WHO Releases New Recommendations to Prevent Cervical Cancer Through Increased Access to Screenings and Treatment

The World Health Organization (WHO) and the Human Reproduction Programme (HRP) have released new guidelines with recommendations for screenings and the treatment of cervical cancer in order to inspire rapid progress and further equity, according to a press release from the World Health Organization.¹

These new guidelines, under WHO’s global strategy for cervical cancer elimination, have set a goal of screening 70% of women around the world regularly for cervical disease with a high-performance test by 2030. The guidelines also detail a plan to vaccinate 90% of girls against the human papillomavirus (HPV), which could prevent 62 million deaths over the next 100 years. Additionally, the global strategy had a goal of bringing appropriate and accessible care to 90% of women who have received a positive test for a cervical lesion.

“This new WHO guideline will guide public health investment in better diagnostic tools, stronger implementation processes and more acceptable options for screening to reach more women and save more lives,” Princess Nono Simelela, MD, assistant director-general for Strategic Programmatic Priorities: Cervical Cancer Elimination at the WHO, said in a press release.²

Recommendations for the General Populace

A total of 604,000 women are diagnosed with cervical cancer and 342,000 die annually from the disease around the world in 2020. Currently, the WHO is recommending an HPV DNA based test rather than visual inspection with acetic acid (VIA) or cytology—the most common in detection pre-cancer lesions—in both the general population and in women living with human immunodeficiency virus (HIV).

The HPV DNA tests detect high-risk strains of HPV that are known to cause almost all cervical cancers. Being an objective diagnostic test, the method leaves little need to interpret test results. The test is also simpler, cost effective, and saves more lives than VIA or cytology. The WHO has also noted that self-collected samples would be acceptable for this type of test.

Until the new HPV DNA test is made operational, the primary screening to use should still be cytology. Those who are still using VIA should transition quickly due to the challenges associated with quality assurance. Moreover, when using a screen-and-treat approach with HPV DNA testing as a primary test, those who test positive should begin treatment.

The general population of women should begin being screened regularly for cervical cancer at age 30. Women who are between the ages of 30 to 49 years old should be given priority testing within this population. Additionally, those who are 50 to 65 years of age who have never been screened should receive priority. A regular screening interval of every 5 to 10 years is recommended for the general population who are receiving HPV DNA detection as the primary screening method.

Recommendations for Women With HIV and Cervical Cancer

HPV DNA is also recommended for women living with HIV over VIA or cytology. The guidelines also recommended that women living with HIV have an HPV DNA screening test with triage to help prevent disease. For those using a screen, triage, and treat approach with HPV DNA detection as the primary test, the guidelines recommend utilizing high-risk HPV DNA tests, cytology, VIA, partial genotyping, and a colposcopy. It is also recommended to start screening at 25 years of age rather than 30 years of age recommended for the general population. Additionally, women with HIV need to be tested more frequently if they test positive for HPV.

Priority testing should also be given to patients with HIV between the ages of 25 to 49 years old. Similar to the general population, patients between the ages of 50 to 65 years old who have never been tested should also receive priority. Additionally, a regular screening interval of every 3 to 5 years is recommended for those living with HIV. The utilization of VIA or cytology are recommended every 3 years for institutions where HPV DNA testing is not yet available.

Actions that can be Taken for the General Population and Those Living With HIV

The guidelines also detailed a number of recommendations that applied to both the general population and for women with HIV. For women who are 50 years of age or older, it is recommended that testing be stopped after 2 back-to-back negative results, although the guidelines recommended regular screening intervals.

The WHO suggested that if women had a positive cytology screening followed by normal results from a colposcopy should be retested within 12 months using the HPV DNA test; if negative, they can resume the recommended regular screening interval. Other recommendations indicate that after the decision to treat is made, treatment should occur within 6 months in order to reduce the risk loss to follow-up. The WHO also recommends the use of large-loop excision of the transformation zone or cold knife conization for both groups of patients who have histologically confirmed adenocarcinoma in situ.

“Effective and accessible cervical screening and treatment programs in every country are non-negotiable if we are going to end the unimaginable suffering caused by cervical cancer,” Simelela concluded.

References:

• WHO. WHO guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention, second edition. Cervical Cancer, version 6.2021. Accessed August 17, 2021. https://bit.ly/3sxg5Ag
• New recommendations for screening and treatment to prevent cervical cancer. News Release. World Health Organization. July 6, 2021. Accessed August 17, 2021. https://bit.ly/3m91Wb4