and the potential negative implications this framing could have on misdirecting policy makers towards ineffective strategies to reduce cervical cancer burden. We appreciate this feedback and the opportunity to clarify our intentions in the published analysis.
and, as noted by Jackson, is linked to persistent infection with high-risk human papillomaviruses (HPVs) that are transmitted through sexual contact. In the GBD study, the risk factor of unsafe sex is used to quantify the risk of having sex with someone that might have an infection that can be sexually transmitted if protection is not used, and is a risk factor associated with HIV, sexually transmitted infections, and cervical cancer as outcomes.
As this exposure can be challenging to estimate, 100% of cervical cancer burden is estimated to be attributable to this risk factor.
We agree that vaccination against HPV should be emphasised as a crucial cervical cancer prevention strategy and, in alignment with the WHO cervical cancer elimination initiative,
that evidence-based strategies towards the elimination of cervical cancer should also include screening and treatment of precancer and invasive cancer. The burden of cervical cancer weighs disproportionately in low Socio-demographic Index settings, and is most likely multifactorial in aetiology and includes disparities in access to high-quality screening and treatment.
I declare no competing interests.
References
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The global burden of cancer attributable to risk factors, 2010–19: a systematic analysis for the Global Burden of Disease Study 2019.
Lancet. 2022; 400: 563-591
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Cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life years for 29 cancer groups from 2010 to 2019: a systematic analysis for the Global Burden of Disease Study 2019.
JAMA Oncol. 2022; 8: 420-444
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Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019.
Lancet. 2020; 396: 1223-1249
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Global strategy to accelerate the elimination of cervical cancer as a public health problem.
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Cervical cancer elimination initiative.
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Published: 18 February 2023
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- A systematic analysis points in the wrong direction for cervical cancer elimination
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In August, 2022, the GBD 2019 Cancer Risk Factors Collaborators published a systematic analysis that identified unsafe sex as the second leading risk factor for cancer in women globally.1 This finding was driven by data on cervical cancer, which is linked to persistent infection with high-risk human papillomaviruses (HPVs) that are transmitted through sexual contact. The authors concluded that reducing exposure to unsafe sex and other modifiable risk factors would reduce the global burden of cancer.
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