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Atualmente não há tratamento para infecção por HPV. Existem tratamentos para verrugas genitais, pré-cânceres cervicais e câncer cervical.

Verrugas genitais não cancerosas e lesões pré-cancerosas no colo do útero, vagina, vulva, ânus ou pênis podem ser removidas ou tratadas por ablação (congelamento ou aquecimento) ou por cirurgia.

Actualmente, o cancro do colo do útero (cancro do colo do útero) é o único cancro causado pelo HPV para o qual estão disponíveis testes de rastreio.

Os tratamentos para cancros causados ​​pelo HPV (incluindo cancro do colo do útero) são mais eficazes se diagnosticados precocemente. O tratamento deve começar rapidamente após o diagnóstico.

Saiba mais sobre o tratamento do pré-câncer cervical aqui: Ficha informativa da OMS sobre câncer cervical

As vias de gestão para o tratamento do cancro invasivo são ferramentas importantes para garantir que um paciente seja encaminhado prontamente e apoiado à medida que percorre os passos para o diagnóstico e as decisões de tratamento. Uma equipe multidisciplinar deve garantir que o diagnóstico e o estadiamento (exames histológicos, patologia, imagem) ocorram antes das decisões de tratamento, que podem incluir cirurgia, radioterapia e terapia sistêmica, como quimioterapia. As decisões de tratamento devem estar em conformidade com as directrizes nacionais e as intervenções devem ser apoiadas por cuidados psicológicos, espirituais, físicos e paliativos holísticos.

À medida que os países de baixo e médio rendimento intensificam o rastreio do colo do útero, serão detectados mais casos de cancro do colo do útero invasivo, especialmente em populações anteriormente não rastreadas. Portanto, as estratégias de encaminhamento e tratamento precisam ser implementadas e ampliadas juntamente com os serviços de prevenção.

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Programa Útero é Vida: coleta do exame citopatológico 02

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Programa Útero é Vida: coleta do exame citopatológico

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1. WHO. Global strategy to accelerate the elimination of cervical cancer as a public health problem. November 2020. Available from: https://www.who.int/publications/i/item/9789240014107

2. WHO HPV Vaccine Global Market Study, April 2022. Available from: https://www.who.int/publications/m/item/who-hpv-vaccine-global-market-study-april-2022

3. MSD, News Release. Expansion of Elkton, Virginia Manufacturing Facility to Further Increase Merck’s HPV Vaccine Supply and Support Broader and Equitable Access. April 4th 2022. Available from: https://www.merck.com/news/expansion-of-elkton-virginia-manufacturing-facility-to-further-increase-mercks-hpv-vaccine-supply-and-support-broader-and-equitable-access/ (last accessed: 17 July 2022)

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The 4-7 April convening of the WHO Strategic Advisory Group of Experts on Immunization (SAGE) evaluated the evidence that has been emerging over past years that single-dose schedules provide comparable efficacy to the two or three-dose regimens.

SAGE's review concluded that a single-dose Human Papillomavirus (HPV)vaccine delivers solid protection against HPV, the virus that causes cervical cancer, that is comparable to 2-dose schedules. This could be a game-changer for the prevention of the disease; seeing more doses of the life-saving jab reach more girls.

Often referred to as the 'silent killer' and almost entirely preventable, cervical cancer is a disease of inequity of access; the new SAGE recommendation is underpinned by concerns over the slow introduction of the HPV vaccine into immunization programs and overall low population coverage, especially in poorer countries.

More than 95% of cervical cancer is caused by sexually transmitted HPV, which is the fourth most common type of cancer in women globally with 90% of these women living in low- and middle-income countries.

"The HPV vaccine is highly effective for the prevention of HPV serotypes 16 & 18, which cause 70% of cervical cancer," said Dr Alejandro Cravioto, SAGE Chair. "SAGE urges all countries to introduce HPV vaccines and prioritize multi-age cohort catch up of missed and older cohorts of girls. These recommendations will enable more girls and women to be vaccinated and thus preventing them from having cervical cancer and all its consequences over the course of their lifetimes."

SAGE recommends updating dose schedules for HPV as follows:

one or two-dose schedule for the primary target of girls aged 9-14

one or two-dose schedule for young women aged 15-20

Two doses with a 6-month interval for women older than 21.

Immunocompromised individuals, including those with HIV, should receive three doses if feasible, and if not at least two doses. There is limited evidence regarding the efficacy of a single dose in this group.

WHO's recommendations will be updated following further consultation across stakeholders.

WHO Assistant Director-General Dr Princess Nothemba (Nono) Simelela commented, "I firmly believe the elimination of cervical cancer is possible. In 2020 the Cervical Cancer Elimination Initiative was launched to address several challenges including the inequity in vaccine access. This single-dose recommendation has the potential to take us faster to our goal of having 90 per cent of girls vaccinated by the age of 15 by 2030."

Globally, the uptake of the life-saving vaccine has been slow, and coverage in countries much lower than the 90% target. Consequently, in 2020 global coverage with 2 doses was only 13%. Several factors have influenced the slow uptake and low coverage of HPV vaccines including supply challenges, as well as the programmatic challenges and costs related to delivering a two regimen to older girls who are not typically part of childhood vaccination programs. Added to this has been the relatively high cost of HPV vaccines, particularly for middle-income countries.

Dr Simelela continued "we need political commitment complemented with equitable pathways for the accessibility of the HPV vaccine. Failure to do so is an injustice to the generation of girls and young women who may be at risk of cervical cancer."

The option for a single dose of the vaccine is less costly, less resource intensive and easier to administer. It facilitates implementing catch-up campaigns for multiple age groups, reduces the challenges link ed to tracing girls for their second dose and allows for financial and human resources to be redirected to other health priorities."

Other meeting highlights of the April 4-7 Strategic Advisory Group of Experts on Immunization (SAGE) convening include:
COVID-19 Vaccines
SAGE evaluated the data on the CanSino Bio (Ad5-nCOV-S) vaccine. The outcomes of this discussion will be made available subject to WHO EUL being granted.

SAGE also discussed the evidence on the immunity from infection and in combination with vaccination ("hybrid immunity") and requested a technical paper to be produced by WHO.
Hepatitis A
SAGE recommends that either one or two dose schedules of inactivated hepatitis A vaccine can be used by programmes.
Poliovirus vaccine
SAGE endorsed calls for an intensified planning effort for "Oral Polio Vaccine (OPV) Cessation" to anticipate the post-certification of wild-type poliovirus eradication time, and the eventual global end of the use of all live, attenuated oral polio vaccines as part of routine immunization programs.

