1ST CITY CLINICAL HOSPITAL

03/28/2024

The world community is against cancer and confirmation of this is the announcement at the WHO General Assembly in November 2020 about the course towards the complete elimination (eradication) of cervical cancer (hereinafter referred to as cervical cancer). This event is truly historic, since 194 countries, as part of a World Health Assembly resolution, for the first time committed to achieving the elimination of cancer. Such an ambitious goal became possible thanks to the distant 70s of the twentieth century, when the German scientist, physician and virologist Harald zur Hausen discovered the role of the human papillomavirus (hereinafter referred to as HPV) in the development of cervical cancer. By the time the scientist’s theory was recognized worldwide, it was proven that HPV-negative carcinoma is extremely rare, and the detection rate of this virus in cervical cancer is almost absolute and reaches 99.7%.

According to the new WHO document, a decrease in the incidence of cervical cancer below four cases per 100 thousand women can be considered a victory for medicine over this gynecological cancer. Achieving indicators that can be conditionally associated with the almost ideal female proportion “90-70-90” will help to set a confident course towards elimination by 2030 in all countries:

• full vaccination against human papillomavirus (HPV) for 90% of girls by age 15;
• high-quality screening of 70% of women at age 35 and again at age 45;
• providing treatment to 90% of women diagnosed with cervical disease (treating 90% of women with precancerous lesions; managing 90% of patients with invasive cancer).

Currently, the statistics in terms of cervical cancer are as follows:

• cervical cancer is the fourth most common type of cancer among women worldwide;
• WHO estimates that 604,127 new cases occurred in 2020, of which 341,831 deaths from cervical cancer occurred in low- and middle-income countries;
• CC is the most common cancer in women in 45 countries around the world. In 55 countries, more women die from cervical cancer than from any other cancer;
• Every day, more than one and a half thousand women become ill with cervical cancer, that is, approximately 1 patient succumbs every minute.

Considering that cervical cancer is a preventable disease, there is a clear trend towards preventive medicine in terms of this disease. In 2014, WHO defined 3 types of CC prevention:

• Primary prevention: HPV vaccination targeting adolescents aged 9-13 years before sexual debut;
• Secondary prevention: availability of screening with subsequent treatment of identified cervical precancer;
• Tertiary prevention: access to cervical cancer treatment and management for women of all ages, including surgery, chemotherapy, radiotherapy and palliative care.

Vaccination against HPV infection has not yet been included in the National Preventive Vaccination Calendar and is not carried out at the population level. In practice, many women are vaccinated against HPV and are interested in vaccinating their daughters voluntarily, on their own initiative, but the use of vaccines is effective, first of all, before the onset of sexual activity.

If the opportunity for vaccination is missed, then the lifeline is cervical screening, carried out in accordance with current instructions and clinical recommendations, and allowing for the identification of cervical diseases at the precancerous stage, their timely treatment and dynamic follow-up.

In countries where organized screening has existed for many years, the mortality rate from cervical cancer is significantly lower. Cervical screening as a goal of secondary prevention of cervical cancer is undergoing continuous evolutionary changes. Historically, the main method for diagnosing cervical cancer was a cytological examination of material from the cervix, most often referred to in everyday life as a “cytology smear” (hereinafter referred to as PAP test). Nowadays, the traditional Pap test is being replaced by modern technologies such as liquid cytology and HPV testing. According to international recommendations, HPV testing is currently present in all modern versions of cervical screening, as it allows identifying significantly more precancerous lesions compared to cytological screening alone and increasing the interscreening interval to 5 years.

In some countries, cervical screening is already starting with HPV testing, including in the Republic of Belarus. In accordance with the updated instructions, cervical screening in the Republic of Belarus is carried out in women aged 30 to 60 years inclusive (at the time of screening) by performing HPV testing once every 5 years in accordance with the procedure for cervical cancer screening. CC screening is not carried out in women:

• under 30 years old. Women in this age category undergo a PAP test every 3 years at ages 21, 24, and 27;
• over 60 years of age who have two negative HPV testing results 5 years apart;
• with suspected cervical cancer or with a history of cervical cancer diagnosis;
• who have undergone a total hysterectomy (removal of the uterus and cervix uterus), due to reasons not related to cancer or precancerous condition of the cervix;
• have not had sexual intercourse.

The effectiveness and success of screening activities for any disease depend on both the coverage of the population and its awareness of it. Unfortunately, cervical screening options are limited by both factors. It is important to remember that screening can detect precancerous cervical lesions and prevent cancer. It is affordable and does not require much time or physical effort. Start taking care of you and getting examined to rule out cervical pathology now.