Associate feature: Taking the next step in the race to eliminate cervical cancer
MSD has funded and had editorial control over this article, with input and endorsement from Sue Webber MSP and Athena Lamnisos, CEO of The Eve Appeal.
The potential to eliminate cervical cancer has long been recognised, with human papillomavirus (HPV) vaccination and cervical screening making 99.8% of cervical cancer cases preventable.1 Over 300 women are currently diagnosed with cervical cancer in Scotland every year,2 and we have the highest cervical cancer death rates in the UK.3 Elimination would have a profound impact on women’s health, the lives of their families, and society as a whole.
The foundations are in place to reach elimination. Scotland is the only UK nation hitting the 90% HPV vaccination target (in S4 girls, 2022/23)4 set by the World Health Organization (WHO) to work towards elimination. Government research has also shown that that no cervical cancer cases have been detected in women who were fully vaccinated at age 12-13, since HPV vaccination was introduced in Scotland in 2008.5 The challenge now is replicating this success across the prevention pathway.
Leaving no community behind
Improving access to cervical screening is fundamental to expediting cervical cancer elimination. Screening protects women from developing cervical cancer by identifying, and facilitating early health system intervention, when someone is identified as being at risk.
Sadly, Scotland’s cervical screening coverage rates are falling short of the WHO’s target that 70% of women access cervical screening by age 35 and again by 45. In 2021/22, 65.7% of women aged 25-49 were up to date with cervical screening. This figure is a decline on the previous year, and masks significant inequalities: looking at the most deprived areas, coverage falls to 61.2% across Scotland, and is as low as 55.8% in some areas.6 We also know that some groups – including minoritised ethnic communities, women with a learning or physical disability, and LGBTQ+ individuals – are less likely to accept their invitation to participate in screening.7
These inequalities are replicated along the pathway: cervical cancer mortality is more than three times higher in Scotland’s most deprived areas than in the least. If elimination is to benefit everyone, we must equalise access to prevention in every community across Scotland.8
The policy levers exist to make this happen
In August 2021, Scotland was the first UK nation to launch a Women’s Health Plan, with a dedicated focus on reducing inequalities in women’s health outcomes. The plan highlighted the potential of HPV self-sampling in improving access to cervical screening, while removing stigma and embarrassment experienced by some groups, and reiterated the importance of trauma-informed and culturally competent practice.9
Following England’s commitment just over a year ago to eliminate cervical cancer by 2040,10 the Scottish Government has since formed an expert group on cervical cancer elimination.11 The expert group must now take the principles of the Women’s Health Plan forward, setting out concrete actions and timelines to improve access to cervical screening – for example through a “make every contact count” approach to improving understanding of cervical screening, or launching a self-sampling pilot for women who may not ordinarily engage with cervical screening. This must be one part of a robust implementation plan which adopts a holistic approach to elimination, headlined by a national elimination target.
What happens next?
MSD is delighted to be organising an upcoming Scottish Parliament event, hosted by Sue Webber MSP and featuring a contribution from The Eve Appeal, the UK’s leading gynaecological cancer charity, to explore in further detail how a future where no woman needlessly dies from cervical cancer can be realised.
This event will form part of MSD’s Race to Elimination campaign, which is dedicated to uncovering how local areas are already exploring new, more equitable approaches in the delivery of HPV vaccination and cervical screening – from trauma-informed provision to culturally sensitive social media awareness campaigns. The tools to reach cervical cancer elimination already exist: the task is for all of us, in partnership, to bring them to every indivudual who needs them.
GB-NON-10482. November 2024
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1 Cancer Research UK, Cervical cancer statistics. Last accessed October 2024, available from: https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/cervical-cancer
2 Cancer Research UK, Cervical cancer incidence statistics. Last accessed October 2024, available from: https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/cervical-cancer/incidence
3 Cancer Research UK, Cervical cancer mortality statistics. Last accessed October 2024, available from: https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/cervical-cancer/mortality#heading-Zero
4 Public Health Scotland, HPV immunisation statistics Scotland, School year 2022/23, November 2023. Last accessed October 2024, available from: https://publichealthscotland.scot/publications/hpv-immunisation-statistics-scotland/hpv-immunisation-statistics-scotland-school-year-202223/
5 Public Health Scotland, No cervical cancer cases detected in vaccinated women following HPV immunisation, January 2024. Last accessed October 2024, available from: https://publichealthscotland.scot/news/2024/january/no-cervical-cancer-cases-detected-in-vaccinated-women-following-hpv-immunisation/
6 Public Health Scotland, Scottish cervical screening programme statistics, Annual update to 31 March 2022, May 2023. Last accessed October 2024, available from: https://publichealthscotland.scot/publications/scottish-cervical-screening-programme-statistics/scottish-cervical-screening-programme-statistics-annual-update-to-31-march-2022/#:~:text=For%20the%20financial%20year%202021,'Coverage')%20was%2068.7%25.
7 Public Health Scotland, Cervical screening and health inequalities. Last accessed October 2024, available from: https://publichealthscotland.scot/our-areas-of-work/disease-registration-and-screening/screening/cervical-screening/overview/cervical-screening-and-health-inequalities/
8 Scottish Government, Scottish Equity in Screening Strategy 2023 to 2026, July 2024. Last accessed October 2024, available from: https://www.gov.scot/binaries/content/documents/govscot/publications/strategy-plan/2023/07/scottish-equity-screening-strategy-2023-2026/documents/scottish-equity-screening-strategy-2023-2026/scottish-equity-screening-strategy-2023-2026/govscot%3Adocument/scottish-equity-screening-strategy-2023-2026.pdf
9 Scottish Government, Women’s health plan, August 2021. Last accessed October 2024, available from: https://www.gov.scot/publications/womens-health-plan/documents/
10 NHS England, NHS sets ambition to eliminate cervical cancer by 2040, November 2023. Last accessed October 2024, available from: https://www.england.nhs.uk/2023/11/nhs-sets-ambition-to-eliminate-cervical-cancer-by-2040/
11 Scottish Parliament, Question reference: S6W-24720, January 2024. Last accessed October 2024, available from: https://www.parliament.scot/chamber-and-committees/questions-and-answers/question?ref=S6W-24720
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