Immunization Agenda 2030 (IA2030)

SAGE endorsed IA2030's report "Guiding Principles for recovering, building resiliency, and strengthening of immunization in 2022 and beyond"
About The Strategic Advisory Group of Experts on Immunization
The Strategic Advisory Group of Experts on Immunization (SAGE) is charged with advising WHO on overall global policies and strategies, ranging from vaccines and technology, research and development, to delivery of immunization and its linkages with other health interventions.

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One-dose Human Papillomavirus (HPV) vaccine offers solid protection against cervical cancer

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In developing countries, limited access to effective screening means that the disease is often not identified until it is further advanced and symptoms develop. In addition, prospects for treatment of such late-stage disease may be poor, resulting in a higher rate of death from cervical cancer in these countries.

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Infográfico: Uma dose da vacina contra o papilomavírus humano (HPV) é segura e eficaz contra o câncer do colo do útero!

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Este infográfico responde a perguntas como: Por que vacinar as meninas contra o HPV?, O que é o HPV?, Por que a vacina contra o HPV é aplicada preferencialmente em meninas de 9 a 14 anos?, Quantas doses são necessárias para proteger as meninas?, Os meninos podem ser vacinados contra o HPV?, Os adultos podem ser vacinados contra o HPV?

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Overview

This global strategy to eliminate cervical cancer proposes:

a vision of a world where cervical cancer is eliminated as a public health problem;

a threshold of 4 per 100 000 women-years for elimination as a public health problem;

the following 90-70-90 targets that must be met by 2030 for countries to be on the path towards cervical cancer elimination:

90% of girls fully vaccinated with HPV vaccine by age 15 years

70% of women are screened with a high-performance test by 35 years of age and again by 45 years of age

90% of women identified with cervical disease receive treatment (90% of women with precancer treated, and 90% of women with invasive cancer managed).

a mathematical model that illustrates the following interim benefits of achieving the 90-70-90 targets by 2030 in low- and lower-middle-income countries:

median cervical cancer incidence rate will fall by 42% by 2045, and by 97% by 2120, averting more than 74 million new cases of cervical cancer;

median cumulative number of cervical cancer deaths averted will be 300 000 by 2030, over 14 million by 2070, and over 62 million by 2120.

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Global strategy to accelerate the elimination of cervical cancer as a public health problem

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Cervical cancer is a preventable disease. It is also curable if detected early and adequately treated. Yet it remains one of the most common cancers and causes of cancer-related death in women across the globe.

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World Health Organization - Regional Office for the Eastern Mediterranean

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Cervical Cancer Awareness Month 2023

Cervical cancer develops in a woman's cervix (the entrance to the uterus from the vagina). Almost all cervical cancer cases (99%) are linked to infection with high risk human papillomavirus (HPV), an extremely common virus transmitted through sexual contact. Although most infections with HPV resolve spontaneously and cause no symptoms, persistent infection can cause cervical cancer in women.

Cervical cancer is the 6th most common cancer in women in the Eastern Mediterranean Region. In 2020, an estimated 89 800 women were diagnosed with cervical cancer in the Region and more than 47 500 women died from the disease.

January is Cervical Cancer Awareness Month. It is a perfect opportunity for WHO and partners to raise awareness about cervical cancer and HPV vaccination. This year, we are focusing on ending cervical cancer within a few generations as the theme for Cervical Cancer Awareness Month.

When diagnosed, cervical cancer is one of the most successfully treatable forms of cancer, as long as it is detected early and managed effectively. Cancers diagnosed in late stages can also be controlled with appropriate treatment and palliative care. With a comprehensive approach to prevent, screen and treat, we can end cervical cancer as a public health problem within a few generations.

On this Cervical Cancer Awareness Month, the messages are clear.

Get informed. Find out the facts about cervical cancer and the human papilloma virus (HPV) that causes it. Help educate other women in your life too.

Get screened. Cervical cancer screening typically starts at age 30 and is repeated periodically.

Get vaccinated. The HPV vaccine is given in 2 doses that should begin when a girl is between 9 and 14 years old.

Cervical Cancer Awareness Month also comes at a time when the world continues to recover from the COVID-19 pandemic, where substantial disruptions to essential health services persist. So during this month and beyond, let us work together, to build back healthier communities by improving access to HPV vaccination, screening, treatment for cervical pre-cancer and management of cervical cancer by 2030 and end cervical cancer within a few generations.

Despite being a preventable and curable disease, cervical cancer is responsible for a large burden of suffering in women around the world, especially in low- and middle-income countries. To uphold the right to health for adolescent girls and women, it is important that disparities in access to high-quality health services are addressed.

In 2020, the World Health Organization (WHO) set a goal to eliminate cervical cancer as a public health problem globally by 2120. To reach this goal, WHO's Member States should strive to meet the following interim scale-up targets by 2030:

90% of girls are fully vaccinated with human papillomavirus (HPV) vaccine by 15 years of age;

70% of women are screened using a high-performance test by 35 years of age and again by 45 years of age;

90% of women with pre-cancer are treated, and 90% of women with invasive cancer are managed.

To build on the momentum of the Global strategy to accelerate the elimination of cervical cancer as a public health problem, a regional cervical cancer elimination strategy has been developed for the WHO Eastern Mediterranean Region that is adapted to the religious, cultural, social, economic and geographical contexts in the Region.

Regional cervical cancer elimination strategy: Executive summary English | Arabic | French

Regional cervical cancer elimination strategy: English | Arabic | French

11 January 2023 | Cairo, Egypt

The World Health Organization (WHO) Regional Office for the Eastern Mediterranean formally launched today the Regional Cervical Cancer Elimination Strategy for the Eastern Mediterranean at a hybrid press conference hosted by WHO leaders and joined by women who have survived cervical cancer, advocates fighting the disease and high-level speakers. The event introduced the "90-70-90" targets set by the strategy: for countries to achieve 90% human papillomavirus (HPV) vaccination coverage for girls by age 15, 70% screening coverage for women by ages 35 and 45, and 90% treatment for cervical pre-cancer and management for women with cancer by 2030.

Press release English | Arabic

In August 2020, the World Health Assembly adopted the Global Strategy for Cervical Cancer Elimination. The Strategy outlines a comprehensive approach that includes prevention, effective screening and treatment of pre-cancerous lesions, early cancer diagnosis and programmes for the management of invasive cervical cancer including palliative care.
Global strategy to accelerate the elimination of cervical cancer as a public health problem
The Cervical Cancer Elimination Initiative Knowledge Repository was established to support the implementation of the Global Strategy by Member States. There are many sources of relevant guidance and information to guide these efforts. The Knowledge Repository is a web-based platform, which aims to map and provide "one-stop" access to the knowledge collected from a variety of sources.

