RASHIDATU ZAKARI
(0313012822)
CERVICAL CANCER
Cancer of the cervix of the uterus which afflict women when diagnosed early and managed
effectively is one of the most successful treatable forms of cancer. Cervical cancer is ranked
fourth of all cancers and the fourth most common of cancer among women in the worldwide
(Singh, et al., 2023). WHO in its 2020 launch of the global Cervical Cancer Elimination
Initiative to accelerate the elimination of cervical cancer targets the reduction of the incidence
below a threshold of 4 per 100,000 women-year in every country and narrow disparities
associate with the disease worldwide (WHO, 2020). The initiative is to achieve the 90-70-90
targets by 2030 which require that 90% of girls vaccinated by aged 15 years, 70% of women
to be screened with a high-performance test at least twice by age 45 years and 90% of women
identified with cervical precancer or cancer to be treated (WHO, 2020). National health
authorities around the world are doing everything necessary to meet the WHO’s 2030 targets.
This essay will discuss the epidemiology of cervical cancer globally, Africa and Ghana in
particular, the pathogenesis of the disease will be looked at, treatment and management
strategies will follow, current advances in research and technologies about the disease and final
draw conclusions and make recommendations from the discussions.
Epidemiology
Cervical cancer incidence is estimated globally to be 604,127 cases and 341831 deaths with
matching age-standardized incidence of 133 cases per 100,000 women-year and mortality rate
of 7.2 per 100,000 women-year in 2020 (Singh, et al., 2023). There are wide variabilities in
cervical cancer incidence around the with Iraq has estimated incidence of 2.2 per 100,000
women-year while in Eswatini has estimated incidence rate of 84.6 per 100,000 women-year.
Switzerland has a mortality rate of 1.0 per 100,000 women-year and Eswatini record a mortality
rate of 55.7. Incidence rate in term of age-standardized, Malawi recorded the highest of 67.9
per 100,000 and Zambia was 65.5 in Africa. In Latin America, Bolivia and Paraguay have the
highest of 36.6 per 100,000 women-year and 34.1 per 100,000 women- year respectively.
Maldives and Indonesia in Asia have age-standardized incidence of 24.5 and 24.4 per 100,
1000 women-year, and Fiji and Papua New Guinea respectively have estimated agestandardized incidence of 29.8 and 29.2 per 100,000 women-year (Singh, et al., 2023).
Approximately, 12,800 new cases are diagnosed in the United States America and about 4,800
deaths occur each year (Hartmann, Hall, & Zolnoun, 2002). Between 2016 and 2018, there
were 3200 new cervical cancer cases reported annually by the Cancer Research UK (Sunyoung
Choi, Ayden Ismail, George Pappas-Gogos, & Boussios, 2023).
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Sub-Saharan Africa has one of the highest invasive cervical cancer incidences in the world with
age-standardized of 31.0 per 100,000 women-year (Louie, de Sanjose, & Mayaud, 2009).
In Ghana, cervical cancer ranks second most common cancer among women and second most
common cancer for women between 15 and 44 years old. Data is not available on the burden
of HPV in the general population but annual new cases number is about 2,797 and death is
about 1,699 with age-standardized incidence of 27.4 per 100,000 women-year and 17.8 per
100,000 women-year. About 4.3% of women in the general population are estimated to have
cervical HPV-16/18 infection at a given time (ICO/IARC, 2023).
Pathogenesis
Human Papillomavirus (HPV) is the main cause of cervical cancer with strains 16 and 18 being
the most common types that are associated with the development of cervical cancer. In the UK
HPV contribute the 99.7% of new all cases with smoking, immunosuppression, poor sexual
health and screening non-attendance are the other risk factors (Sunyoung Choi, Ayden Ismail,
George Pappas-Gogos, & Boussios, 2023). There are almost half a million cases of HPV
identified yearly, there are low-grade infections and will naturally resolve within two years.
Other carcinogenic factors accompany the progression of high-grade lesions and cancer.
Patients with cervical cancer in the early stages are asymptomatic. Patients’ history and
physical examination are used to evaluate presence of the disease. History includes asking
about the age of first sexual intercourse, postcoital bleeding, pain during intercourse (Fowler,
Maani, Dunton, & Jack, 2022). Questions about previous sexually transmitted infection,
number life-time partners, previous history HPV infections, history HIV, use of tobacco and
history of HPV vaccination. Menstrual pattern and any abnormal bleeding, persistent virginal
discharges, irritations or known cervical lesions should be ascertained from women (Fowler,
Maani, Dunton, & Jack, 2022).
