Cervical cancer is the fourth most common cancer among women worldwide, with an estimated 604,000 new cases and 342,000 deaths in 2020. In 2020, about 90% of new cases and deaths worldwide occurred in low- and middle-income countries (1) .
Two types of human papillomavirus (HPV) (16 and 18) cause nearly 50 percent of high-grade cervical precancers.
HPV is usually transmitted sexually, and most people become infected with HPV soon after having sex. Over 90% of them eventually clear the infection.
Women with HIV are six times more likely to develop cervical cancer than women without HIV.
HPV vaccination and screening and treatment of precancerous conditions are cost-effective ways to prevent cervical cancer.
Cervical cancer can be cured if it is diagnosed at an early stage and treated promptly.
Comprehensive cervical cancer control includes primary prevention (vaccination against HPV), secondary prevention (detection and treatment of precancerous conditions), tertiary prevention (diagnosis and treatment of invasive cervical cancer) and palliative care.
Overview
Worldwide, cervical cancer is the fourth most common cancer among women, with 604,000 new cases in 2020. About 90% of the 342,000 deaths from cervical cancer in 2020 occurred in low- and middle-income countries. HIV-infected women are 6 times more likely to develop cervical cancer than non-HIV-infected women, and 5% of all cervical cancer cases are associated with HIV infection (2). Also, in all regions of the world, the contribution of HIV to cervical cancer is relatively small in young women.
In high-income countries, there are programs to vaccinate girls against HPV and to ensure women receive regular screening and appropriate treatment. Screening allows pre-cancerous conditions to be detected at an easily treatable stage.
In low- and middle-income countries, access to these preventive measures is limited, and cervical cancer is often not detected until it is advanced or symptomatic. In addition, cancer treatments (eg, cancer surgery, radiation therapy, and chemotherapy) may be limited, leading to higher cervical cancer mortality rates in these countries.
The high global mortality rate from cervical cancer (age-standardized rate for women: 13.3/100 000 in 2020) can be reduced by effective interventions at different life stages.
HPV and cervical cancer
The majority of cervical cancers (more than 95%) are caused by human papillomavirus (HPV).
HPV is the most common viral infection of the reproductive tract. Most sexually active women and men will be infected at some point in their lives, and some may be infected repeatedly. More than 90% of the infected population clears the infection.
Cervical cancer is the most common disease associated with HPV. Almost all cases of cervical cancer can be attributed to HPV infection.
Although most HPV infections are self-limiting and most precancerous lesions resolve spontaneously, all women are at risk of developing chronic HPV infection and developing precancerous lesions into invasive cervical cancer.
It takes 15-20 years for a woman with a normal immune system to develop cervical cancer. For immunocompromised women, such as HIV-infected women, it takes only 5-10 years.
Cervical cancer surveillance: a comprehensive approach
The Global Strategy to Eliminate Cervical Cancer as a Public Health Problem, adopted by the World Health Assembly in 2020, proposes a comprehensive approach to cervical cancer prevention and control. The proposed intervention spans the lifespan.
