Looking Back, Moving Forward: Challenges and Opportunities for Global Cervical Cancer Prevention and Control

Abstract

Despite the introduction of Pap testing for screening to prevent cervical cancer in the mid-20th century, cervical cancer remains a common cause of cancer-related mortality and morbidity globally. This is primarily due to differences in access to screening and care between low-income and high-income resource settings, resulting in cervical cancer being one of the cancers with the greatest health disparity. The discovery of human papillomavirus (HPV) as the near-obligate viral cause of cervical cancer can revolutionize how it can be prevented: HPV vaccination against infection for prophylaxis and HPV testing-based screening for the detection and treatment of cervical pre-cancers for interception. As a result of this progress, the World Health Organization has championed the elimination of cervical cancer as a global health problem. However, unless research, investments, and actions are taken to ensure equitable global access to these highly effective preventive interventions, there is a real threat to exacerbating the current health inequities in cervical cancer. In this review, the progress to date and the challenges and opportunities for fulfilling the potential of HPV-targeted prevention for global cervical cancer control are discussed.

Keywords: HPV-related cancers; Human papillomavirus (HPV); Pap testing; cervical cancer; cytology; gynecologic oncology; vaccination.

Figure 1

(A) country-specific relationship between 2022 cervical cancer incidence [1] and gross domestic product (GDP) per capita (on a log scale) in 2022 [11] (black dotted line shows the linear trend); (B) country-specific relationship between 2022 cervical cancer mortality [1] and GDP per capita in 2022 (black dotted line shows the linear trend); and (C) country-specific relationship between the ratio of cervical cancer mortality to incidence and 2022 cervical cancer incidence [1] in 2022 (green dashed line shows the logarithmic trend). * If GDP per capita was not available for 2022, the most recent data were used.

Figure 2

Some of the barriers and possible solutions for delivering self-collection and HPV testing for cervical cancer screening along the care continuum in the U.S. ^† Need to be paid members of the medical home, which will require a billable CMS code for their services. ^‡ Women who test HPV positive (HPV+) but are negative for HPV16 and HPV18 will need an extra visit for cytology in the U.S. Self-collected specimens cannot be used for cytology because there are not enough diagnostic cells, and it is unlikely that the medium used for the self-collected specimen will preserve whole cells.