Cervical cancer elimination initiative knowledge repository

The aim of the WHO Cervical Cancer Country Profiles is to bring out the current status of cervical cancer for each WHO Member States (194 total) curated from multiple data sources. These profiles help to establish a baseline for the country and support monitoring trends toward the achievement of the elimination of cervical cancer as a public health problem.

The profiles include the following information:

Burden of cervical cancer. Cervical cancer incidence, cumulative risk of cervical cancer, total number of deaths and trends in deaths, and cervical cancer mortality to incidence.

Primary prevention. HPV vaccination programme coverage and programme details, related risk factors including tobacco use prevention, condom use at last high risk sex and HIV incidence.

Secondary prevention. National screening programme for cervical cancer details and cervical cancer screening rate.

Treatment and supportive care. National guidelines for cervical cancer management, cancer diagnosis and treatment service availability, availability of specialized medical staff, palliative care.

Cervical cancer country profiles for all WHO Member States, 2021

Cervical cancer country profiles for WHO Member States in the Eastern Mediterranean Region, 2021

What is cervical cancer?

Cervical cancer develops in a woman's cervix, which is the entrance to the uterus from the vagina. Almost all (99%) cervical cancer cases are linked to infection with high risk human papillomavirus (HPV), an extremely common virus transmitted through sexual contact.

Human papillomavirus (HPV)

Human papillomavirus (HPV) is the most common viral infection of the reproductive tract. Most sexually active women and men will be infected at some point in their lives and some may be repeatedly infected. HPV is sexually transmitted, but penetrative sex is not required for transmission. Skin-to-skin genital contact is a well-recognized mode of transmission.

There are many types of HPV, and many do not cause problems. HPV infections usually clear up without any intervention within a few months after acquisition, and about 90% clear within 2 years. A small proportion of infections with certain types of HPV can persist and progress to cervical cancer.

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Cervical cancer develops in a woman's cervix (the entrance to the uterus from the vagina). Almost all cervical cancer cases (99%) are linked to infection with high risk human papillomavirus (HPV), an extremely common virus transmitted through sexual contact. Although most infections with HPV resolve spontaneously and cause no symptoms, persistent infection can cause cervical cancer in women.

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Key facts

Cervical cancer is the fourth most common cancer in women globally with around 660 000 new cases and around 350 000 deaths in 2022.

The highest rates of cervical cancer incidence and mortality are in low- and middle-income countries. This reflects major inequities driven by lack of access to national HPV vaccination, cervical screening and treatment services and social and economic determinants.

Cervical cancer is caused by persistent infection with the human papillomavirus (HPV). Women living with HIV are 6 times more likely to develop cervical cancer compared to women without HIV.

Prophylactic vaccination against HPV and screening and treatment of pre-cancer lesions are effective strategies to prevent cervical cancer and are very cost-effective.

Cervical cancer can be cured if diagnosed at an early stage and treated promptly.

Countries around the world are working to accelerate the elimination of cervical cancer in the coming decades, with an agreed set of three targets to be met by 2030.

Overview

Globally, cervical cancer is the fourth most common cancer in women, with around 660 000 new cases in 2022. In the same year, about 94% of the 350 000 deaths caused by cervical cancer occurred in low- and middle-income countries. The highest rates of cervical cancer incidence and mortality are in sub-Saharan Africa (SSA), Central America and South-East Asia. Regional differences in the cervical cancer burden are related to inequalities in access to vaccination, screening and treatment services, risk factors including HIV prevalence, and social and economic determinants such as sex, gender biases and poverty. Women living with HIV are 6 times more likely to develop cervical cancer compared to the general population, and an estimated 5% of all cervical cancer cases are attributable to HIV (1). Cervical cancer disproportionately affects younger women, and as a result, 20% of children who lose their mother to cancer do so due to cervical cancer (2).

Human papillomavirus (HPV) is a common sexually transmitted infection which can affect the skin, genital area and throat. Almost all sexually active people will be infected at some point in their lives, usually without symptoms. In most cases the immune system clears HPV from the body. Persistent infection with high-risk HPV can cause abnormal cells to develop, which go on to become cancer.

Persistent HPV infection of the cervix (the lower part of the uterus or womb, which opens into the vagina - also called the birth canal) if left untreated, causes 95% of cervical cancers. Typically, it takes 15-20 years for abnormal cells to become cancer, but in women with weakened immune systems, such as untreated HIV, this process can be faster and take 5-10 years. Risk factors for cancer progression include the grade of oncogenicity of the HPV type, immune status, the presence of other sexually transmitted infections, number of births, young age at first pregnancy, hormonal contraceptive use, and smoking.

Prevention

Boosting public awareness, access to information and services are key to prevention and control across the life course.

Being vaccinated at age 9-14 years is a highly effective way to prevent HPV infection, cervical cancer and other HPV-related cancers.

Screening from the age of 30 (25 years in women living with HIV) can detect cervical disease, which when treated, also prevents cervical cancer.

At any age with symptoms or concerns, early detection followed by prompt quality treatment can cure cervical cancer.

HPV vaccination and other prevention steps

As of 2023, there are 6 HPV vaccines available globally. All protect against the high-risk HPV types 16 and 18, which cause most cervical cancers and have been shown to be safe and effective in preventing HPV infection and cervical cancer.

As a priority, HPV vaccines should be given to all girls aged 9-14 years, before they become sexually active. The vaccine may be given as 1 or 2 doses. People with reduced immune systems should ideally receive 2 or 3 doses. Some countries have also chosen to vaccinate boys to further reduce the prevalence of HPV in the community and to prevent cancers in men caused by HPV.

Other important ways to prevent HPV infection include:

being a non-smoker or stopping smoking

using condoms

voluntary male circumcision.

Cervical screening and treatment of precancers

Women should be screened for cervical cancer every 5-10 years starting at age 30. Women living with HIV should be screened every 3 years starting at age 25. The global strategy encourages a minimum of two lifetime screens with a high-performance HPV test by age 35 and again by age 45 years. Precancers rarely cause symptoms, which is why regular cervical cancer screening is important, even if you have been vaccinated against HPV.

Self-collection of a sample for HPV testing, which may be a preferred choice for women, has been shown to be as reliable as samples collected by healthcare providers.

After a positive HPV test (or other screening method) a healthcare provider can look for changes on the cervix (such as precancers) which may develop into cervical cancer if left untreated. Treatment of precancers is a simple procedure and prevents cervical cancer. Treatment may be offered in the same visit (the see and treat approach) or after a second test (the see, triage and treat approach), which is especially recommended for women living with HIV.

