Cervical Cancer Deaths Can Be Reduced By Over 63 Per Cent With Primary HPV Test Every 5 Years

The implementation of updated screening guidelines by the World Health Organization (WHO) can help reduce over 63 per cent of cervical cancer death rates in low-to-middle-income countries, new research led by the Daffodil Centre, a research centre on cancer control and policy, and a joint venture of Cancer Council NSW and the University of Sydney, has found. The findings have been published in two papers in Nature Medicine. As part of both studies, human papillomavirus (HPV) was screened in women in the general population in 78 countries, and multiple screening scenarios for women with human immunodeficiency virus (HIV) were analysed. These scenarios were calibrated for Tanzania, where HIV infection is endemic.

The studies took into consideration women in the general population, and analysed screening options in low- and middle-income countries. The reason why the studies were conducted was to support a major revision of WHO guidelines to help eliminate cervical cancer. 

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In 2020, the WHO called to eliminate cervical cancer as a public health problem. Since then, there has been significant global progress in implementing and expanding human papillomavirus immunisation, and cervical cancer screening and treatment programmes. 

In 2021, the WHO updated the organisation’s cervical cancer screening and treatment guidelines to further support the global strategy for cervical cancer elimination. This happened after an extensive review of existing scientific evidence was conducted. 

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In its updated guidelines, the WHO recommended the use of high-performance screening tests such as primary human papillomavirus DNA screening as the main approach for cervical cancer tests. 

The two new studies published in Nature Medicine have highlighted the key aspects of the evidence base for the WHO recommendations. 

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The aim of the studies was to assess the benefits and potential for harm of different approaches with a variety of cervical cancer screening tests, screening intervals, and age ranges to start and stop screening. 

Women living with HIV and women in the general population were given separate recommendations. This is because women living with HIV have a six-fold increased risk of developing cervical cancer. 

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The reason behind this is that the presence of HIV infection weakens the immune system, and makes individuals more vulnerable to human papillomavirus infection. This leads to rapid progression of human papillomavirus-related diseases. 

Therefore, the WHO updated its guidelines and recommended a shorter screening interval of every three to five years with a primary human papillomavirus DNA test for women living with HIV. Meanwhile, the general population of women were recommended a screening interval of five to 10 years. 

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Women living with HIV were asked to undergo a primary human papillomavirus DNA test, followed by a second triage test at a five-yearly interval. A triage test is one which confirms whether or not a person has a disease. This strategy was more effective at reducing cervical cancer cases and deaths compared to screening with visual inspection with acetic acid every three years, the WHO said in a statement.

For women living HIV who tested positive for human papillomavirus, a second triage test reduced the number of precancer treatments by 11 to 52 per cent. Therefore, the WHO recommended that an appropriate triaging strategy must be implemented for women living with HIV.

The Australian Government recently announced a $12.5 million grant to a consortium led by the Daffodil Centre to support the elimination of cervical cancer in the Indo-Pacific region. 

In a statement released by the University of Sydney, Dr Kate Simms, the lead author on the first paper, said human papillomavirus is responsible for almost all cervical cancers, and that the use of human papillomavirus screening in low- and middle-income countries, as has occurred in Australia, can significantly reduce mortality rates through earlier intervention.

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Human papillomavirus screening was found to be the most clinically effective and cost-effective, and reduced mortality by 63 to 67 per cent when offered every five years. 

Dr Michaelia Hall, the lead author on the second paper, said in the statement that primary human papillomavirus testing with triage compared with no screening reduced cervical cancer mortality by up to 71 per cent.

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