Europe's Path to Eliminating Cervical Cancer as a Public Health Problem

The first anniversary of the adoption of the Global Strategy for the Elimination of Cervical Cancer as a Public Health Problem was commemorated on 17^th November 2021. For the first time, an international commitment has been made to eliminate a major cancer [1]. This important anniversary represents a moment to consider the measures that must be taken to achieve the ambitious 90-70-90 ‘triple elimination’ targets of the strategy, which have been set for 2030 [2].

Eliminating cervical cancer is a global movement in which every country and region has the responsibility to translate commitments into action, leaving no one behind. Countries in Europe face their own set of specific challenges. Although some countries are on the threshold of reaching the target for cervical cancer incidence, stark inequalities exist in the incidence, mortality and access to quality care between countries in Europe [3]. Annual world-age standardised incidence rates range from 6.8 per 100,000 women in Western Europe to 16 per 100,000 women in Central and Eastern Europe [4].

Adopted on World Cancer Day 2021, Europe's Beating Cancer Plan makes bold commitments in support of the Human Papillomavirus (HPV) vaccination and cervical cancer screening targets of the Global Strategy, providing much needed political support at the European level [5]. Seizing the twin opportunities of the Global Strategy and Europe's Beating Cancer Plan, over 50 organisations (see supplementary material) have endorsed a joint statement outlining the seven priority actions that should be taken to accelerate the progress towards reaching the 90-70-90 targets. These priorities are: 1) Implement evidence-based screening policies; 2) Deliver cervical cancer screening in an organised framework; 3) Optimise screening coverage to reach non-responders; 4) Ensure treatment of the screen detected precancers and cancers; 5) Maximise HPV vaccination coverage; 6) Update the EU guidelines for cervical cancer control; 7) Empower women, working with civil society (Supplementary material).

The joint statement brings together a wide array of organisations, which demonstrates the breadth of support from the whole of society to make the elimination of cervical cancer a reality. During this critical window of opportunity, the joint statement highlights to decision makers the immediate priorities that must be taken in order to diminish inequalities in coverage and quality of care, thereby improving the chances of reaching the 2030 elimination targets in Europe.

Through determined action to implement the Global Strategy, European countries have the opportunity to provide an inspiring example to the global community that the elimination of cervical cancer is feasible. Our joint statement can, therefore, serve as a model to be adapted to other global regions for the purposes of developing the priorities for reaching the 2030 targets in each continent.

Achieving the ultimate goal of the Global Strategy will require decades of sustained effort. Yet, the clock is ticking for us to reach the 2030 targets. We have no time to lose. With this joint statement, the signatories call on countries in Europe to take the lead by implementing the seven priorities to accelerate the path towards eliminating cervical cancer.

Contributors

Each author contributed to the drafting, review and final approval of the manuscript. The authors’ contributions, following the CRediT, was as follows:

David Ritchie: conceptualisation; writing – original draft; corresponding author.

Marc Arbyn: concept of the consensus building regarding the European answer to the WHO call to eliminate cervical cancer; statistical analysis of incidence and mortality data; critical review of manuscript.

Partha Basu: development, review & endorsement of the priority statement, critical review of manuscript; MC: development, review & endorsement of the priority statement, critical review of manuscript.

Elena Fidarova: development, review & endorsement of the priority statement, critical review of manuscript.

Urska Ivanuš: development, review & endorsement of the priority statement, critical review of manuscript.

Ginevra Papi: conceptualisation, writing – review & editing;

Julie Torode: development, review & endorsement of the priority statement, critical review of manuscript.

Chrysoula Zacharopoulou: development, review & endorsement of the priority statement, critical review of manuscript.

Disclaimers

Where authors are identified as personnel of the International Agency for Research on Cancer/World Health Organization, the authors alone are responsible for the views expressed in this article, and they do not necessarily represent the decisions, policy, or views of the International Agency for Research on Cancer/World Health Organization. DR and GP have received funding under an operating grant (SGA: 101015525) from the Third Health Programme (2014-2020). The content of this paper does not reflect the views of the European Commission, the European Health and Digital Agency (HADEA) Executive Agency or any other body of the European Union. The European Commission and the Agency do not accept any responsibility for use that may be made of the information it contains. No funding body had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Declaration of Competing Interest

Dr. ARBYN reports grants from Belgian Foundation Against Cancer, grants from the Horizon 2020 Framework Programme for Research and Innovation of the European Commission, through the RISCC Network (grant no. 847845), during the conduct of the study;