Cervical cancer elimination: are targets useful?
Ce dossier présente deux études mettant en évidence les stratégies de prévention pouvant conduire à l'élimination du cancer du col de l'utérus dans la plupart des pays à revenu faible ou intermédiaire d'ici la fin du siècle, répondant ainsi à un objectif de développement durable de l'Organisation Mondiale de la Santé
Résumé en anglais
Cervical cancer is the most common cause of cancer-related deaths in women in 42 low-income and lower-middle-income countries (LMICs), with the highest age-standardised incidence rates (40 cases per 100 000 women-years) occurring in 15 countries in sub-Saharan Africa. The gross disparity of the burden of this highly preventable disease, whereby 290 000 (51%) of the 570 000 new cases estimated to occur annually befall women in LMICs,has led many people to call attention to the need for urgent action. In fact, valuable new tools have been developed in the past 20 years to make prevention more feasible, even in low-resource settings: the human papillomavirus (HPV) vaccine, HPV testing, the use of self-collected samples for HPV testing, thermal ablation for treating cervical pre-cancer, the use of mobile phones to improve follow-up after screening, and machine learning to improve visual assessment. These developments have raised the possibility that we can now have a substantial impact in preventing cervical cancer, if these advances are scaled up and applied judiciously. We also finally have political momentum and a global champion in Dr Tedros Adhanom Ghebreyesus, Director-General of WHO, who sounded the call in 2018 to eliminate cervical cancer as a public health problem. Dr Tedros's call to action has spurred WHO to convene expert consultations and develop a consensus definition of elimination (four cases per 100 000 women-years) and draft targets, known as the triple intervention strategy: 90% coverage of the HPV vaccine, 70% coverage of twice-lifetime screening of women at the ages of 35 years and 45 years, and 90% delivery of treatment needed for cervical cancer and precancer by 2030.
