The World Health Organization (WHO) and the Human Reproduction Programme (HRP)—the main instrument within the United Nations system for research in human reproduction—have launched a new guideline to help countries make faster progress, more equitably, in the screening and treatment of cervical cancer.
In 2020, more than half a million women globally contracted cervical cancer, and about 342,000 women died as a result—most in the poorest countries. Quick and accurate screening programs are critical, so that every woman with cervical cancer gets the treatment she needs, and avoidable deaths are prevented.
WHO’s global strategy for cervical cancer elimination—endorsed by the World Health Assembly in 2020—calls for 70% of women globally to be screened regularly for cervical disease with a high-performance test, and for 90% of those needing it to receive appropriate treatment. Alongside vaccination of girls against the human papillomavirus (HPV), implementing this global strategy could prevent more than 62 million deaths from cervical cancer in the next 100 years.
“Effective and accessible cervical screening and treatment programs in every country are nonnegotiable if we are going to end the unimaginable suffering caused by cervical cancer,” said Dr. Princess Nono Simelela, Assistant Director-General for Strategic Programmatic Priorities: Cervical Cancer Elimination. “This new WHO guideline will guide public health investment in better diagnostic tools, stronger implementation processes, and more acceptable options for screening to reach more women, and save more lives.”
Changes in the Guideline
The new guideline includes some important shifts in WHO’s recommended approaches to cervical screening. In particular, it recommends an HPV DNA–based test as the preferred screening method, rather than visual inspection with acetic acid (VIA) or cytology, currently the most commonly used methods globally to detect precancerous lesions.
HPV-DNA testing detects high-risk strains of HPV which cause almost all cervical cancers. Unlike tests that rely on visual inspection, HPV-DNA testing is an objective diagnostic, leaving no space for interpretation of results. Although the process for a health-care provider obtaining a cervical sample is similar with both cytology or HPV-DNA testing, HPV-DNA testing is simpler, prevents more precancers and cancers, and saves more lives than VIA or cytology. In addition, it is more cost-effective.
More access to commodities and self-sampling is another route to consider for reaching the global strategy target of 70% testing by 2030. WHO suggests that self-collected samples can be used when providing HPV-DNA testing. Studies show that women often feel more comfortable taking their own samples rather than going to see a provider for screening. However, women need to receive appropriate support to feel confident in managing the process.
Recommendations Respond to the Link Between HPV and HIV
Women who are immunocompromised, such as those living with human immunodeficiency virus (HIV), are particularly vulnerable to cervical disease; they are more likely to have persistent HPV infections and more rapid progression to precancer and cancer. This results in a sixfold higher risk of cervical cancer among women living with HIV.
In recognition of this, the new guideline includes recommendations that are specific for women living with HIV. This includes using an HPV-DNA primary screening test followed by a triage test if results are positive for HPV to evaluate the results for risk of cervical cancer and need for treatment. The global recommendations also advise that screening for these women start at an earlier age (25 years) than for the general population of women (30 years). Women living with HIV also need to be retested after a shorter time interval following a positive test and following treatment than women without HIV.
“With these new guidelines, we must leverage the platforms already developed for HIV care and treatment to better integrate cervical cancer screening and treatment to meet the health needs and rights of the diverse group of women living with HIV to increase access, improve coverage, and save lives,” said Meg Doherty, MD, PhD, Director, WHO Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programs.
