Elimination of cervical cancer in the European Region

As part of its mission to promote health and well-being, the World Health Organization (WHO) European Region has prioritized the elimination of cervical cancer, which largely hinges on effective strategies to combat HPV.

More than 66,000 women are diagnosed with cervical cancer and more than 30,000 deaths are recorded annually in the Region. In the last decade, access to HPV vaccination in the European Region has increased. Over 80% of the member states in the WHO European Region have introduced the HPV vaccine into their national immunization programs. Vaccines are currently recommended for girls between the ages of 9 and 14 in 38 of the 53 countries in the region. Early vaccination before contact with the virus is essential to achieve the maximum benefits of vaccination.

In countries with established vaccination programs, coverage for the first dose among target groups ranged between 70% to 90%, though there were variances from country to country.

However, Eastern Europe lags behind Western and Northern Europe in terms of HPV vaccination coverage. While some Western European countries boast coverage rates above 80%, many Eastern European nations struggle to achieve even 20% coverage among the target population.

90-70-90 targets

The World Health Organization (WHO) launched a global strategy in November 2020 to accelerate the elimination of cervical cancer as a public health problem. The strategy is based on three key pillars, often referred to as the "90-70-90 targets" to be achieved by every country by 2030 [1]:

Prevention

Target: Vaccinate 90% of girls with the HPV vaccine by the age of 15.
Action: The WHO recommends the introduction and scaling-up of the HPV vaccination in national immunization programs. Given that persistent infection with specific high-risk HPV types is the primary cause of cervical cancer, vaccinating pre-adolescent girls (and, where feasible, boys) can significantly reduce the risk.

Screening and Diagnosis

Target: Screen 70% of women using a high-performance HPV DNA test at 35 and 45 years of age.
Action: The WHO recommends that women undergo screening at key ages to detect and treat precancerous lesions before they become invasive cancers. The emphasis on HPV DNA testing, which detects the presence of the virus rather than changes in cervical cells, is due to its higher sensitivity and longer-lasting negative predictive value compared to traditional cytology-based methods like the Pap smear.

Treatment and Care

Target: Treat 90% of women identified with cervical disease.
Action: This includes:
- Treating 90% of women with precancerous lesions through methods like cryotherapy, LEEP (Loop Electrosurgical Excision Procedure), or cold coagulation.
- Providing 90% of women diagnosed with invasive cervical cancer access to more advanced treatments such as surgery, radiotherapy, and chemotherapy.

The European Commission launched Europe's Beating Cancer Plan in February 2021, which aims to tackle the entire disease pathway, from prevention to quality of life of survivors. Cervical cancer, being one of the most preventable forms of cancer when adequate measures are in place, is specifically addressed within the plan [2].

Key objectives and actions related to cervical cancer in the Europe's Beating Cancer Plan include:

Prevention through Vaccination: The plan emphasizes the importance of vaccination against HPV, which is responsible for the vast majority of cervical cancer cases. Aiming to vaccinate at least 90% of the EU target population of girls (and, where feasible, boys) by 2030. Efforts will also be made to promote catch-up vaccination for those who did not receive it at the target age.

Screening: The goal is to screen 90% of the EU target population of women for cervical cancer by 2030. Screening plays a vital role in the early detection of precancerous lesions, allowing for timely treatment.
The plan promotes the implementation and improvement of population-based screening programs, ensuring they adhere to the best practices and guidelines. Improving access, quality, and diagnostics of screening programs is emphasized, especially utilizing HPV DNA-based tests, which are more effective than traditional cytology in detecting high-risk HPV strains.

Successful models in eliminating HPV infection

The UK's experience with HPV vaccination demonstrates that cervical neoplasm is a preventable disease. In the United Kingdom, one of the first countries in the WHO European Region [3] to introduce HPV vaccination, it has been shown that through the immunisation programme cervical cancer is almost eliminated in women born after 1 September 1995. They were vaccinated at the age of 12-13 years. In these women, the incidence of high-grade precancerous cervical lesions (CIN3) was significantly reduced.

The UK's strategy has several components:

HPV Vaccination: The UK introduced the HPV vaccination program in 2008, and since then, girls aged 12 to 13 have been offered the HPV vaccine for free as part of the school-based vaccination program. In 2019, the UK expanded the HPV vaccination program to include boys aged 12 to 13 as well, with the aim of protecting them against HPV-related cancers and diseases.
Cervical Cancer Screening: The UK's cervical screening program has been in place since the 1980s and offers free cervical screening tests to women aged 25 to 64. In 2019, the UK introduced a more sensitive test for HPV as part of its cervical screening program, which aims to detect HPV infection and cervical cancer earlier.
Public Health Campaigns: The UK government and various health organizations have launched public health campaigns to increase awareness about the importance of HPV vaccination and cervical screening. The campaigns aim to address the misconceptions surrounding HPV and encourage more people to take up the HPV vaccine and cervical screening.

Through these components, the UK aims to eliminate cervical cancer as a public health problem, with a goal to reduce the number of cervical cancer cases by 90% by 2035. The success of the UK's HPV elimination strategy can already be seen, with the HPV vaccination program and cervical screening program contributing to a significant decrease in the incidence of cervical cancer and related deaths.

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