Ireland on track to eliminate cervical cancer by 2040

Describing HPV (Human papillomavirus) vaccination for girls and boys as a “game-changer”, Ireland’s Health Minister Stephen Donnelly has revealed that Dublin is on target to eliminate cervical cancer by 2040 and is now in “a strong position to exceed the World Health Organisation [cervical cancer] global targets”.

The Irish Cancer Society welcomed the minister’s announcement, made earlier in November.

“It really is within our grasp now, but in order to make that happen, we can’t have any slippage in HPV vaccination rates or cervical screenings […] We need to back this target up with real investment,” Amy Nolan, director of clinical affairs at the Irish Cancer Society, told Euractiv.

A spokesperson for Ireland’s Health Service Executive (HSE) explained to Euractiv that Ireland’s target date for cervical cancer elimination has been determined by extensive data modelling.

“Ireland’s Cervical Cancer Elimination Partnership worked with researchers in the Daffodil Centre (a joint venture between the University of Sydney and Cancer Council New South Wales, Australia), leading experts in mathematical modelling of cervical cancer led by Professor Karen Canfell,” the spokesperson said.

The research used the model platform known as ‘Policy1-Cervix’, a dynamic model of HPV transmission, HPV vaccination, cervical precancer, cancer survival, screening, diagnosis, and treatment.

The modelling used Irish data on HPV, CIN 2/3 (the two more severe stages of Cervical Intraepithelial Neoplasia), cervical cancer incidence, survival and mortality, screening, and vaccination programmes and predicted that Ireland would achieve cervical cancer elimination by 2040.

A recent study published by the Irish Journal of Medical Science on the “effect of HPV vaccination on the rate of high-grade cytology in 25-year-old women attending cervical screening in Ireland” provides early evidence of the potential impact of HPV vaccination on cervical disease in the Republic of Ireland.

The country’s current rate of cervical cancer is around 10.4 cases per 100,000 women; elimination is defined as fewer than 4 cases per 100,000 women.

Because nine in 10 cervical cancers are caused by certain types of human papillomavirus, Ireland’s Health Service Executive said lessons learned about illnesses caused by other viruses have been applied to cervical cancer.

“We have learned from other instances where we have prevented a virus from causing widespread illness through vaccination strategies,” said the HSE.

“We know the HPV vaccine protects against the types of HPV that cause 9 out of 10 cervical cancers; and we know that we can vaccinate against HPV, test for the presence of HPV, look for signs of early disease and prevent it from developing further,” it added.

Cancer care inequalities

Contacted by Euractiv, EU Commission spokesperson Stefan de Keersmaecker said on average, cancer affects men slightly more than women in Europe, with 54% of new cases and 56% of deaths.

He noted that “there are also considerable inequalities within, and between EU member states, and between population groups in the areas of early detection, diagnosis, treatment and the quality of patient care”.

This, he said, is particularly striking regarding estimated cervical cancer incidence rates, which varied five-fold across the EU in 2020, and mortality rates, varying eight-fold.

These wide variations can be explained by differences in the prevalence of HPV and vaccination and cervical cancer screening policies in the EU countries.

“Reducing inequalities across the entire disease pathway is the overarching goal of Europe’s Beating Cancer Plan,” said de Keersmaecker.

HPV causing other cancers

Daniel Kelly, co-chair of ECO HPV Action Network, told Euractiv that HPV causes a wide range of diseases, including penile cancer, anal and vulval cancer, head and neck cancers, and possibly others that are still being explored.

“These cancers are also preventable, and by vaccinating boys as well as girls, the best protection can be achieved”, Kelly noted.

He said there is a need to promote the positive outcomes of successful campaigns – such as in Sweden – so that people can see the true worth of vaccination, that “[it] can stop a number of cancers devastating to people’s lives – as we saw in Ireland with Laura Brennan.”

Regional differences

In terms of regional differences and success rates, Kelly stressed that countries in the west of Europe are doing well but others still have a way to go.

“We are observing strong historical and cultural factors that may view vaccination with scepticism… One size does not fit all,” he noted.

In 2022, the Commission launched new EU Cancer Plan actions to support member states in addressing inequalities, improving screening and vaccination against HPV, and supporting persons who have experienced cancer.

As part of a prevention package, the Commission will put forward “in the near future” a proposal for a Council Recommendation on vaccine-preventable cancers.

The aim will be to support member states in boosting the uptake of Human papillomaviruses and Hepatitis B vaccination among all affected population groups. An HPV vaccination campaign will start in January 2024.

[By Brian Maguire | Edited by Vasiliki Angouridi/Zoran Radosavljevic]

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