Preventable and treatable
European governments need to do more to raise public awareness of HPV and cervical cancer and to ensure that more people are vaccinated and regularly attend cervical screening tests, reports Brian Johnson.
Those were the key messages emerging from the launch, last month, of the Europe-wide Cervical Cancer Prevention Policy Atlas in the UK’s House of Commons, organised by the European Parliamentary Forum for Sexual & Reproductive Rights (EPF) and the UK’s All-Party Parliamentary Group on Population, Development and Reproductive Health.
The launch event was hosted by Baroness Jenny Tonge, who reminded participants that - despite being preventable and treatable - cervical cancer was the second most common cause of female cancer deaths in women aged 15-44. “When I was practicing as a doctor in the 70s and 80s, cervical cancer wasn’t considered to be a young person’s disease.”
“When we were calling women in for smears, we didn’t bother with younger women. Then we gradually saw more and more positive smears coming in from young people and from teenagers, and gradually the link with the human papillomavirus (HPV) was made.”
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Over 67,000 women are diagnosed with cervical cancer in Europe each year and more than 25,000 die from the disease annually.
The EPF’s Cervical Cancer Prevention Policy Atlas provides country-by-country ranking based on access to online information on cervical cancer, national cancer screening and HPV vaccination programmes.
With a score of 100 percent, Belgium, Denmark, Ireland and the UK were dubbed the Atlas’s prevention policy ‘champions’. EPF Secretary Neil Datta explained that the Policy Atlas wasn’t so much an analysis of HPV and cervical cancer incidence rates, but of government policies.
“The human papillomavirus is a common sexually-transmitted infection; in fact, most of us will get it at some point in our lives. It usually clears up rather easily but, in some people, it doesn’t, and this type of HPV can lead to certain types of cervical cancer.”
“Increasing HPV awareness is really important as is increasing understanding about screening and about the vaccine” Kate Sanger, Head of Communications and Public Affairs at Jo’s Cervical Cancer Trust
He added that vaccination and well-organised cervical screening programmes are highly effective in reducing cervical cancer incidence and mortality.
However, several European countries are failing to adequately provide these policies.
She said, “There are huge inequalities across Europe in cervical cancer prevention policies, specifically in Eastern and South-Eastern Europe. Unfortunately, this results in a disproportionately heavy burden of cervical cancer incidence and mortality in those regions.”
Emeritus Professor of Epithelial Biology at the University of Cambridge, and member of the expert group that advised on the Policy Atlas, Dr Margaret Stanley, said the “twin pillars of cervical cancer prevention and control” were vaccination and screening.
Outlining details of the UK’s vaccination programme, which began in 2008, Stanley explained that the programme had been a fantastic success, immunising more than 80 percent of 12-year-old girls every year.
“The way to go is to get them while they are at school. When they’ve left school, you can’t get them so easily. Getting HPV is easier than getting pregnant, both being sexually transmitted. Screening and immunisation work, if most people get involved. So high coverage is crucial.”
The UK also started a vaccination programme for boys in 2019. “We need to immunise boys because this is not confined to women, you’ve got to get it from somewhere, and it takes two to tango. If we get rid of it in men, you’ll get rid of it in women. If you get rid of it in women, you’ll get rid of it in men, so it’s the way to go.”
Stanley added, “We’re doing brilliantly with vaccination, but the take-up of screening is declining.”
Kate Sanger, Head of Communications and Public Affairs at Jo’s Cervical Cancer Trust echoed Stanley’s comments, saying, “In the UK, we have a fantastic screening programme, women are invited every three years from the age of about 25, up to 49 and then it’s every five years from 50 to 64.”
However, attendance is quite low, with around one in four women in the UK not attending screening when invited.
“While effective policies and political will are a crucial step in the right direction, without proper implementation, cervical cancer incidence and mortality rates will remain high” EPF Secretary Neil Datta
Sanger suggested that there were many different reasons for this. “Anyone who has ever been for cervical screening would probably agree that it’s not pleasant, it’s not particularly something we all run and jump to go to.”
There are also cultural factors and barriers associated with HPV and its link to sexual contact. “There are many minority ethnic groups where it’s a really taboo subject as well.”
For many women, HPV is just a very confusing issue. Sanger read out a statement from a woman who was diagnosed with cervical cancer. “I knew nothing about HPV before I was diagnosed with cervical cancer.
“I felt dirty and thought I had done something wrong. I felt unable to talk to people about my cancer diagnosis because of the stigma about HPV, I was ashamed. No one should feel like this, especially when you have the biggest fight ever against cancer.”
Sanger said she heard from women every day. “There is so much fear, anxiety and confusion about HPV, infidelity, promiscuity, shame; it is really, really widespread and a lot of people come to us saying, ‘I’ve got this thing, what do I do?’ So, increasing HPV awareness is really important as is increasing understanding about screening and vaccine.”
Echoing this sentiment, Datta said that all countries, even those that had scored 100 percent in the Policy Atlas, could improve their programmes.
He called on national governments to do much more to raise public awareness, to include HPV vaccination for boys and girls into routine state schedules and to improve the uptake of screening programmes.
“While effective policies and political will are a crucial step in the right direction, without proper implementation, cervical cancer incidence and mortality rates will remain high.”
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