We Might Actually Be Able To Eliminate Cancer. But How?

The target to eliminate cervical cancer within the next four decades sounds too good to be true.

However, Australia has reason to be optimistic. The country has a strong strategy — combining its high coverage of HPV vaccination with a very effective screening programme, including appropriate follow-up measures for women who show abnormalities.

According to Professor Dr Woo Yin Ling, a consultant gynaecological oncologist from Universiti Malaya, cervical cancer is the only cancer where 99.7 percent of it is due to a virus, called the human papillomavirus (HPV).

“So if we can get rid of HPV, we can get rid of the cancer,” Woo says confidently.

Elimination requires two interventions to be carried out in tandem. HPV vaccination protects a woman from getting infected with the virus. Meanwhile, screening makes it possible to look for the virus that causes the cancer — regardless of whether or not she’s been vaccinated.

Australia was one of the first countries to implement HPV vaccination, adding to a successful screening programme.

“As a result, the country has achieved good herd immunity and the level of the circulating virus is much lower than it used to be,” reports Associate Professor Marion Saville, a cytopathologist and Executive Director of Victorian Cytology Service Ltd in Australia.

In Malaysia, where cervical cancer is the second most common cancer among women, the government took the bold step to introduce HPV vaccination in 2010 as part of the National Immunisation Programme.

As a result of this, more than 90 percent of 13-year-old girls in Malaysia are vaccinated against HPV.

However, getting high coverage for Pap smear screening has proven to be more challenging. Many women do not want to see a doctor to get a Pap smear because they find it highly uncomfortable.

A fairly groundbreaking development is a new method of screening called the HPV-based cervical screening. Australia is already moving towards implementing this test, which only needs to be done by women every five years.

Saville says this new screening test will likely result in a further decrease of 30 percent in the death rate in Australia.

Woo explains that the test is more acceptable for women as it allows a woman to collect the sample herself. A study piloted the use of the test in five klinik kesihatan in Selangor, where more than 90 percent of the women reported finding it acceptable.

Woo adds that studies carried out in disadvantaged communities globally have shown that the chances of getting false results are extremely low, as the sensitivity of the test is higher than that of the Pap smear.

For now, the HPV-based cervical test has to be further studied before it can replace the Pap smear as the recommended routine screening method.

Meanwhile, the national budget for 2019 has allocated RM20 million for free mammograms, HPV vaccination and Pap smear tests, which women should take full advantage of.

Cervical cancer is one of the few cancers that can be prevented before it develops. We already have the methods to eliminate it — nothing should stop us from achieving this vision.

---

Listen to the podcast ‘Can We Eliminate Cervical Cancer?’: