About cervical cancer

The burden of cervical cancer

Cervical cancer is the fourth most common cancer among women worldwide, with 604,127 new diagnoses and 341,831 deaths registered in 2020 (IARC, 2021). The Global South is disproportionately affected by the burden of cervical cancer. Compared to high-income countries, incidence is almost twice as high in low- and middle-income countries, while mortality is three times higher (WHO, 2020).

Age standardized (world) incidence rates, cervix uteri, all ages

Cervical cancer prevention

Cervical cancer is called a ‘silent killer’: the disease can develop slowly and without symptoms over a period of 10 to 15 years. This window of time offers the opportunity to detect pre-cancerous stages that are treatable. Through conventional cytology-based screening, i.e. taking a cervical smear or pap smear, cervical cells are examined under the microscope to identify cellular changes. Low- and middle-income countries have not been able to effectively implement cytology-based screening programs due to various reasons such as lack of adequate infrastructure, trained manpower and absence of political will. Cervical cancer screening using visual inspection with acetic acid (VIA) has therefore been considered as a possible solution to these issues since it is a cheap and fast alternative that can be implemented in less equipped clinics. However, VIA is a subjective test, with a suboptimal sensitivity.

Low screening coverage is an important driver of high cervical cancer incidence. In countries where organised screening programmes are poorly designed or inadequately implemented, the proportion of under- or never-screened women is higher, and consequently, cervical cancer tends to affect more women.

The Human Papillomavirus

Cervical cancer is caused by the Human Papillomavirus, which is sexually transmittable. The virus is very common and up to 80% of all women become infected with HPV once in their life. Most women can clear such an infection and do not develop cervical cancer. There are also many types of HPV and only a few, the so-called oncogenic or high-risk HPV types, cause cervical cancer. Other HPV types are the causal agents of (genital) warts.

HPV testing is a relatively new form of cervical cancer screening in which the presence of HPV in a cervical smear is assessed and as such can prevent the development of cervical cancer at an early stage. As a result, women don’t need to be screened for HPV as regularly as conventional cytology-based screening. However, due to the high prevalence of HPV infections, false positive results happen more often (i.e. the detection of HPV infections that do not lead to the development of cervical cancer).