Fighting cervical cancer around the globe

Limited awareness and access to cervical cancer diagnosis and treatment

Cervical cancer is one of the most preventable cancers today, thanks to vaccination, screening and early treatment. Unlike most cancers, the main cause of cervical cancer is well known; over 95% of all cases are caused by the human papillomavirus (HPV) and two of the highest risk types HPV16 and HPV18, are responsible for close to 70% of all cases. Yet, it remains a leading cause of death in women worldwide, with one woman succumbing to the disease every two minutes.

Nearly 90% of annual cervical cancer deaths occur in low and lower middle income countries. Of the 20 countries worldwide with the highest burden of cervical cancer in 2018, 19 were in Africa. In some countries in the Asia Pacific region, cervical cancer is the second most common cancer and in Latin America, a woman dies from cervical cancer every 19 minutes. Women living with HIV are six times more likely to develop invasive cervical cancer.

In 2020, 194 countries signed up to the World Health Organization's (WHO) global strategy for eliminating cervical cancer worldwide within the next century. This requires a comprehensive, triple-intervention strategy of vaccination, advanced screening and diagnostics, and the early treatment of precancerous or cancerous lesions.

Central to the strategy are WHO’s 90-70-90 targets that call on countries to take action now, in order to meet the 10-year ambition by 2030. To date, and as a result of the COVID-19 pandemic, progress has not ramped up to the level of expectations.

In 2021, the WHO also published updated guidelines that recommend HPV DNA-based tests as the primary screening method, rather than visual inspection or cytology.

Increasing awareness and raising standard of care for cervical cancer

Through its Global Access Program, Roche is working on eradicating cervical cancer by increasing awareness, screening accuracy and linkage to care for all women - no matter where they live. In low and lower-middle income countries, we are working with governments, healthcare facilities and international agencies to strengthen the infrastructure needed to run scalable cervical cancer screening programs. We engage in a range of activities including disease awareness and educational programs, healthcare worker training, improving lab efficiency, digital solutions, along with global advocacy. Our primary goal is to increase screenings to identify precancerous lesions caused by HPV so they can be removed to prevent invasive cancers from developing, and to find cervical cancers at an early stage, when they have a chance to be treated successfully.

For example:

To eliminate cervical cancer, countries in the region are implementing state-of-the-art cervical cancer screening programs in key sites. As part of the BRIDGE project, Roche is working with governments and other partners of national healthcare systems in Brazil, Chile, Mexico and Peru to implement comprehensive cervical cancer elimination programs. BRIDGE offers an end to end adaptable solution to maximize clinical impact. It consists of molecular biology and pathology laboratory instruments for screening, triage and diagnosis, educational programs aimed at laboratory professionals, doctors and patients and awareness materials for the general audiences.

In July 2021 we joined the Go Further partnership that aims to reduce new cervical cancer cases by 95% among women with HIV in twelve African countries which have some of the highest rates of HIV prevalence and cervical cancer incidence in the world. It invests in partner countries to integrate and scale-up cervical cancer screening and treatment services within existing platforms for HIV treatment and women’s health. Go Further was established in 2018 as an innovative public-private partnership between the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the George W. Bush Institute and the Joint United Nations Programme on HIV/AIDS (UNAIDS). One of the first countries we are working in under the partnership is eSwatini which has the highest rate of cervical cancer in the world. Together with the Ministry of Health and other partners, we are co-creating a sustainable, comprehensive cervical cancer program covering awareness, screening, and linkage to care.

  • As a key part of Mozambique’s effort to reach the WHO’s 2030 cervical cancer elimination goals, Roche is supporting Project SALVA, a public-private partnership with the Ministry of Health and other partners including the Center of Disease Control (CDC). Project SALVA is a comprehensive screen, triage and treat approach using HPV DNA testing, reflex testing through visual inspection and thermal ablative treatment if required. We anticipate that learnings from Project SALVA will inform cervical cancer prevention scale-up in countries throughout Africa, as well as other LMICs. During the initial phase, the project aims to screen 16,000 HIV-positive women with our HPV tests while funding complementary technologies such as mobile colposcopy and thermal-ablation devices, providing training to healthcare workers and educational and awareness materials.

  • Kenya has one of the world’s highest incidences of cervical cancer: nearly 10% of women in the general population are estimated to carry the highest risk cervical HPV 16 or 18 infections at any given time! To help eliminate cervical cancer in Kenya, Roche designed a study using the iThemba Life application, originally designed for HIV screening. One of the greatest challenges in implementing HPV screening programs is returning test results: Either letting a woman know that she is HPV negative so she doesn’t require another screening test for 3 to 5 years, or, more importantly, that she had a positive test result and needs to return to the clinic for follow-up care. This is where the iThemba Life app can play a huge role. Participants are sent a message to say that their results are ready and they can access them via the platform. The goal of the study is to test the potential of improving adherence to follow-up care during cervical cancer screening. Working with the International Cancer Institute (ICI), a leading organization focusing on cancer control in Sub-Saharan Africa, we will begin enrolling 8,000 Kenyan women attending ICI-affiliated cervical cancer screening sites in an 18-month study. This study will inform the scale-up of HPV-based cervical cancer screening and contribute towards reaching the WHO cervical cancer elimination goals.

Ongoing efforts within the Asia-Pacific Economic Cooperation (APEC) forum have

provided a path forward towards cervical cancer elimination since 2013. In August 2021, the APEC Roadmap was launched to address rising cervical cancer cases and to promote sustainable economic advancement for women through prevention and control in member economies. Roche contributed to the development of the APEC roadmap, supporting greater inclusion of cervical cancer screening, especially using HPV molecular testing.

A strengthened cervical cancer care ecosystem

To date, as part of the Bridge program in LATAM, first key achievements include:

  • Brazil: healthcare professionals and patients have become engaged through education; screening coverage has increased from 30% to >80% (~95%) in women aged 25-64 years; digital solutions have reduced previous pap testing waste from 63% to <1%; and the new Brazil medical society HPV test guidelines have reached over 40,000 ob/gyn healthcare professionals. According to a study published by The Lancet Regional Health, the new screening with DNA-tests was able to detect 67% of cervical cancer cases in early stage and 19% in the late stage compared to 8.3% of cases in early and 67% in late stage under the previous program.

  • Chile: more than 2,000 healthcare professionals have been trained, including 90% of all primary care, and ten molecular diagnostic centers have been established.

The WHO estimates that achieving and sustaining the 90:70:90 targets set for countries as part of the cervical cancer elimination strategy will avert 74 million new cases of cervical cancer, and 62 million deaths in 78 low and middle income countries in the coming decades.

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