Treatments of precancers are quick and generally painless causing infrequent complications. Treatment steps include colposcopy or visual inspection of the cervix to locate and assess the lesion followed by:

thermal ablation, which involves using a heated probe to burn off cells;

cryotherapy, which involves using a cold probe to freeze off the cells;

LEETZ (large loop excision of the transformation zone), which involves removing your abnormal tissues with an electrically heated loop; and/or

a cone biopsy, which involves using a knife to remove a cone-shaped wedge of tissue.

Early detection, diagnosis and treatment of cervical cancer

Cervical cancer can be cured if diagnosed and treated at an early stage of disease. Recognizing symptoms and seeking medical advice to address any concerns is a critical step. Women should see a healthcare professional if they notice:

unusual bleeding between periods, after menopause, or after sexual intercourse

increased or foul-smelling vaginal discharge

symptoms like persistent pain in the back, legs, or pelvis

weight loss, fatigue and loss of appetite

vaginal discomfort

swelling in the legs.

Clinical evaluations and tests to confirm a diagnosis are important and will generally be followed by referral for treatment services, which can include surgery, radiotherapy and chemotherapy as well as palliative care to provide supportive care and pain management.

Management pathways for invasive cancer care are important tools to ensure that a patient is referred promptly and supported as they navigate the steps to diagnosis and treatment decisions. Features of quality care include:

a multidisciplinary team ensuring diagnosis and staging (histological testing, pathology, imaging) takes place prior to treatment decisions;

treatment decisions in line with national guidelines; and

interventions are supported by holistic psychological, spiritual, physical and palliative care.

As low- and middle-income countries scale-up cervical screening, more cases of invasive cervical cancer will be detected, especially in previously unscreened populations. Therefore, referral and cancer management strategies need to be implemented and expanded alongside prevention services.

WHO Response

All countries have made a commitment to eliminate cervical cancer as a public health problem. The WHO Global strategy defines elimination as reducing the number of new cases annually to 4 or fewer per 100 000 women and sets three targets to be achieved by the year 2030 to put all countries on the pathway to elimination in the coming decades:

90% of girls vaccinated with the HPV vaccine by age 15

70% of women screened with a high-quality test by ages 35 and 45

90% of women with cervical disease receiving treatment.

Modelling estimates that a cumulative 74 million new cases of cervical cancer can be averted, and 62 million deaths can be avoided by by 2120 by reaching this elimination goal. Explore the cervical cancer knowledge repository for resources from WHO, UN agencies and other partners: Cervical cancer elimination initiative.

Prevention of HPV-associated precancer and cancer is also a key element of WHO's Global health sector strategy on HIV, hepatitis and sexually transmitted infections 2022-2030, and the World Health Assembly resolution WHA74.5 (2021) on oral health includes actions on mouth and throat cancers.
References

1. Stelze, Dominik et al. Estimates of the global burden of cervical cancer associated with HIV. The Lancet. 2020. https://doi.org/10.1016/S2214-109X(20)30459-9

2. Guida, F., Kidman, R., Ferlay, J. et al. Global and regional estimates of orphans attributed to maternal cancer mortality in 2020.Nat Med 28, 2563-2572 (2022). https://doi.org/10.1038/s41591-022-02109-2

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WHO fact sheet on cervical cancer, including key facts, causes, prevention and WHO response.

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Key facts

Human papillomavirus (HPV) is the name of a group of 200 known viruses. They do not cause concerns in most people, but infection with some high-risk types is common and can cause genital warts or cancer.

In 90% of people the body controls the infection by itself. Persistent HPV infection with high-risk HPV types is the cause of cervical cancer and is associated with cancers of the vulva, vagina, mouth/throat, penis and anus (1).

HPV infection causes about 5% of all cancers worldwide, with an estimated 625 600 women and 69 400 men getting an HPV-related cancer each year.

Women living wit h human immunodeficiency virus (HIV) are 6 times more likely to develop cervical cancer compared to women without HIV.

Prophylactic vaccination against HPV can prevent these cancers. In addition, HPV-screening and treatment of pre-cancer lesions is an effective way to prevent cervical cancer.

Overview

Human papillomavirus (HPV) is a common sexually transmitted infection. Almost all sexually active people will be infected at some point in their lives, usually without symptoms.

HPV can affect the skin, genital area and throat.

Condoms help prevent HPV but do not offer total protection because they do not cover all the genital skin.

HPV usually goes away on its own without treatment. Some HPV infections cause genital warts. Others can cause abnormal cells to develop, which go on to become cancer.

Cancers from HPV can be prevented with vaccines.

The vaccine does not contain any live virus or DNA from the virus so it cannot cause cancer or other HPV-related illnesses. The HPV vaccine is not used to treat HPV infections or diseases caused by HPV, but instead to prevent the development of cancers.

Currently, cervical cancer is the only HPV-caused cancer for which screening tests are available. Screening tests are used to check for disease when there are no symptoms. The goal of screening for cervical cancer is to find precancerous cell changes before they become cancer and when treatment can prevent cancer from developing. Screening for cervical cancer is an important part of routine health care for people who have a cervix. This includes women and transgender men who still have a cervix.

Cervical cancer is the most common type of cancer caused by HPV, other less common cancers affecting men and women, including anal, vulvar, vaginal, mouth/throat and penile cancers.

Scope of the problem

The highest prevalence of cervical HPV among women is in sub-Saharan Africa (24%), followed by Latin America and the Caribbean (16%), eastern Europe (14%), and South-East Asia (14%) (2). Prevalence in men is highly variable based on sexual trends.

Evidence showed that prevalence of the virus is higher among women living with HIV, men who have sex with men, immunocompromised individuals, people with co-infection with other sexually transmitted infections (STI), people who receive immunosuppressive medications and children who have been through sexual abuse.

Globally, it is estimated that 625 600 women and 69 400 men getting an HPV-related cancer each year. Cervical cancer was the fourth leading cause of cancer and cancer deaths in women in 2020, with an estimated 604 127 new cases and 341 831 deaths worldwide (3). Cervical cancers account for 93% of HPV-related cancers in women (1).

The highest rates of cervical cancer incidence and mortality are in low- and middle-income countries. This reflects major inequities where death from cervical cancer is three times higher in in low- and middle-income countries than high income countries.

Symptoms

Most people will not have any symptoms from an HPV infection. The immune system usually clears HPV from the body within a year or two with no lasting effects.

Some HPV infections cause small rough lumps (genital warts) that can appear on the vagina, penis or anus and rarely the throat. They may be painful, itchy or bleed or cause swollen glands.

