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NHS England Pledges to Eliminate Cervical Cancer by 2040

NHS England has set a target date of 2040 to eliminate cervical cancer through a combination of HPV vaccination and screening.

Its Chief Executive, Amanda Pritchard, said making the "ambition" a reality would be "an incredible achievement", as she appealed to people to come forward for vaccination and screening appointments when invited.

Addressing the NHS Providers' conference in Liverpool on Wednesday, Ms Pritchard said that the combination of the school-based HPV vaccine programme and cervical screening meant the disease was "on track to be eradicated". This would make England one of the first countries in the world to make a pledge to eliminate the disease within the next two decades. 

The World Health Organization (WHO) considers that cervical cancer can be eliminated as a public health problem when the incidence rate drops below 4 cases per 100,000 women per year. Three years ago it set global targets that if met by 2030, would put countries on the path towards cervical cancer elimination. These were to have:

  • 90% of girls fully vaccinated with the HPV vaccine by age 15
  • 70% of women screened by age 35, and again by age 45
  • 90% of women with access to treatment

More Flexibility for Vaccine Locations 

NHS England (NHSE) said that in order to make HPV vaccination as accessible as possible, it would support health and care professionals in targeted outreach, and give them increased flexibility to locate vaccine services in more convenient local settings such as libraries, community centres, and local leisure or sport facilities. Routine vaccinations will be offered alongside other health checks, such as blood pressure measurement, within a 'one-stop shop' setting.

In addition, the NHS app will be expanded to improve access to online vaccination appointments and enable people to view their full vaccination record, "so that everyone has their vaccine history and booking options in the palm of their hand", said Ms Pritchard.

One-third of Women Do Not Take Up Screening Offer

Currently, a third of women invited for cervical screening do not take up the offer, which Professor Peter Johnson, NHSE's national clinical director for cancer, said represented "a big risk for our plans".

Last year's annual figures from NHS Digital showed an increase in the absolute number of people undergoing cervical screening in 2021-2022 compared with the previous year, but this was influenced by increases in the eligible population, increased surveillance invitations and referrals to colposcopy, and potential catch-up activity following pandemic era disruptions.

Alongside the vaccination drive, the NHS aims to expand the number of women invited for cervical screening, as well as enabling a trial of self-sampling to assess its potential role within the national screening programme. Research last year by King's College London showed that just over half of women would opt for self-sampling if given the choice, and the proportion rose to 70% among those not attending regular screening.

HPV Self-sampling a "Game Changer"

In January this year cervical cancer charity Jo's Trust described HPV self-sampling as "the top game changer" in moving closer to the elimination goal, with the potential to increase participation rates in nonattendees by up to a third or more. However, while agreeing there was now the chance to consign the disease to the history books, it highlighted inequalities in access and falling uptake of both HPV vaccination and cervical screening.

The UK Health Security Agency (UKHSA) in January also expressed "concern" over falling HPV vaccine coverage, noting that it had "yet to return to prepandemic levels" as the programme had been disrupted by school closures. During the 2021-2022 academic year, it had decreased by 7% in year 8 females and 8.7% in year 8 males compared with the previous year.

NHSE said that that through routine and postpandemic catch-up programmes, 86.5% of girls and 81.5% of boys had now received one dose of the HPV vaccine by school year 10. However, following advice from the Joint Committee on Vaccination and Immunisation (JCVI), the programme had now been changed to offer a single dose (instead of two) for young people up to 25 years of age. 

The move aimed to make vaccination more convenient and increase uptake, and a single dose was now being offered within the school programme to those in year 8 (aged 12 or 13 years). Children can also get the HPV vaccine at community clinics, and anyone eligible who hasn't received one dose can catch up through their GP practice until their 25th birthday.

Resources, Training, and Infrastructure Needed

Cancer Research UK's head of health and patient information, Dr Julie Sharp, said that the charity supported NHSE's target and pledge, but that to ensure equal access "there must be targeted action to increase HPV vaccination coverage and reduce barriers to cervical screening". The ambition would only be achieved if the vaccination and screening programmes were "backed by sufficient resources and modern IT infrastructure", she said.

Commenting on Ms Pritchard's speech, Miriam Deakin, director of policy and strategy at NHS Providers, welcomed the elimination goal but cautioned that ensuring healthcare staff had the resources and training needed to implement the plans effectively would be "crucial" to its success.