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Combating Cervical Cancer: Where Do We Stand?

by Swathi Kodaikal, MSc | Jul 31, 2023 | Clinical Diagnostics Insider, Diagnostic Testing and Emerging Technologies, Special Focus-dtet

Accessible screening tests and inclusive management strategies may limit the global cervical cancer incidence rate.

Cervical cancer is both preventable and curable (if diagnosed early and treated appropriately)—so why are people still dying of this disease at a rate of one every minute and a half?¹

The answer likely lies in a lack of awareness, access, and uptake of measures for prevention and early detection. Although regular screening may reduce cervical cancer deaths by 41 to 92 percent,² uptake is low; only 10 percent of women aged 30 to 49 in low- and middle-income countries participate in screening, whereas even in high-income countries, the average is 42 percent.³ The WHO’s global strategy to reduce cervical cancer, which calls for implementation by 2030, aims to see 70 percent of women screened for cervical cancer by age 35 and again by age 45 using a high-performance test.⁴

Furthermore, although persistent human papillomavirus (HPV) infection is implicated in almost all (99.7 percent) of cervical cancers, global HPV vaccine coverage is estimated at only 15 percent of the target population.^5,6 Existing HPV vaccination programs have reduced the rate of cervical cancers by approximately half,⁷ with the WHO’s target of 90 percent vaccination coverage by 2030 predicted to reduce incidence by up to 75 percent.^4,8

Recent Advances in HPV Screening and Detection

In 2021, the WHO updated its cervical cancer screening guidelines to encourage the use of HPV DNA and HPV mRNA tests to screen and detect precancerous lesions. Unlike traditional cytology, molecular screening tests involving HPV DNA and mRNA are technically accurate, sophisticated, and error-free/unbiased.⁹ Unfortunately, the price tags on such tests can be prohibitive—but newly developed technology may help alleviate the cost burden. Bioengineering professor Rebecca Richards-Kortum, PhD, and her team at Rice University, TX, have developed a novel DNA testing platform that greatly simplifies the HPV DNA screening equipment and procedure, thereby reducing the per-test price.¹⁰

In the study, the researchers demonstrated an integrated test for HPV types 16 and 18—which cause well over half of all cervical cancers—using a prototype consisting of just two pieces of equipment. They evaluated the test’s performance using synthetic and provider-collected clinical samples in a high-resource setting in the US and self-collected clinical samples in a low-resource setting in Mozambique. In both settings, the integrated test delivered reliable results in 45 minutes at a projected per-test price of less than $5, demonstrating the feasibility of a point-of-care HPV DNA screening test.¹²

Toward Inclusive, Accessible HPV Screening

About 90 percent of global new cervical cancer cases and deaths in 2020 occurred in low- and middle-income countries.⁹ Women from resource-limited areas are often under-screened, likely due to barriers in understanding or access, fear of pain or embarrassment, cultural deprioritization of women’s health, or even negative provider attitudes.^13,14,15

The My Body, My Test-3 study was developed to assess the potential of at-home testing to address cervical cancer under-screening. In the Phase 3 trial, 665 under-screened women in North Carolina aged 25 to 64 were mailed HPV self-collection tests and given appointment-scheduling assistance. The researchers reported that the uptake of cervical cancer screening nearly doubled (72 percent) when women received the kits versus when they received appointment-scheduling assistance alone (37 percent).^{16, 17}

“We’re now working with clinical partners to identify women who might be overdue for screening through electronic medical records. We hope to provide the option of either mailing them a self-collection kit to use at home to mail back to us or handing a kit directly to them when they come into clinics for other services with the vision to eventually make self-collection a regular clinical provision,” said study co-author Noel T. Brewer, PhD, Gillings Distinguished Professor in Public Health, UNC Gillings School of Global Public Health, in a recent press release.¹⁸

The Way Forward

To reduce cervical cancer incidence and mortality, governing bodies and professional organizations emphasize the need to increase preventive measures such as screening and HPV vaccination. The Association for Diagnostics & Laboratory Medicine (ADLM, formerly AACC) states that “medical organizations now recommend screening for cervical cancer with either primary HPV testing, or by co-testing with both HPV testing and traditional cervical cytology.”¹²

As previously reported by G2 Intelligence, the ADLM recently published a guidance document to update laboratorians and other healthcare professionals on the latest advancements in cervical cancer detection and help them select the most effective strategy for their patients.^19,20 The guidance offers a testing report template for labs’ and clinicians’ perusal, examines the latest evidence supporting screening tests using self-collected samples, and addresses key questions about cervical cancer screening and diagnosis.

“People who are routinely screened very rarely progress to cervical cancer,” Richards-Kortum stated in a press release.¹⁰ “It’s people who have never been screened in their lives, or who get screened on really infrequent intervals, who are really at risk. That’s why it’s so critical to address the disparities that exist and think about new ways to deliver screening, diagnosis, and treatment.”