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Making Cervical Cancer 'a Thing of the Past'

To coincide with Cervical Cancer Prevention Week, which starts today, cervical cancer charity Jo's Trust has launched its biggest ever campaign, aiming to 'End Cervical Cancer in the UK'. Its latest report, also published today, on the opportunities and challenges to eliminating the disease, said: "Our vision is of a day where cervical cancer is a thing of the past. This goal is not beyond our reach."

"The UK has the tools to get there. We have a wide-reaching HPV vaccination programme, and highly effective cervical screening and colposcopy services. Innovations in these programmes mean we are preventing more cases than ever before," the report said.

"However, we are also faced with inequalities in access, falling uptake, and other barriers preventing progress.” The charity called for collaboration, innovation, and investment for these programmes, which "have the potential to reduce some of the pressure on the NHS on a longer-term basis".

'Opportunity' to Consign Cervical Cancer 'To the History Books'

"We have an opportunity to effectively consign a cancer to the history books. This will reduce costs to the NHS and UK economy as well as saving lives. We want to get to that point as fast as we can," the report said.

Elimination would require "political will, investment, and collaboration", and the Trust called on UK Governments "to rise to the challenge and to commit to taking the necessary steps to achieve a future free from cervical cancer".

The report included a survey of 848 practice nurses, clinical nurse specialists, biomedical scientists, radiographers, oncologists, and researchers working in cervical cancer prevention and treatment across the UK. It highlighted that, while 87% of health professionals believed that cervical cancer elimination should be a priority for the UK Government, only 17% thought enough was currently being done to achieve this. Only a fifth (20%) thought that there was sufficient action to ensure high levels of HPV vaccine uptake, and just 16% believed that efforts to support cervical screening uptake were enough. 

HPV Self-sampling Top 'Game Changer'

Jo's Trust reports that cervical cancer is the fourth most common cancer in women globally. It currently kills two women in the UK every day, with nine more per day newly diagnosed, and an incidence of 11.1 per 100,000. The World Health Organisation target is 4 per 100,000.

The Trust highlighted the need for Government commitment, with clear targets and timelines, alongside speed in innovations such as HPV self-sampling, which it described as "the top game changer" to move closer to the elimination goal. It added that measures to improve cervical cancer prevention also had "the potential to aid future workforce pressures and costs in the NHS on a longer-term basis".

However, according to Cancer Research UK (CRUK), cervical screening coverage has been declining for around two decades, and Jo's Trust bemoaned that the latest figures showed that in England just 69.6% of women were up to date with their screening. The survey revealed that staff believed that the biggest challenges to elimination were workforce pressures and inequalities in uptake of HPV vaccination and cervical screening.

Since the UK HPV vaccine roll out, cases of cervical cancer have fallen 87% amongst women in their 20s, but uptake of the first dose England for the 2021/22 school year fell by 7% in eligible girls and 8.6% in boys compared with the previous year. Two-dose coverage for girls was just 67.3% by year 9. While this is higher than the 60.2% achieved in 2020/21, it is still 20% lower than pre-pandemic levels.

In Wales, two-dose coverage for girls in school Year 10 was just 55.1% in 2021/22, an improvement from 37.7% in 2020/21, but again still significantly below pre-pandemic levels of 81.2%.

HPV self-sampling was considered one of the biggest opportunities to eliminate cervical cancer in the UK by more than 70% of survey respondents, closely followed by national public awareness campaigns about the role of vaccination and screening, which 68% thought offered a major opportunity to eliminate cervical cancer – more than increasing cervical screening coverage (53%), extending the vaccination programme (43%) or targeted/risk-based screening (35%).

Self-Sampling Preferred by More Than Half of Women

The charity noted that self-sampling, which allows women to test for HPV in their own home, had increased participation rates by up to 34.2% among screening non-attendees in countries where it had been offered, and that women generally preferred it to clinician-led screening.