HPV infection that does not go away on its own can cause changes to cervical cells, which lead to precancers that may become cervical cancer if left untreated. It usually takes 15-20 years for cervical cancer to develop after HPV infection.

The early changes in cervical cells and precancers mostly do not cause symptoms. Symptoms of cervical cancer may include bleeding between periods or after sexual intercourse or a foul-smelling vaginal discharge. These symptoms may be due to other diseases. People with these symptoms should speak to their healthcare provider.

Prevention

Being vaccinated is the best way to prevent HPV infection, cervical cancer and other HPV-related cancers. Screening can detect cervical precancers that can be treated before they develop into cancer.

HPV vaccines should be given to all girls aged 9-14 years, before they become sexually active.

The vaccine may be given as 1 or 2 doses. People with reduced immune systems should receive 2 or 3 doses. Check with your healthcare provider to determine what is best for you.

Using condoms during sex is an important way to prevent HPV infection. Voluntary male circumcision also reduces the risk of infection. Being a non-smoker or stopping smoking reduces the chances of developing persistent HPV infection.

Testing cells from a woman's cervix for HPV is used to screen women for cervical cancer. Women should be screened every 5-10 years starting at age 30. Women living with HIV should be screened every 3 years starting at age 25.

After a positive HPV test (or other screening method), a healthcare provider can look for changes on the cervix or precancers that could develop into cervical cancer if left untreated. Treatment of precancers prevents cervical cancer. Precancers rarely cause symptoms, which is why regular screening to check cervical health is important.

Learn more about vaccination of boys and older age groups: WHO position paper

Treatment

There is currently no treatment for HPV infection. Treatments exist for genital warts, cervical precancers and cervical cancer.

Non-cancerous genital warts and precancerous lesions in the cervix, vagina, vulva, anus or penis can be removed or treated by ablation (freezing or heating) or with surgery.

Currently, cancer of the cervix (cervical cancer) is the only HPV-caused cancer for which screening tests are available.

Treatments for cancers caused by HPV (including cervical cancer) are more effective if diagnosed early. Treatment should begin quickly after diagnosis.

Learn more about cervical precancer treatment here: WHO fact sheet on cervical cancer

Management pathways for invasive cancer care are important tools to ensure that a patient is referred promptly and supported as they navigate the steps to diagnosis and treatment decisions. A multidisciplinary team should ensure diagnosis and staging (histological testing, pathology, imaging) takes place prior to treatment decisions which could include surgery, radiotherapy and systemic therapy such as chemotherapy. Treatment decisions should be in line with national guidelines and interventions should be supported by holistic psychological, spiritual, physical and palliative care.

As low- and middle-income countries scale-up cervical screening, more cases of invasive cervical cancer will be detected, especially in previously unscreened populations. Therefore, referral and treatment strategies need to be implemented and expanded alongside prevention services.

WHO response

Giving the global public health burden of cervical cancer caused by HPV, the World Health Assembly (WHA. 73.2) adopted the Global strategy to accelerate the elimination of cervical cancer as a public health problem with the following targets:

90% of girls fully vaccinated with HPV vaccine by age 15;

70% of women are screened with a high-performance test by 35, and again by 45 years of age; and

90% of women identified with cervical disease receive treatment (90% of women with pre-cancer treated; 90% of women with invasive cancer managed).

Prevention of HPV-associated precancer and cancer is also a key element of WHO's Global health sector strategy on, respectively, HIV, hepatitis and sexually transmitted infections, 2022-2030 and the resolution WHA74.5 (2021) on oral health includes actions on mouth/throat cancers.

The joint work of the WHO at global, regional and national level, alongside UN sister agencies delivers to:

1. increase political commitment to formulate policy and support implementation

2. offer contextualized technical assistance, lessons learned and best practices

3. develop norms and standards based on latest evidence

4. lead the global health ecosystem to achieve the targets and improve quality of care.

References

1. de Martel et al, Lancet Global Health 2019, https://pubmed.ncbi.nlm.nih.gov/31862245/

2. Bruni L et al. Cervical human papillomavirus prevalence in 5 continents: meta-analysis of 1 million women with normal cytological findings. J Infect Dis. 2010;202(12):1789-1799. https://pubmed.ncbi.nlm.nih.gov/21067372/

3. Sung H et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-249. https://pubmed.ncbi.nlm.nih.gov/33538338/

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WHO fact sheet on human papilloma virus and cancer, including overview, scope of the problem, symptoms, treatment, prevention and WHO response.

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Closing the Women’s Health Gap: A $1 TrillionOpportunity to ImproveLives and Economies

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Closing the Women’s Health Gap: A $1 TrillionOpportunity to ImproveLives and Economies

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Health Gap: A $1 Trillion

Opportunity to Improve

Lives and Economies

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Over the past two centuries, the rise in life expectancy-for both men and women-has been a tremendous success story. Global life expectancy increased from 30 years to 73 years between 1800 and 2018. But this is not the full picture. Women spend more of their lives in poor health and with degrees of disability (the "health span" rather than the "life span"). A woman will spend an average of nine years in poor health, which affects her ability to be present and/or productive at home, in the workforce, and in the community and reduces her earning potential (see sidebar "Terminology used in this report").

Critically, better health is correlated with economic prosperity. The women's health gap equates to 75 million years of life lost due to poor health or early death per year (Exhibit 1), the equivalent of seven days per woman per year. Addressing the gap could generate the equivalent impact of 137 million women accessing full-time positions by 2040. This has the potential to lift women out of poverty and allow more women to provide for themselves and their families. Addressing the drivers of this gap-namely, lower effectiveness of treatments for women, worse care delivery, and lack of data-would require substantial investment but also reflect new market opportunities.

While improving women's health has positive economic outcomes, it is foremost an issue of health equity and inclusivity. Addressing the women's health gap could improve the quality of life for women, as well as creating positive ripples in society, such as improving future generations' health and boosting healthy aging.

The challenges women face when seeking healthcare play out in multiple different ways and in different diseases and sectors of society. In terms of the potential economic impact of addressing these challenges, all age groups and geographies could benefit, with most of the potential coming from women of working age (Exhibit 2).

Embracing the full definition of women's health

Women are most likely to be affected by a sex-specific condition between the ages of 15 and 50. Other conditions occur throughout women's lives, but nearly half of the health burden affects women in their working years, which often has an impact on their ability to earn money and support themselves and their families (Exhibit 4).

Health equity encompasses access to the interventions and options that are right for each individual, regardless of their gender, sex, sexual identity, sexual orientation, age, race, ethnicity, religion, disability, education, income level, or any other distinguishing characteristic. For women, this can start with a better understanding of and access to interventions that lead to the best outcomes.

