Cervical cancer prevention: a challenge for high income countries?
Cervical cancer is strongly associated with socioeconomic status: there is a substantial discrepancy between numbers of women affected in high income countries (HICs), compared with low to middle income countries (LMICs);
In HICs, the most marginalised women (homeless people, sex workers, drug users, prisoners, asylum seekers) have the worst morbidity and mortality;
Our systematic reviews will determine coverage of cervical screening, focusing on groups more exposed to social deprivation in HICs.
Image credit: The Eve Appeal
Cervical carcinoma is the fourth-most common type of cancer in women. In LMICs, it is the third-most common cause of cancer deaths but, significantly, it is ninth in HICs. Within Europe, the pattern is similar: incidence rates are highest in Romania and lowest in Switzerland. This suggests that high-standard and well-structured screening and prevention programmes play a key role.
Cervical cancer mostly follows infections by the Human Papillomavirus (HPV). Therefore, vaccination and screening programmes are fundamental to prevent and detect the disease. High income countries, including the United Kingdom, offer effective resources for both preventing and screening cervical cancer. These include routine vaccination against HPV and screening with the conventional Papanicolaou (Pap) smear test.
However, screening in the UK is currently at its minimum level since records were kept, mostly due to non-attendance to planned checks. Thus, incidence rates are expected to rise by 43% by 2035.
Cervical cancer in HICs is more prevalent in women who are never or only rarely screened. These include women experiencing deep social exclusion: homeless women, victims of domestic abuse, sex workers, substance misusers, migrants from LMICs and prisoners. There are many reasons why these women are “invisible” to the health services: from having no fixed address, to living in patriarchal communities where they can face discrimination when dealing with a gynecological condition. These issues affect the progress of maternal, child and adolescent health in HICs, and ultimately slow down socioeconomic development. Therefore, it is essential that governments and research institutions in HICs respond to the need of overcoming health disparities between women in different socio-economic groups.
Guaranteeing every woman easy and consistent access to screening and prevention
resources, regardless of their ethnicity, social condition and education level, is crucial in
shaping the future of the disease.
Inclusion health is a cross-disciplinary framework of research, services and policies working to reduce health inequalities in lower socio-economic groups. It is one way of increasing the success of cervical cancer prevention programmes.
This year, Polygeia will team up with researchers at University College London to produce two systematic reviews. The reviews will summarise existing strategies to improve cervical screening and HPV immunisation in the most excluded women, giving an idea of currently available programmes for these marginalised women in HICs. Moreover, the reviews will suggest future action to improve prevention strategies.
National health systems, healthcare authorities and competent organisations will benefit from this up-to-date and socially-informed picture, which will be essential to shape an equal, inclusive and comprehensive access to cervical cancer prevention services.
References and further reading
Torre L.A. et al., Global Cancer Statistics, 2012. Ca Cancer J Clin (2015), 65: 87–108
Bernard V.B. et al., The effectiveness of targeting never or rarely screened women in a national cervical cancer screening program for underserved women. Cancer Causes Control (2015), 26: 713–719
Aldridge R.W. et al., Morbidity and mortality in homeless individuals, prisoners, sex workers, and individuals with substance use disorders in high-income countries: a systematic review and meta-analysis. The Lancet (2018), 10117: 241–250
About the author
Mariangela is a neuroscientist studying how memories are established and consolidated in our brain. She strongly believes in the social value of science and thinks that all scientists should feel responsible to make their work accessible to everyone. The mental and physical health of the most sensitive parts of the population, such as young women and migrants, are particularly close to her heart. She joined Polygeia in 2018 to work on these themes, as well as on technological approaches to improve the healthcare system.
Marta is currently carrying out her MRes in Translational Medicine at Imperial College, where she's working on breast cancer. She is deeply convinced that research and health services can have a real impact on health emergencies only through an approach as closest as possible to patients, both in the definition of the research prorities and in an inclusive delivery of high-quality solutions. She joined Polygeia in 2018 with the aim to give voice to women health and rights in shaping policies able to reach the most marginalized part of the population, like migrants.