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Title: Response to: Scaling up cervical screening and HPV vaccination for global elimination of cervical cancer and Global elimination of cervical cancer: Indigenous women must be included.
Authors: Simms KT; Steinberg J; Caruana M; Smith MA; Lew JB; Canfell K
Categories: Cancer Type - Cervical Cancer
Year: 2019
Journal Title: Lancet Oncology
Volume: 20
Issue: 5
Abstract: Our recent study1 found that if very high global coverage of both human papillomavirus (HPV) vaccination and cervical screening is achieved from 2020, 12·5–13·4 million cervical cancer cases could be prevented globally over the next 50 years, and that even if a low threshold of four cases per 100000 women is set, most countries could achieve elimination of cervical cancer as a public health problem by 2099. Prabhat Kumar and colleagues propose that achieving this level of coverage would be a “herculean task” for many low-income and middle-income countries. We agree, and discussed in the original paper the barriers to scaling up cervical cancer prevention in many countries, including access to screening tests, and provision of quality colposcopy, pathology, and precancer treatment procedures.1 However, the availability of point-of-care HPV testing and self-sampling (shown to be highly acceptable and effective across many settings) holds considerable promise as a way to improve access to screening. Some low human development index (HDI) countries have introduced national HPV vaccination programmes with very high coverage, including Bhutan, Malaysia, and Rwanda. Kumar and colleagues also note that vaccine hesitancy might present a substantial challenge in India. Lessons can be taken from countries like Denmark and Ireland, where vaccine confidence and thus coverage were disrupted but have since been restored.2,3 We also wish to highlight to Kumar and colleagues that we captured declining trends of cervical cancer in India in our original analysis; we performed a statistical trends analysis using International Agency for Research on Cancer data for 37 registries across 20 high-density countries, including four Indian registries. We found that, despite declining trends, India would experience the highest absolute burden of cervical cancer in the world over the next 50 years with more than 7·5 million cases diagnosed if screening and vaccination are not scaled up. Almost 2·5 million of these cases could be averted if access to screening and vaccination is rapidly scaled up.
Division: Cancer Research Division
Funding Body: KTS, JS, MC, MAS, J-BL, PEC, and KC report grants from the National Health and Medical Research Council. MC is an investigator and KC co-principal investigator on an investigator-initiated trial of cytology and primary HPV screening in Australia (Compass; ACTRN12613001207707 and NCT02328872), which is conducted and funded by the VCS Foundation, a government-funded health promotion charity; the VCS Foundation have received equipment and a funding contribution for the Compass trial from Roche Molecular Systems and Ventana, USA. However, neither KC, MC, nor their institution on their behalf (Cancer Council New South Wales) receive direct or indirect funding from industry for Compass Australia or any other project. PEC has received at reduced or no cost HPV tests and assays for research from Roche, Becton Dickinson, Cepheid, and Arbor Vita Corporation. FB and IS declare no competing interests.
Appears in Collections:Research Articles

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