How to read this report

The analysis presented in this report includes an assessment of the health burden associated with the women's health gap as measured in potential years of healthy life. This health improvement potential was then translated to economic potential, measured as contribution to gross domestic product (GDP). Sections 2 through 4 of this report focus on health improvement potential (measured in DALYs), broken down by three root causes related to disparities in science, data, and care delivery. The economic value of this combined health improvement potential is presented in section 6, where economic impact is measured in terms of additional GDP.

While this report focuses on the potential economic benefits of closing the women's health gap, there is also a moral imperative to close the women's health gap and to improve the lives of millions of women worldwide.

Effectiveness of and access to medical therapies may vary

There are well-known cases where women and men experience important differences in the uptake or effectiveness of a medicine designed and approved for use in both sexes. This is true, for example, for some therapies used in asthma and cardiovascular disease. Analysts looked at 183 of the most widely used interventions across 64 health conditions representing roughly 90 percent of the health burden for women, reviewing more than 650 academic papers, to assess the extent of this phenomenon. Of the interventions studied 50 percent reported sex-disaggregated data. In cases where sex-disaggregated data was available, 64 percent of the interventions studied were found to put women at a disadvantage due to lower efficacy, more limited access, or both, while for men this was the case only for 10 percent of interventions (Exhibit 5).

Examples include:

Asthma is a common respiratory condition affecting men and women at similar prevalence rates. Acute asthma exacerbations present as symptoms such as shortness of breath, wheezing, cough, or chest tightness. A mainstay of treatment is inhaler therapy with bronchodilators and corticosteroids, but studies indicate that this treatment is around 20 percentage points less effective in reducing exacerbations in women than in men.

Cardiovascular and cerebrovascular disease-particularly ischemic heart disease and stroke-is the biggest single contributor to disease burden globally for both men and women, accounting for 16 percent of DALYs globally for men and 14 percent for women. One German study found that, despite identical technical success of a percutaneous cardiac intervention for men and women, the age-adjusted risk of death or of cardiac events was 20 percent higher in women than in men.

Research in women's health primarily focuses on diseases with high mortality, overlooking diseases leading to disability

One way to assess research priorities is through pipeline assets. There is up to a tenfold higher volume of new therapies in development for some of the most common women's cancers compared with debilitating gynecological conditions (Exhibit 6). One possible reason is the higher mortality rate of oncologic conditions. The solution is not to trim cancer funding, but to recognize the possibilities for advances in research related to other women's health conditions-in particular, menopause, premenstrual syndrome, endometriosis, and polycystic ovary syndrome.

In all, when tackling women's health, the solution is not to divide more slices of one pie: it's to make more pie.

How the lack of sex- and gender-specific data and research affects safety

The research conducted indicates that systematic lack of disease understanding created a women's health gap of 40 million to 45 million DALYs per year, or four days per woman per year. This is equivalent to around 60 percent of the total gap due to sex-related biology differences (see Exhibit 1 above). This estimate includes the known gap for conditions that affect both sexes and an estimate of the gap represented by the average lower effectiveness for women-specific conditions relative to men. It also includes the "unknown" gap: this is where no sex-disaggregated evidence is available for specific conditions that could, if evidence existed, potentially demonstrate levels of effectiveness difference comparable to conditions where sex-based analysis is available. The longevity of women cannot explain the disparity, and the effectiveness gap has a disproportionate impact on women and girls between ten and 40 years old and in certain regions (Latin America and Central Asia).

Shining a light on the interventions for which this information was not reported would benefit both men and women by enabling innovators to develop interventions that are better suited for specific subpopulations.

Gaps exist across the data value chain

Stage 1: Pre-data generation

The data gap starts at the very definition of women's health. There is a lack of consistent and aligned definitions and measurement scales for conditions and symptoms affecting women. For example, definitions of health-related burden associated with menopause or menstrual syndromes differ, and pain instruments and scales lack consistency.

Stage 2: Data generation

Stage 3: Data aggregation

Stage 4: Data analysis

Women can face barriers to timely and accurate diagnosis

Gaps in understanding the effectiveness of health interventions

Ensuring sex-differentiated results

Representative clinical studies capable of producing stratified results may involve larger and longer clinical trials, increasing costs and extending time to market. However, the results would likely lead to more effective interventions with higher uptake among patients. The risk/reward equation for investors becomes more balanced if payers (governments, insurers, and patients) and regulators insist on evidence for cohort-specific impact.

Today, some conditions, such as leukemia and meningitis, are believed to affect men and women equally. But the research to identify potential differences is lacking. Stakeholders may explore how a systematic and proactive approach to designing and reporting clinical outcomes could take sex and gender into account.

Inequalities exist throughout the full pathway of care

The care pathway runs from awareness of a health issue to access to services and preventive care, timely and accurate diagnosis and effective treatment and follow-up. At each segment of this pathway, inequalities exist, especially for women who are disadvantaged in ways beyond their gender (see sidebar "Intersectionality and health outcomes").

Awareness and prevention

The importance of increasing awareness goes beyond patients. Many doctors are unaware of how diseases can affect or manifest differently in women, so they are unable to provide proper care to many patients.

Accessibility and affordability of care

Timely diagnosis

Choice of treatment

Creating solutions to tackle care disparities

Overall, the gap in care delivery contributes 34 percent to the women's health gap (see Exhibit 1 above). Consider how sex- and gender-appropriate care delivery could reduce the women's health burden by 25 million DALYs per year globally, corresponding to 2.5 days per woman per year.

Improvements in the diagnostic tools available would represent a major step forward for patients. Yet even without innovative tools, it would be possible to improve care and bridge the gaps in diagnosis with more consistent and standardized screening and data collection. Earlier diagnosis and a more holistic, patient-centric treatment approach could help improve disease and symptom management, prevent uncontrolled progression and resulting complications, and reduce unnecessary treatments.

At a global level, AI, unbiased data sets, and interoperable electronic records are potential options for enhancing care delivery. Ultimately, a combination of innovation, investment, and ability to scale could unlock better care delivery solutions for women.

There has been a historical underinvestment in women's health research from the public, social, and private sectors. Funding sources typically overlook the fact that many conditions manifest differently in each sex, creating variances in outcome.

Closing the health gap will require increased investment not only for understanding sex-based differences but also for addressing unmet needs in women's health. Further, additional funding and new business models could support sex- and gender-appropriate care.

Research funding neglects women's health

Private equity/venture capital investors are increasing investments in women's health, with excitement about digital health solutions

Given the large unmet need and resulting opportunity, those who continue to forgo investing in women's health may find themselves left behind by the players that tap into this high-potential market.

