Clare Gilham, Assistant Professor at LSHTM’s Faculty of Epidemiology and Population Health, explains how effective HPV vaccination and cervical screening programmes have greatly reduced cancer rates.

Cervical cancer is the fourth most common cancer in women in the world with around 350,000 global deaths per year. The highest rates are in low- and middle-income countries where vaccination programmes are in their infancy and there is rarely any organised screening.

Almost all cases of cervical cancer are caused by HPV (human papillomavirus) infection. This provides a unique possibility for elimination. In 2020, the WHO launched a global initiative to “eliminate” cervical cancer using a three-pronged approach: vaccination, screening, and treatment. In this case elimination does not mean zero cases, but so few cases that it ceases to be a public health problem – defined as less than four cases per 100,000 women.

We have published research this week which discusses in more detail whether England is on track for elimination. The NHS cervical screening programme is highly effective. Since its launch in 1988, the number of cervical cancer deaths have dropped, which without screening, would have resulted in England having one of the highest rates in the world. The school-based HPV vaccination programme has also been a great success. The majority of children have been vaccinated against HPV since the programme began in 2008 for girls and in 2019 for boys. As a result, cervical cancer has fallen in those aged under 30 by 80% and England is likely to reach the NHS and WHO targets of elimination by 2040.

The cervical screening programme has made some good improvements over the last few years, particularly the change in 2019 from smear tests to HPV testing. The advantage is the reassurance given to those who test negative for HPV as they will have a particularly low risk of cervical cancer.

Around half of those in England who die from cervical cancer are aged over 65 because they have never been offered an HPV test and are no longer screened. At LSHTM, we are evaluating a catch-up HPV test in women who are now too old to be included in the screening programme. Our project involves posting a urine collection kit to 18,000 women aged 60-79 in the Manchester and Hull areas to screen them for HPV and identify those at increased risk of developing cervical cancer. The beauty of this project is that women can be screened at home using a simple urine kit.

The NHS is currently evaluating several other self-sampling options to encourage participation in those who for various reasons have not attended screening for several years. Those who are not vaccinated or screened regularly are at the highest risk of developing cervical cancer. It is also important that those who have been vaccinated continue to be screened as the vaccine does not cover all the HPV strains that cause cancer, but since the risk is very low, the advice is likely to change in the future so that they can attend screening less frequently.