The Elimination Of Cervical Cancer In NZ Is Within Reach In Our Lifetime – But Not Without Funding And A Plan

After committing to a global plan to eliminate cervical
cancer, New Zealand is lagging behind Australia and other
countries in how it manages this preventable
disease.

Each year approximately 175
New Zealanders are diagnosed with cervical cancer and 55
people die from it.

Human papillomavirus (HPV) is the
cause of 95% of cervical cancers and some throat and anal
cancers. New Zealand has a very effective vaccine against
this cancer. And HPV screening can detect changes on the
cervix before cancer occurs.

With vaccination and
screening it is now realistic to aim to eliminate cervical
cancer in our lifetime – but it requires a strategy and
investment.

Global goals

The World Health
Organization’s global
elimination strategy for cervical cancer rests on three
targets:

• 90% of girls fully vaccinated with the
  HPV vaccine by the age of 15
• 70% of women screened
  using a high-performance test (for example, HPV testing) by
  the age of 35 and again by the age of 45
• 90% of
  women with pre-cancer treated and 90% of women with invasive
  cancer managed.

But to achieve this in Aotearoa
New Zealand, there needs to be a commitment from the
government to develop and resource an elimination
strategy.

This is not currently happening. And,
despite some advances, women continue to die.

The
rise in self-testing

HPV self-testing was introduced
as part of the national screening programme in September
2023. Testing for the virus provides 60-70%
greater protection against developing invasive cervical
cancers compared with cervical cytology (the “smear” –
involving a speculum examination by a trained
provider).

It is such good a test that following a
negative result (and no symptoms) another
test is not needed for five years.

Switching to
HPV-testing has potential to reduce the annual number of
cervical cancers by 15%. Women can do the test themselves
and, under the new scheme, 80% are choosing
self-testing.

There has also been a high uptake from
never-screened or under-screened women. This is important
because more than 85% of our cervical
cancers occurred in those not regularly
screened.

Before the introduction of the HPV
self-test, just 67.1% of eligible people were up to date
with their screening. Over the past year this has increased
to 70.8% – reaching the WHO target. However, coverage for
Māori remains below – increasing from 56.3% to just
61.9%.

Low vaccination rates

While screening
coverage has increased to 70.8% overall, New Zealand’s HPV
vaccination coverage is low (45-60%) – nowhere near the
90% target, which Australia is close to.

Australia is
set to become the
first to achieve elimination, after the government
committed A$48.2 million to support their national
elimination strategy and its implementation.

HPV
vaccination is an essential pillar of cervical cancer
prevention.

A recent
study found no cases of cervical cancer in a cohort of
girls immunised between the age of 12 and 13 (born between
1996 and 1998) in Scotland’s school-based vaccination
programme. But there were cases of cervical cancer in the
unvaccinated group.

More work
needed

Champions, researchers, clinicians and whānau
campaigned and contributed to our new (albeit overdue) HPV
cervical screening programme. But more action is
needed.

This is particularly the case as funding
for healthcare is cut back.

To achieve the
elimination goals we have committed to, three things need to
happen:

1. Free cervical screening (unlike breast
   and bowel screening, New Zealand’s cervical screening
   programme not fully-funded).
2. A cervical cancer
   elimination strategy with dedicated
   funding.
3. Boosting HPV vaccination
   uptake.

It’s essential everyone is included to
achieve elimination. The WHO global targets – set to
address the differential burden of cervical cancer between
countries – fail to address the rights of Indigenous
peoples to be counted within the elimination targets.
Within-country inequities may remain hidden as a country can
claim elimination based on data that doesn’t separate
different ethnic groups.

Countries, including
Aotearoa New Zealand, need to meet
elimination targets for all women.

Aotearoa has
the tools (HPV self-testing, vaccination and treatment for
cell changes) to make elimination for all a reality. But
without an equitable strategy or funding to drive progress,
the end of cervical cancer for New Zealanders will not be as
close or as equitable as it should be.

Francesca
Storey, Deputy Director Te Tātai Hauora o Hine –
National Centre for Women’s Health Research Aotearoa, Te
Herenga Waka — Victoria University of Wellington
and Bev
Lawton, Professor, Te Tātai Hauora o Hine – National
Centre for Women’s Health Research Aotearoa, Te
Herenga Waka — Victoria University of
Wellington

Disclosure statement

Bev
Lawton receives funding from The Health Research Council of
New Zealand and the Ministry of Health. She is a member of
the National Cervical Screening Programme Clinical Practice
Guidelines Committee and a member of the National Cervical
Screening Programme Advisory and Action
Group.

Francesca Storey does not work for, consult,
own shares in or receive funding from any company or
organisation that would benefit from this article, and has
disclosed no relevant affiliations beyond their academic
appointment.

This article is republished from
The
Conversation under a Creative Commons license.
Read the original
article.

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