The disparities in women's health affect not only women's quality of life but also their economic participation and ability to earn a living for themselves and their families. Health is intricately linked to economic productivity, prospects for prosperity, and contribution to economic output. Economic growth over the past 70 years has been closely tied to women's increased labor force participation. Therefore, it is not surprising that the gap in women's health results in lost economic potential.

Addressing the health gap women face could boost the global economy by adding at least $1 trillion to the global economy by 2040. This means a 1.7 percent increase in the average per capita GDP generated by women.

Women's economic participation has been and will be a major driver of economic growth

Addressing the gap could generate the equivalent impact of 137 million women accessing full-time positions by 2040. This would enable women to secure an income to support themselves and their families and has the potential to lift more women out of poverty.

Better health often enables individuals to work more effectively

Looking at the different channels affecting GDP, the largest impact, amounting to around $400 billion or avoiding 24 million years with disability, would be created through fewer health conditions (Exhibit 9). Expanded participation and increased productivity could each contribute more than 20 percent of total impact.

Treating ten health conditions would contribute more than half of the economic impact

The conditions having the greatest economic impact in different countries will differ from one geographic region to another based on each region's disease burden and healthcare status. The examination of economic impact, rather than DALY impact, gives more weight to conditions that affect people during years of working age, as that is when economic contribution is highest. Conditions such as ischemic heart disease may affect more people, but if the burden of morbidity and premature mortality happens after the usual age of retirement, the economic impact is more limited.

Generally, a reduction in health conditions is tied to a woman's economic potential, with allowances for regional socioeconomic and healthcare factors (Exhibit 11). The top two conditions by contribution to GDP impact of the women's health gap are always a combination of two of the top four global conditions: PMS, depression, migraine, or other gynecological conditions. Larger differences among regions are observed when looking at the top ten or more conditions.

Across the four channels, the highest GDP impact relative to women's GDP is observed in HICs and LICs (Exhibit 12). For LICs, most of the impact comes from fewer early deaths and fewer health conditions. Both upper-middle-income (UMIC) and lower-middle-income (LMIC) regions exhibit an overall lower projected GDP impact.

Investing in women's health shows positive return on investment (ROI): for every $1 invested, approximately $3 is projected in economic growth

The expected economic return varies by region. The ROI is greatest in higher-income settings, where it is around $3.50 returned for every $1 invested. More investment is probably needed in some LICs to establish the basic health infrastructure required to support low-cost delivery of high-quality health services, as well as to create better and more rewarding economic opportunities for women. Still, the analysis indicates that the overall benefit would exceed the costs even in these settings, at a rate of around $2 returned on $1 invested.

The analysis examines only the direct costs of addressing the gaps in care delivery identified. In the longer term, a range of greater positive returns is possible, given that improvement in the lives of women influences the health and resilience of their families and communities.

Where to start tackling the women's health gap to reap the greatest benefit for all

Globally, the top ten conditions by economic impact account for more than 50 percent of the total GDP impact. This highlights areas with high unmet needs and potential, aiding decision makers in prioritizing efforts to address health disparities. Specific conditions and their socioeconomic contexts vary among regions, influencing their contribution to the economy. This information could guide tailored strategies toward health equity.

The content and sequence of each action will need to be tailored to regional conditions. Building on the knowledge developed throughout this report, a fact-based strategic assessment can lead to better health equity for each country.

As noted in this report, women's health has been under-researched, and women face different challenges from men in affordability and access to treatment. This health gap creates unnecessary suffering and preventable economic losses.

It does not have to be this way. Through collaborative efforts on five fronts, a more equitable and healthy future is possible. There is an opportunity to close the women's health gap by (1) investing in women-centric R&D, (2) strengthening the collection and analysis of sex- and gender-disaggregated data, (3) enhancing access to gender-specific care, (4) encouraging investments in women's health innovation, and (5) examining business policies to support women.

Invest in women-centric research to fill the knowledge and data gaps in women-specific conditions, as well as in diseases affecting women differently and/or disproportionately

The women's health gap could be narrowed by increasing funding to achieve equality with investments in funding for men's health and using protocols that set standards of equity and diversity. Scientists, life science companies (pharma, biotech, medtech), healthcare providers, and others in the healthcare ecosystem may consider how the traditional understanding of disease is focused primarily on the male body. A more in-depth understanding of these differences would enable more effective care interventions and improved health outcomes. One example of venture-capital-backed funding addressing this disparity is Repro Grants, which allots up to $100,000 for research projects aimed at deepening understanding of female reproductive biology.

For conditions that affect women differently or disproportionately, more effective interventions start with clinical trials designed with inclusivity at their core, informed by preclinical research using female animal models. Specifically, there should be stronger diversity, equity, and inclusion guidelines for clinical trial design. Guidance could incorporate male versus female disease prevalence mix and use sex-specific thresholds for biomarkers to yield an adequate patient representation in clinical trials.

Systematically collect and analyze sex-, ethnicity-, and gender-specific data to have more accurate representation of women's health burden and the impact of different interventions

The prevalence of conditions such as endometriosis and menopause is underestimated, leading investors and life science companies to underestimate the market potential of these conditions and underinvest. By accurately assessing and reporting on the prevalence of such conditions, national health institutes and other authorities may direct additional funding to the research and treatment of these underserved conditions.

Biotech, medtech, and FemTech enterprises also have exciting opportunities related to AI and ML, which ensures that these models do not exacerbate existing biases or violate patient privacy rules. Developing robust, secure, and holistic data sets could enable companies to differentiate in an overcrowded marketplace.

Enhance access to gender-specific care, from prevention to diagnosis and treatment

Women deserve the same high-quality level of care from their healthcare providers as men, which doesn't mean the same care per se. There is a pressing need to redesign medical curricula as well as residency and fellowships to reflect sex and gender differences. In addition to medical schools, continuing medical education organizations and credentialing entities could assess whether healthcare providers are receiving the latest information and training on the women's health gap and sex- and gender-based differences. Current and future healthcare professionals of all specialties must be equipped with accurate and updated knowledge of biological differences, including sex-specific manifestations of symptoms. Future certification or tests could include questions meant to address whether providers have internalized this knowledge.

Governments, educational bodies, philanthropic institutions, and many other stakeholders can use this moment to raise awareness of the sex-specific manifestations of disease-for example, ensuring that newly diagnosed endometriosis patients have access to up-to-date resources, including which trials they could potentially participate in. Healthcare entities, philanthropic organizations, or community health workers could start or reinvigorate in-person support groups for conditions such as endometriosis or menopause or for mental health support. Collectively, better education and resources, plus new diagnostics, are among the ways to potentially elevate the quality of healthcare women receive.

