The economic imperative of cervical cancer elimination: A call to action for healthcare leaders

As healthcare leaders, we have a responsibility to not only improve patient outcomes, but also to drive efficiencies and ensure the sustainability of our systems. Investing in a comprehensive approach to cervical cancer elimination presents a compelling economic opportunity, particularly when we incorporate innovative tools like HPV self-collection into existing vaccination and treatment programs.

The data speaks volumes. A 2023 study in the U.S. revealed that cervical cancer screening accounted for over 58% of all life-years saved through cancer screenings, highlighting its significant impact on both health and economic outcomes.1 Globally, it’s estimated that every $1 invested in cervical cancer prevention and treatment can yield $3.20 in economic returns.2 Achieving global elimination targets by 2030 could inject nearly $30 billion into the global economy over the next 25 years.3 These figures underscore that addressing cervical cancer is not just a public health imperative, it is also a  sound economic strategy.

The economic argument for a comprehensive approach to cervical cancer, which includes HPV vaccination, early detection through screening, and timely treatment, is clear and compelling. Early detection significantly improves survival rates. Over 90% of women diagnosed at an early stage of cervical cancer can survive five years or more, compared to less than 20% for those diagnosed at a late stage.4  An analysis by the McKinsey Health Institute and the World Economic Forum found that addressing cervical cancer could unlock 2.4 million Disability-Adjusted Life Years (DALYs) annually and add $10 billion to the global GDP each year.5

Beyond the economic case, the human impact is profound. Every hour, 120 children lose their mothers to cancer—nearly 1 million children each year.6 Almost half of these maternal losses are due to breast and cervical cancer. Investing in screening programs is therefore not just a medical  priority, but an economic and societal one too.

One of the most promising advancements in our arsenal is the integration of HPV self-collection into existing screening programs. This approach offers several key benefits for healthcare providers:

• Enhanced efficiency through task-shifting: Self-collection empowers individuals to collect their own samples with accuracy comparable to clinician-collected samples.7 This frees up valuable healthcare provider time, allowing them to focus on other critical services, particularly crucial in settings facing health workforce shortages.

• Expanded reach and uptake: With only 36% of women globally having ever been screened, self-collection can significantly improve reach, particularly among under-screened populations.8 By making screening more accessible, we can detect and treat precancerous lesions earlier, thereby reducing the long-term costs associated with managing advanced-stage cervical cancer and its sequelae.

• Streamlined integration with existing health visits: Offering self-collection during routine health visits, such as antenatal or postnatal care, creates efficiencies by reaching women already engaged with the health system. This minimizes the need for separate appointments and the associated costs of travel and time for both patients and the system.

• Community-based delivery: Self-collection facilitates “out of clinical setting” and community-based delivery models, such as mobile clinics and community health workers. This expands coverage to underserved communities, ensuring more equitable access to screening.

Conversely, over-screening, especially with less sensitive methods like Pap smears (conventional cytology) or Visual Inspection with Acetic Acid (VIA), can lead to unnecessary procedures, increased costs, and potential harm without improving health outcomes.9 Cervical cancer typically develops slowly, generally over10–20 years in individuals with healthy immune systems.10 The shift towards high-performance HPV-DNA testing, recommended by the WHO, allows for extended screening intervals (5 to 10 years),11 optimizing benefits, minimizing harm, and reducing the burden on both individuals and healthcare systems.12

However, we must also acknowledge the barriers that hinder regular cervical cancer screening. These include social and cultural barriers related to stigma and low awareness, but also structural issues that hinder a country’s ability to promote optimal health. These structural issues, which can be elaborated upon using the WHO health system building blocks framework, encompass weak health systems characterized by a lack of capacity or functionality across areas such as service delivery, health workforce, health information systems, access to medical products and technologies, health financing, and leadership/governance. Furthermore, economic factors such as out-of-pocket costs, as well as the absence of adequate diagnostics service infrastructure, low health worker capability, reduced healthcare financing, or lack of healthcare coverage, contribute significantly to these structural impediments.13 Addressing these nuances, encompassing both socio-cultural and multifaceted structural elements, is crucial for designing effective and equitable screening programs.

HPV self-collection has emerged as a game-changer in expanding access to screening. In Peru, more than 300,000 women from communities along the Amazon River have been screened  using self-collection in regions where healthcare access may be logistically challenging.14 In Australia, its expansion has contributed to a significant increase in overall screening uptake, now accounting for 27% of all cervical screening tests.15 Data from the Netherlands also shows a substantial rise in the acceptance rate of self-collection.16 These examples demonstrate the potential of self-collection to bridge the screening gap.

Health systems are diverse, and to design effective, equitable interventions, we must start by understanding the unique realities in each setting. While there is no one-size-fits-all solution for every country or community, by embracing innovative strategies like HPV self-collection, optimizing screening programs, and addressing barriers to access, we can not only save lives but also create more efficient and sustainable healthcare systems. The economic rationale for investing in cervical cancer elimination is clear.  As healthcare leaders, let us seize this opportunity to prioritize cervical cancer elimination, driving both health and economic value for our communities.