On physical examination, full evaluation of external and internal genitalia should be included
and women with cervical cancer examination findings must include a friable cervix, lesions,
erosions or bleeding with examination and fixed adnexa (Fowler, Maani, Dunton, & Jack,
2022).
Treatment and management strategies
Interventions in cervical cancer target both primary and secondary preventions. Decreasing the
burden and mortality of cervical cancer can be achieved through primary prevention and
screening methods. Screening and diagnostic effort are directed toward early identification of
high-risk HPV lesions by HPV testing and Pap smear. HPV testing is not recommended for
women below the age of 30 years, screening should start for younger women at age 21 through
to age 65. 3 to 5 years intervals between screening based on previous results and the use of Pap
and HPV co-testing. Cervical cancer is a sexually transmitted disease, it is preventable and
through education, screening and intervention its burden can be reduced.
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Low-risk lesions are monitored and reevaluated often and high-risk lesions are treated based
on size, location and staging. Precancerous lesions with limited size and depth can be managed
by cryotherapy or excision. Extensive lesions and lesions including endocervical canal can be
managed with conization, laser or Loop Electrosurgical Excision Procedure (LEEP).
When invasive cancer is diagnosed, staging determines further treatment in the steps
management which is based on findings from examination, tissue findings, imaging and
reported signs and symptoms. Grading determines the size and depth of cancer and the spread
to other organs. Early-stage of the disease has surgical resection treatment which can range
from conization to modified radical hysterectomy. Chemotherapy and radiation treatment may
be required for women with high risk features post-resection.
Increasing vaccination coverage worldwide is the best way to prevent cervical cancer and
possibly eliminate it which the WHO target for 2030 is seeking to achieve.
Current advances in research about cervical cancer
Advanced imaging modalities were allowed for staging such as MRI and PET scans. A pelvic
MRI is excellent for detecting local tumor extension. It can also be used for gauging tumor
response. PET scans are more sensitive than CT for the detection of nodal and visceral
metastasis. This is critical as the presence of nodal disease can greatly influence the prognosis.
Conclusions and recommendations
Cervical cancer is preventable and treatable, women of 30 years and above should be encourage
to going for regular screening. Females between ages of 9 and 45 years should go for the
vaccination as recommended and increased health education on the vaccination can help
increased the coverage in every country thereby help reduce the burden of the disease.
References
Fowler, J., Maani, E. V., Dunton, C. J., & Jack, B. (2022, 11 2). Cervical Cancer. Florida:
StatPearls Publishing. Retrieved 3 25, 2023 from
https://www.ncbi.nlm.nih.gov/books/NBK431093/?report=printable
Hartmann, K., Hall, S. A., & Zolnoun, D. (2002). Screening for Cervical Cancer. North
Carolina: Research Triangle Institute/University of North Carolina.
ICO/IARC. (2023). Ghana:Human Papillomavirus and Related Cancers, Fact Sheet 2023.
Barcelona, Spain: ICO/IARC Information Centre on HPV and Cancer.
Louie, K., de Sanjose, S., & Mayaud, P. (2009). Epidemiology and prevention of human
papillomavirus and cervical cancer in sub-Saharan Africa: a comprehensive review.
Tropical Medicine and International Health, 14(10), 1287–1302.
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Singh, D., Vignat, J., Lorenzoni, V., Eslahi, M., Ophira Ginsburg, O., Lauby-Secretan, B., . . .
Vaccarella, S. (2023). Global estimates of incidence and mortality of cervical cancer
in 2020: a baseline analysis of the WHO Global Cervical Cancer Elimination
Initiative. The Lancet, 11.
Sunyoung Choi, S., Ayden Ismail, A., George Pappas-Gogos, G., & Boussios, S. (2023). HPV
and Cervical Cancer: A Review of Epidemiology and Screening Uptake in the UK. .
Pathogens, 12(298).
WHO. (2020). WHO. Global strategy to accelerate the elimination of cervical cancer as a
public health problem. Geneva: World Health Organization.
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