Can cervical cancer be eliminanted?
There is one area of women’s health that is progressed a touch differently from others. That area is cervical cancer, which in the year 2018 became the primary and still only cancer that the planet Health Organisation urged the world to eliminate.
The campaign around cervical cancer has shown us that if the impetus and leadership exists, also eradication of a disease is more than possible.Indeed, recent research from the united kingdom shows that the human papillomavirus (HPV) vaccination, has cut cases of cervical cancer by ninety per cent. And, thanks to innovation and improvements in screening programs, those that typically have a pelvic examination to check for the virus that causes cancer, will now be able to access a simple, less invasive swab test. The test is going to be available to eligible Australians from midway through the coming year.
When I spoke to Professor Marion Saville for the Women’s Health Project podcast, within hours of that announcement regarding the swab test being made, she was doubtless agitated and optimistic about what lay ahead.
We can not underestimate the significance and possibility of this swab screening in dismantling a number of the barriers that come with a more traditional pelvic examination.
She spoke about how this new swab process would help reach those falling through the cracks of the more traditional pelvic examination process, particularly in reached under-screened populations.
This self-collection method involves an easy swab accessed through a health provider, and similar to a Coronavirus-19 swab which could be done in a restroom or behind a curtain. it is less invasive than the more traditional screening process and is anticipated to enhance participation rates across currently under- screen populations, including linguistically diverse women and Aboriginal and Torres, strait Islander women.
Professor Saville has been with the VCS Foundation for decades, which changed its name just over every week ago to The Australian Centre for the Prevention of Cervical Cancer to better speak to its key goal of eliminating cervical cancer as a public health problem within the country.
She said Australia could become the primary country to succeed in the WHO elimination target.
So what is helped make this happen?
“ it is not an overnight success. There has been decades of support for an organised approach and has become the general public cervical screening program,” she said.Professor Saville noted a significant drop in cervical cancer figures that occurred within the year the 1990s when pap test registers were established and a variety of underperforming labs were regulated out.
When those falling figures plateaued within the early 2000s, there have been a few new developments the arrival of the HPV vaccine alongside a comprehensive rollout program, also as further improvements to screening and the screening reminder process.
But it has not been an equitable result.
“ without doubt equity in our program is the biggest challenge,” says Saville.
“ We will be the primary country to get there but we do not want to leave communities behind. Importantly Aboriginal women are two and a half to three times more likely to develop this cancer than other Australian women and almost four times as likely to die from it.”
As well as major attention needed on Indigenous communities, Saville says there's work to do in others like CALD and LGBTQI communities that are oft under-screened.
For decades, Professor Saville has been involved in various campaigns to reach under-screened women and has seen incremental gains in participation.
But she says around fifteen per cent of the eligible screening population are not going to participate in a pelvic examination. That is why the less invasive swab test is going to be such a game changer.
“ In our surveys of acceptability, I might characterise the rates we were seeing as a breakthrough in participation, not an incremental gain.
“ it is not one hundred per cent, but in our studies among women refusing a pap smear, we got around eighty-five per cent to return a swab they collected. Which is way greater than anything we did with reminders and support.
Easily for a few people there is physical discomfort. There are cultural barriers. Some people have experienced sexual abuse. There is a whole range of reasons why lying down and having a pelvic examination is just not something some people are willing to try to do.
The announcement is not saying you can not have a sample collected within the same way, of course, you can. But it is putting the participant in charge of that decision.”
Also, there is the scalability of the swab test, which just would not be possible with pelvic examinations.
Professor Saville speaks to the possibilities in places like Papua new guinea, where the rate of cervical cancer is around thirty in ( compared with Australia’s six) due to low rates of screening and detection.
“ it is a tragedy in those communities because it strikes women in their forties and fifties when they are critical to their families. multiple of them die without a diagnosis and adequate treatment,” she says.
“ there is a lot of work to do in those regions. But there's no way we were going to roll in the hay with our pap program.
“Self-collection gives us the scalability in lower and middle-income countries to have any hope of meeting those targets.”
Internationally, we have the tools to form the WHO’s elimination strategy a possibility.
But as Professor Saville says, we now need to figure out how to urge alike tools to as multiple communities internationally as possible.
“That is about political will, scaling up and implementation. That is where we were working now. It is an exciting time to be involved.”