The WHO adopts a global cervical-cancer elimination strategy

Four cases per 100,000

On 19 August 2020 the World Health Assembly adopted a global strategy to end cervical cancer as a public health problem.

"Elimination" here has a number attached. WHO sets it at fewer than four new cases per 100,000 women each year. Reach that rate, and hold it, and the country has eliminated the disease as a public health problem. It does not mean no one gets cervical cancer.

That is an unusual thing to say about a cancer. It is only sayable about this one because of what causes it.

Why this cancer is the one they picked

Almost all cervical cancer starts with a virus.

The human papillomavirus, or HPV, is a common infection passed on through sexual contact. Most infections clear on their own. A few do not, and a few of those slowly change the cells of the cervix.

NCI's clinical summary names the worst actors. Of the many HPV types that infect people, types 16 and 18 are most closely tied to severe cell changes and to cancer.

Those changes have a name and a shape. The precursor is called dysplasia — cervical intraepithelial neoplasia, or CIN, in the squamous cells, or adenocarcinoma in situ in the gland cells. NCI reports that of people with untreated in situ cervical cancer, 30% to 70% go on to develop invasive cancer over 10 to 12 years. In about 10%, the change happens in under a year.

A decade is a long window. That is the whole basis of the strategy: there is a virus to vaccinate against, and a slow pre-cancer to find and remove.

What 90-70-90 asks for

WHO set three targets for every country to hit by 2030.

• 90% of girls fully vaccinated against HPV by age 15.
• 70% of women screened with a high-performance test by age 35, and again by age 45.
• 90% of women found to have cervical disease treated. WHO counts that as 90% of pre-cancer treated and 90% of invasive cancer managed.

They rest on three pillars: vaccination, screening with treatment of pre-cancer, and care for invasive cancer including palliative care. WHO says all three have to run together and at scale.

A "high-performance test" means a test for the virus itself, rather than only looking at cells under a microscope. NCI notes that testing for HPV 16 or 18 predicts severe cell changes better than cytology alone, and that the prediction holds for up to 18 years after the test.

The gap the strategy is aimed at

WHO's own figures show why this was framed as a fairness problem.

Cervical cancer killed more than 300,000 women in 2018. Nearly 90% of those deaths were in low- and middle-income countries. In those countries, more than 60% of women diagnosed die of it. WHO describes that as more than twice the proportion in many high-income countries, where it can be as low as 30%.

As of 2020, fewer than a quarter of low-income countries had put HPV vaccine into their routine schedules. More than 85% of high-income countries had. Women living with HIV are six times as likely to develop cervical cancer.

When to get checked

Early cervical cancer often causes nothing at all. That is why screening exists.

NCI lists the signs that should prompt a visit:

• Bleeding from the vagina that is not your normal period.
• Bleeding after sex.
• Vaginal discharge that is unusual for you.
• Pelvic pain.
• Dyspareunia — pain during sex.

Any of these deserves an appointment rather than a wait-and-see. They are far more often caused by something other than cancer, which is exactly why checking is cheap and useful.

Two more points worth holding on to. NCI reports that cervical cancer is diagnosed most often in women aged 35 to 44 — younger than most cancers. And having had the HPV vaccine does not replace screening, because the vaccine does not cover every cancer-causing type.

What happens when cancer is found

Treatment turns on how far the cancer has spread, using the FIGO staging system.

For carcinoma in situ and the earliest invasive stage, NCI lists conization — removing a cone of tissue from the cervix — as an option, along with hysterectomy, or radical trachelectomy, which removes the cervix but leaves the uterus so pregnancy stays possible.

For stages IB and IIA, options include radical hysterectomy with removal of pelvic lymph nodes, or radiation given together with chemotherapy. For stages IIB through IVA, the mainstay is radiation with chemotherapy at the same time. NCI notes that five randomized phase 3 trials found a survival advantage for cisplatin-based chemotherapy given with radiation. For stage IVB and recurrent disease, options include immunotherapy, chemotherapy, and radiation for symptom relief.

The United States picture

SEER, NCI's surveillance program, carries an American Cancer Society projection of about 13,490 new cervical cancer diagnoses and 4,200 deaths in the United States in 2026. SEER's own registry data put median age at diagnosis at 50.

Stage at diagnosis drives the numbers, and these come from women diagnosed between 2016 and 2022. Five-year relative survival is 91.8% when the cancer is still confined to the cervix, 64.0% once it reaches nearby lymph nodes, and 20.5% once it has spread to distant sites. Across all stages it is 68.8%.

Only 41% are caught while still localized. Those are group averages from people diagnosed years ago. They describe a population, not a person. Our page on cervical cancer covers the disease itself, and benefits and harms of screening covers how to weigh a screening test.

What this does not mean

The 70 million cases and 62 million deaths WHO projects as averted by 2120 are model outputs. They assume the targets are actually met. They are not results.

The strategy commits governments, not clinics. Whether vaccination or screening is available to any particular person depends on their national health system, and progress since 2020 has been uneven.

NCI notes that widespread HPV vaccination could cut cervical cancer worldwide by as much as 90% — a projection, again, and one that says nothing about anyone already diagnosed. For that, cancer screening and a care team are the place to start.

Sources

• WHO: World Health Assembly adopts global strategy to accelerate cervical cancer elimination
• NCI PDQ: Cervical Cancer Treatment (Health Professional Version)
• NCI: Human Papillomavirus (HPV) Vaccine
• NCI SEER Cancer Stat Facts: Cervical Cancer

How this article was prepared

An AI-assisted editorial system helped prepare this page. No named medical reviewer has reviewed it unless one is listed.

Cancer Explained is published by the National Cancer Information Foundation. It is not medical advice and does not suggest a test or treatment.

See an error, old source, or unclear wording? Tell us.