pia (2015)

Myanmar (2014)Bur kina Faso (2013)

Iraq (2015)Uganda (2014)Senegal (2015)

Azerbaijan (2017)Tajiki stan (2016)Moro cco (2017)

Uzbekis tan (2014)Solomon Is lands (2015)

Algeria (2016)Kenya (2015)

Malaw i (2017)Kuw ait (2014)

Lebanon (2017)Zamb ia (2017)

Swazi land (201 4)Georgia (2016)

Tuvalu (2015 )Jordan (2007)

Viet Nam (2015)Ar menia (2016)

Kyrgyzstan (201 3)Turkey (2017)

Trin idad and Tobago (2012)Mongol ia (2013)Thailand (2007)

Nauru (2016)Turkmenis tan (2014)

Bhu tan (2014)Dominica (2008)

Bru nei Darussalam (2015)Repu blic o f Mold ova (20 14)

An gu illa (2016)Tokelau (201 4)

Bermuda (2 014)Saint Kitts and Nevis (2008)

Saint Lucia (2012)Belarus (2016)

Bahamas (2013 )

% of women aged 30-49

Source: WHO STEPS

Strategy towards the elimination of cervical cancer as aglobal public health problem: key outputs

VISION: A world without cervical cancer Guiding principles: life course and public health approach, social justice and equity, integrated people-centered health services

Accelerators3

1

2 Increased coverage of

HPV vaccinaMon

Increased coverage of screening & treatment of pre-cancer

lesions

Increased coverage of diagnosis &

treatment for invasive

cancer and palliative care

ACHIEVING 90% COVERAGE OF HPV VACCINATION

WHO recommendations• 2 doses to girls 9-14 , minimum 6 months apart• Introduce to multi-age cohort, 9-14 yrs ( 15-18 if feasible) in first year • 3 doses for: girls 15 y and older; and for immuno-compromised individuals

Challenges• Limited supply of the HPV vaccine • Vaccine not affordable and high delivery cost• ABer introducCon vaccinaCon coverage low in many countries due to factors like choice of

delivery strategy, insufficient communicaCon and hesitancy related factors

AcceleratorsSufficient, affordable supply of HPV vaccine• Concerted effort between partners and private sector to overcome vaccine supply constraintsIntroduction of HPV vaccine• Coordinated initiative to identify and leverage sustainable resources from countries and from

donors/financing agencies to introduce vaccines in more countriesIncreased quality and coverage of service delivery• Develop and implement high quality, multi-sectoral introduction plans• Use or develop sustainable and equitable delivery platforms• Develop high quality and sustained communication and mobilization approaches

ACHIEVING 70% COVERAGE OF SCREENING AND TREATMENT OF PRECANCER LESIONS

WHO recommendaMons• Women aged 30-49 be screened at least once in their lifehme for cervical cancer, and

rescreened every 5 years. • Women living with HIV should be screened every 3 years• Immediate treatment where possible

Challenges• Expensive and complex screen and treat technologies complicate scaling-up• New or optimized service delivery methods required for LMIC contexts

Accelerators• Sufficient, affordable supply of screen and treat technologies & products

• Prompt certification of new products• Price reductions

• National scale-up of screen & treat • Simple algorithms need to be introduced for different settings

• Increased quality and coverage of service delivery• Countries detailed implementation plans to introduce and scale-up products and delivery

models• Strengthen patient retention and linkage to treatment

TOWARDS CERVICAL CANCER ELIMINATION STRATEGY: TIMELINE

April– May Web-based consultation

May 13-15 African regional consultation

June 18-20 Eastern Mediterranean regional consultation

Aug-Sept RCM agenda item

Jan 2020 Executive Board Meeting

WHO Governing Bodies Meetings

Global consultation

May 2020 World Health Assembly

https://www.who.int/cancer/cervical-cancer

June 24-26 Western Pacific regional consultation

June 27-28 South East Asia regional consultation

Aug 01-02 Americas regional consultation

“Consign cervical cancer to the history books “