THE IMPORTANCE OF THE CERVICAL CANCER ORGANISED SCREENING PROGRAMS
Abstract
According to the most recent published data from 2020, cervical cancer is among the first five most frequently diagnosed cancers in the female population. It is the second leading cause of cancer mortality in young, working women during their reproductive period. Prevention of cervical cancer through screening programs has been applied since the 1960s, and the scientific community agrees that it is a highly preventable disease with a strong possibility for cure if detected in a premalignant and early malignant phase and effective treatment administrated without delay.
Countries that effectively implement organized screening programs record a significant decrease in the incidence and mortality rates of cervical cancer. Their experience can be useful as a model for countries that still do not have established organized programs or have an unsatisfactory level of implementation or quality. These are mainly underdeveloped and developing countries, where exposure to risk factors is still very high, preventive activities are limited and consequently, the burden of cervical cancer is still at a very high level.
The challenge remains how to adapt screening program strategies to the conditions of those countries to achieve high coverage of the target population with a test of appropriate performance to establish control over the increasing trend and in the coming decades to reach the targeted decline in incidence and mortality rates.
So far, it is the only malignant disease for which there is scientific evidence that it can be eliminated to a frequency that will no longer represent a public health problem. Reducing the incidence rates should be an effect that would be seen at the global level, and to achieve it, it is necessary to strongly support countries in establishing adequate programs of prevention and early detection of cancer supported by effective treatment and care.
References
1. Global strategy to accelerate the elimination of cervical cancer as a public health problem. World Health Organization 2020.
2. Ferlay J, Ervik M, Lam F, Colombet M, Mery L, Pineros M, et al. Global Cancer Observatory: Cancer Today. Lyon, France: International Agency for Research on Cancer 2020.
3. Arbyn M, Weiderpass E, Bruni L, de Sanjosé S, Saraiya M, Ferlay J, et al. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. Lancet Glob Health. 2020; 8(2):e191–203.
4. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021; 71(3):209–49.
5. IARC Working Group on the Evaluation of Cancer-Preventive Interventions. Cervical Cancer Screening: IARC Handbooks of Cancer Prevention. Vol.18. Lyon France: International Agency for Research on Cancer; 2022.
6. Dhillon PK, Yeole BB, Dikshit R, Kurkure AP, Bray F. Trends in breast, ovarian and cervical cancer incidence in Mumbai, India over a 30-year period, 1976–2005: an age-period-cohort analysis. Br J Cancer. 2011; 105(5):723–30.
7. Vaccarella S, Franceschi S, Zaridze D, Poljak M, Veerus P, Plummer M, et al. Preventable fractions of cervical cancer via effective screening in six Baltic, central, and eastern European countries 2017–40: a population-based study. Lancet Oncol. 2016; 17(10):1445–52.
8. Ojamaa K, Innos K, Baburin A, Everaus H, Veerus P . Trends in cervical cancer incidence and survival in Estonia from 1995 to 2014. BMC Cancer. 2018; 18(1):1075.
9. Jedy-Agba E, Joko WY, Liu B, Buziba NG, Borok M, Korir A, et al. Trends in cervical cancer incidence in sub-Saharan Africa. Br J Cancer. 2020; 123(1):148–54.
10. Li X, Zheng R, Li X, Shan H, Wu Q, Wang Y, et al. Trends of incidence rate and age at diagnosis for cervical cancer in China, from 2000 to 2014. Chin J Cancer Res. 2017; 29(6):477–86.
11. Allemani C, Matsuda T, Di Carlo V, Harewood R, Matz M, Nikšić M, et al.; CONCORD Working Group. Global surveillance of trends in cancer survival 2000–14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet. 2018; 391(10125):1023–75.
12. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Human Papillomaviruses. Lyon (FR): International Agency for Research on Cancer; 2007.
13. Poljak M, Kocjan B, Oštrbenk A, Hošnjak L. Značilnost okužbe sa HPV. Zbornik predavanj , 5. izobraževalni dan programa ZORA 2014.
14. Bruni L, Serrano B, Diaz Sanchis M, Bosch José FX, de Sanjosé Llongueras S. Update of global estimates of HPV prevalence: meta-analysis of 2.4 million women with normal cytology. Presented at International Papillomavirus Conference, Sydney, Australia.2016.
15. Joura EA, Kyrgiou M, Bosch F, Kesic V, Niemenen P, Redman C et al. Human papillomavirus vaccination: The ESGOeEFC position paper of the European society of Gynaecologic Oncology and the European Federation for colposcopy. European Journal of Cancer.2019; 201;116:21-26.
16. Castellsague X, Munoz N, Pitisuttithum P, Ferris D, Monsonego J, Ault K. End-of-study safety, immunogenicity, and efficacy of quadrivalent HPV (types 6, 11, 16, 18) recombinant vaccine in adult women 24-45 years of age. Br J Canc. 2011;105:28-37.
17. World Health Organization. Human papillomavirus vaccines (HPV). https://www.who.int/teams/immunization-vaccines-and-biologicals/diseases/human-papillomavirus-vaccines-(HPV). [Accessed 19th March 2023].
18. IARC Working Group on the Evaluation of Cancer Preventive Strategies. Cervix cancer screening. IARC Handb Cancer Prev. Vol.10. Lyon France: International Agency for Research on Cancer; 2005.
19. Basu P, Lucas E, Carvalho AL, Sauvaget C, Muwonge R, Herrero R, et al. Cancer screening in five continents. https://canscreen5.iarc.fr. [Accessed 19th March 2023]
20. Arbyn M, Anttila A, Jordan J, Ronco G, Schenck U, Segnan N, et al. European guidelines for quality assurance in cervical cancer screening. Second edition – summary document. Ann Oncol. 2010; 21(3):448–58.
21. Miles A, Cockburn J, Smith RA, Wardle J. A perspective from countries using organized screen-ing programs. Cancer. 2004; 101(S5):1201–13.
22. Cuzick J, Clavel C, Petry KU, Meijer CJ, Hoyer H, Ratnam S, et al. Overview of the European and North American studies on HPV testing in primary cervical cancer screening. Int J Cancer. 2006;119:1095–101.
23. Ronco G, Arbyn M, Meijer CJLM, Snijders PFJ, Cuzick J. Screening for cervical cancer with primary testing for human papillomavirus, S1, in: Anttila A, Arbyn M, De Vuyst H, Dillner J, Dillner L, Franceschi S. European guidelines for quality assurance in cervical cancer screening, Second edition – Supplements. Office for Official Publications of the European Union, Luxembourg, 2015.
24. Von Karsa L, Arbyn M, DeVuyst H, Dillner J, Dillner L, Franceschi S, et al. European guidelines for quality assurance in cervical cancer screening. Summary of the supplements on HPV screening and vaccination. Papillomavirus Res. 2015;1:22–31.
25. Federation of European Academies of Medicine. Statement on the Council cancer screening recommendations. https://www.feam.eu/statement-on-the-european-council-cancer-screening-recommendations/. [Accessed 19th March 2023].
26. Marić G, Birčanin Đ, Kisić V, Dotlić J, Zarić M, Kisić-Tepavčević D, et al. Parental perspective on human papillomavirus (HPV) vaccination in Serbia: Knowledge, attitudes and practice. Sexual & Reproductive Healthcare. 2018;16:192–198.