Globally, cervical cancer is the fourth most prevalent cancer in women.

High mortality rates from cervical cancer globally can be reduced by effective interventions through different stages of life. Primary prevention through the HPV vaccination has proven highly effective in reducing cervical cancer incidence at population level.

Alongside vaccination, WHO global strategy for cervical cancer elimination, calls for 70% of women globally to be screened regularly for cervical disease with a high-performance test, and for   90% of those needing it to receive appropriate treatment. Implementing this global strategy could prevent more than 62 million deaths from cervical cancer in the next 100 years.

 Cervical cancer screening is testing for HPV or pre-cancerous lesions and cancer among women who may have no symptoms and feel perfectly healthy. When the screening detects either an HPV infection or an established pre-cancerous lesion, they can be easily treated and avoid cancer. Screening can also detect cancer at an early stage, enabling women to receive treatment in time. Pre-cancerous lesions can take many years to develop in the general population but take a shorter time in HIV positive patients. The screening will start and be repeated at different time intervals for both populations.

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Screening tests

Available screening tests include:

• Human papillomavirus (HPV) DNA testing
• Visual inspection with acetic acid (VIA)
• Cytology (Pap smear)

Screening algorithms

Screening should start from 30 years of age in the general population of women, and regular screening with a validated HPV test every 5 years

Where the transition to the use of HPV DNA testing is not yet completed, the screening interval for VIA or cytology should be 1 to 3 years for both the general population of women, as well as those living with HIV.

Priority should be given to screening women between 30-49 years in the general population of women. However, if there is no such operational limitation, women between 50-65 should be screened; prioritizing those who have never had a screening. After the age of 50, screening can be stopped after two consecutive negative screening results consistent with the recommended regular screening intervals among both the general population of women and women living with HIV.

Prevention

Primary prevention

• Girls 9–14 years
• HPV vaccination
• Health information and warnings about tobacco use

Secondary prevention

• Women at 30 years of age and beyond, or at younger age for women with HIV
• Screening with a high-performance test equivalent to or better than an HPV test
• Followed by immediate (or as soon as possible) treatment of pre-cancer lesions

Tertiary prevention

• All women as needed.
• Treatment of invasive cancer at any age
• Surgery, Radiotherapy, Chemotherapy, Palliative care

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