A CRUK-funded study from King's College London last year showed that more than half (51.4%) of 3672 women said they would choose self-screening if offered, as against 36.5% who would still prefer clinician screening. Self-testing was particularly preferred by irregular and never attenders (71.1% and 70.1%, respectively), compared with 41.0% in regular attenders.

Pilot studies of self-sampling in the UK have shown that self-sampling clinical accuracy is high, although it has been found to have slightly reduced sensitivity for cervical intraepithelial neoplasia (CIN)2+. In terms of priorities for the cervical screening progamme, more than half (50.9%) of survey respondents thought HPV self-sampling with swab as an option for all women should be a top priority, 45.3% said HPV self-sampling with swab should be offered to non-attenders, and almost a third (31.1%) voted for HPV self-testing with urine.

Jo's Trust said: "HPV self-sampling could provide a step change for many who find the existing test inaccessible. Policy decisions must balance any risks against benefits, while research must continue to remove any risks,

continue to identify further ways to tackle barriers to screening and make the test as accessible as possible for everyone."

The Trust also noted that there was shame and stigma associated with HPV and that this was "overwhelmingly carried by women, as there is no HPV screening programme for men". This stigma can negatively influence willingness to undergo an HPV test, it said.

A World Without Cervical Cancer Could be 'a Reality'

Samantha Dixon, chief executive at Jo’s Cervical Cancer Trust said: "A world without cervical cancer doesn’t have to be a pipe dream. The UK has the tools to make it a reality, which is incredibly exciting. We need Government action to get there as soon as possible, but everyone can play their part. Going for cervical screening when invited, and making sure your child is vaccinated against HPV, will help make cervical cancer a thing of the past.

"We must also continue to invest in research, improve access to treatments, and banish the stigma and blame that too often comes with a cervical cancer diagnosis. Being forward-looking should not mean those living with and beyond cancer get left behind. "

Dr Ellie Cannon, a London NHS GP and broadcaster said: "Ending cervical cancer should be a priority and something we can all get behind. Progress to date has been too slow - GPs like myself are still seeing too many people miss their screening when called, which means they are in danger of being diagnosed late. This needs to change.

"We have an opportunity now to alleviate some of the NHS pressure in this area on a longer-term basis. With the right measures and a joint focus on innovation and protecting the workforce, we can take huge strides forward in this area."

'Government Must Deliver on its Promise'

Asked to comment by Medscape News UK, Cancer Research UK’s chief executive, Michelle Mitchell, said: "This report rightly highlights the potential, through cervical screening and HPV vaccination programmes, to reduce cervical cancer to the point where almost no one develops it. But for this to happen, we need to ensure that the NHS has the resource and capacity to meet demand both now and in the future.

"The Government must deliver on its promise to publish a 10-year cancer plan, which should include action to address barriers to HPV vaccination and cervical screening – with a particular focus on hard-to-reach groups. Otherwise, we risk exacerbating existing inequalities."

Dr Ranee Thakar, president of the Royal College of Obstetricians and Gynaecologists, told Medscape News UK: "We are hugely supportive of Jo's Cervical Cancer Trust’s report and mission to eliminate cervical cancer in the UK. 

"The report sets out key opportunities to reduce inequalities and actions to tackle cervical cancer – increasing symptom awareness, increasing uptake of cervical screenings by removing barriers to access and adopting evidenced-based innovations, and ensuring that there is accurate and accessible patient-centred information throughout every woman’s life. Everyone should have equal access to services and information.

"We join Jo’s Trust in calling for Government action to embrace these opportunities and eliminate cervical cancer in the UK."

The paper was supported by the British Association for Cytopathology, the Eve Appeal, Go Girls, the Primary Care Women’s Health Forum, Saphna, tenov cancer care, the Royal College of Pathologists and Wellbeing of Women, and endorsed by the Faculty of Sexual and Reproductive Healthcare at the Royal College of Obstetricians and Gynaecologists.