More than 6,00,000 new cases of cervical cancer and more than 3,40,000 deaths from the disease were reported around the world in 2020, according to an observational study published in The Lancet Global Health journal. India reported 1,23,907 new cases of cervical cancer and 77,348 deaths, according to the study. Though the incidence of cervical cancer has decreased in many parts of the world —notably in Latin America, Asia, Western Europe, and North America — over the past three decades, the burden remains high in many low- and middle-income countries.
The study used the International Agency for Research on Cancer’s (IARC) Global Cancer Observatory (GLOBOCAN) 2020 database to estimate the burden of cervical cancer incidence and mortality rates in 185 countries. In 2020, overall incidence was 13 per 1,00,000 women; mortality was 7 per 1,00,000 women. As many as 172 out of the 185 countries saw more than the 4 cases per 1,00,000 women per year threshold for elimination set by the World Health Organisation (WHO).
The development of effective vaccination against the human papilloma virus (HPV), which causes cervical cancer, and screening programmes have made cervical cancer a largely preventable disease. In 2020, the WHO announced a target to accelerate the elimination of the disease as a public health problem, aiming to reduce incidence to less than 4 cases per 1,00,000 women per year in every country by 2030. This study tracks the progress on cervical cancer rates and identifies the countries and regions where scaling up efforts are required to reach WHO targets.
Dr Deependra Singh, cancer epidemiologist with IARC/ WHO, France, told The Indian Express: “The effectiveness of vaccination in reducing cervical cancer incidence takes several years or decades. The screening and treatment of precancerous and invasive cervical cancer is still fundamental to achieving the WHO’s elimination target. Vaccination should be encouraged together with sexual health education in schools; it should be part of the school curriculum.”
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PremiumDr Singh said the study has detected encouraging decreases in some high-income countries such as Sweden, Australia, and the UK following successful implementation of HPV vaccination programmes and screening, but globally the burden remains high. “All over the world, women should be free from the risk of preventable cancer, and with the development of effective vaccines and screening over the past 20 years, we have the tools to make this a reality,” he said.
Case rates for cervical cancer ranged from two cases in Iraq to 84 in Eswatini per 1,00,000 women per year, while mortality rates ranged from one death in Switzerland to 56 deaths in Eswatini per 1,00,000 women per year.
An analysis of data from 1988 to 2017 show a clear socioeconomic gradient in incidence and mortality, with higher rates observed in countries with lower socioeconomic development.
The study found major declines in cases in Latin American countries including Brazil, Colombia, and Costa Rica; Asian nations like India, Thailand, and South Korea; and Poland, Slovenia, and the Czech Republic in Eastern Europe.
However, there were increases in cases over the past decade in Latvia, Lithuania, and Bulgaria, in parts of East Africa, as well as in The Netherlands and Italy. Reasons for the recent increases might include increased prevalence of HPV among the younger generations of women and lack of effective screening programmes, according to the study report.
Countries with the largest average declines in incidence rates per year include Brazil (8%), Slovenia (7%), Kuwait (7%), and Chile (6%). The highest increases in rates were seen in Latvia (4%), Japan (3%), Ireland (3%), Sweden (3%), Norway (2%), Northern Ireland (2%), Estonia (2%), and China (2%).
The estimates in the report are based on the best available cancer data in each country, even though the authors caution that these may be incomplete or inaccurate. For instance, cases may appear low in countries where there are no effective screening programmes, or where limited local population-based cancer registry data are available.