In addition, two things to enable closing the gap include:

Create incentives for new financing models to close the women's health gap

Historically, given lower levers of investments overall for women's health under the traditional financing model schemes, new financing models have a critical role to play. These models can accelerate innovation. One example is the advance market commitment (AMC) geared to COVID-19 vaccine development and deployment.

Research and reliable data on the women's health landscape can help spur investment. For investors, the gender-based healthcare landscape presents a mosaic of unexplored opportunities. By pivoting toward this opportunity, investors can channel funds into high-impact areas, bridge the data gap, and enable more investment and innovation.

Governments could explore policies that encourage sex- and gender-responsive health research and services-for example, by earmarking funds, providing tax incentives, lowering application fees, and expediting the drug approval process. Philanthropic organizations, donors, and international bodies could offer grants and prizes at a national or local level to spur innovation while supporting capacity building in regions where gender-based health disparities are highest. Examples might be launching a grant or award program geared toward reducing rates of respiratory illnesses in areas where there is a high percentage of women smokers, or toward a technology-based solution for women in vulnerable populations to access transportation to healthcare services.

With collaboration, stakeholders have the potential to encourage investments and inspire the development of innovative financing models in women's health.

Establish business policies that support women's health

Data-driven, scalable actions to improve women's health may vary widely, but the critical component is to determine how each stakeholder can contribute to narrowing the gap.

If health equity efforts sit within a tree of principles, they can be watered by research, flourish in the sun of business investments, and grow far-reaching branches that stretch into the economy.

Achieving health equity is a collaborative and ongoing endeavor that relies on the active participation of governments, healthcare institutions, nongovernmental organizations, individuals, and all stakeholders vested in this cause. Tackling the women's health gap depends on addressing the interconnected factors outlined in this report: the deficit of women-specific knowledge in science, the glaring data gaps, the disparities in healthcare delivery, and the insufficient investment in women's health.

Recognizing the vast potential to improve the lives and livelihoods of half the global population while boosting the economy serves as the catalyst for closing the women's health gap. Every facet of this gap, from limited education to suboptimal treatments, offers an opportunity for transformation with the active involvement of governments, life science innovators, educational institutions, philanthropists, activists, and more.

In this endeavor lies an opportunity of $1 trillion in economic potential driven by improved women's health and economic participation. The question is not whether this wealth of opportunities exists but rather who will take the initiative to seize it and drive change.

Women's health is not a stand-alone issue; it is a cornerstone of societal well-being and progress. Better health and well-being for women creates a ripple effect that extends to families, communities, and nations. This holistic approach, supported by collective action and sustained investment, will not only narrow the health gap but also contribute to the betterment of a shared global future.

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Closing the women's health gap: A $1 trillion opportunity to improve lives and economies

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Investments addressing the women's health gap could add years to life and life to years-and potentially boost the global economy by $1 trillion annually by 2040.

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An international consensus on the essential cancer screnning  iarc 2022

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Too many women worldwide - particularly the poorest women - continue to die from cervical cancer; a disease which is both preventable and treatable. Today, WHO and HRP have launched a new guideline to help countries make faster progress, more equitably, on the screening and treatment of this devastating disease.

Ending suffering from cervical cancer

Last year, in 2020, more than half a million women contracted cervical cancer, and about 342 000 women died as a result - most in the poorest countries. Quick and accurate screening programmes are critical so that every woman with cervical disease gets the treatment she needs, and avoidable deaths are prevented.

WHO's global strategy for cervical cancer elimination- endorsed by the World Health Assembly in 2020 - 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. Alongside vaccination of girls against the human papillomavirus (HPV), implementing this global strategy could prevent more than 62 million deaths from cervical cancer in the next 100 years.

" Effective and accessible cervical screening and treatment programmes in every country are non-negotiable if we are going to end the unimaginable suffering caused by cervical cancer," says Dr Princess Nono Simelela, Assistant Director-General for Strategic Programmatic Priorities: Cervical Cancer Elimination. "This new WHO guideline will guide public health investment in better diagnostic tools, stronger implementation processes and more acceptable options for screening to reach more women - and save more lives."

A shift in care

The new guideline include some important shifts in WHO's recommended approaches to cervical screening.

In particular, it recommends an HPV DNA based test as the preferred method, rather than visual inspection with acetic acid (VIA) or cytology (commonly known as a 'Pap smear'), currently the most commonly used methods globally to detect pre-cancer lesions.

HPV-DNA testing detects high-risk strains of HPV which cause almost all cervical cancers. Unlike tests that rely on visual inspection, HPV-DNA testing is an objective diagnostic, leaving no space for interpretation of results.

Although the process for a healthcare provider obtaining a cervical sample is similar with both cytology or HPV DNA testing, HPV DNA testing is simpler, prevents more pre-cancers and cancer, and saves more lives than VIA or cytology. In addition, it is more cost-effective.

More access to commodities and self-sampling is another route to consider for reaching the global strategy target of 70% testing by 2030.

WHO suggests that self-collected samples can be used when providing HPV DNA testing. Studies show that women often feel more comfortable taking their own samples, for instance in the comfort of their own home, rather than going to see a provider for screening. However, women need to receive appropriate support to feel confident in managing the process.

Recommendations respond to the link between HPV and HIV

Women who are immunocompromised, such as those living with HIV, are particularly vulnerable to cervical disease; they are more likely to have persistent HPV infections and more rapid progression to pre-cancer and cancer. This results in a six-fold higher risk of cervical cancer among women living with HIV.

In recognition of this, the new guideline include recommendations which are specific for women living with HIV. This includes using an HPV DNA primary screening test followed by a triage test if results are positive for HPV, to evaluate the results for risk of cervical cancer and need for treatment. The global recommendations also advise that screening start at an earlier age (25 years of age) than for the general population of women (30 years of age). Women living with HIV also need to be retested after a shorter time interval following a positive test and following treatment than women without HIV.

" With these new guidelines, we must leverage the platforms already developed for HIV care and treatment to better integrate cervical cancer screening and treatment to meet the health needs and rights of the diverse group of women living with HIV to increase access, improve coverage, and save lives " Dr. Meg Doherty, Director, WHO Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes.

Every intervention counts to eliminate cervical cancer

Data showing where countries around the world currently stand in relation to their burden of cervical cancer and coverage for screening and treatment, are due to be published by the end of 2021. These country profiles can help ministries of health identify where their programmes need strengthening and measure progress towards the 2030 targets.

For a cervical cancer prevention and control programme to have impact, strengthening patient retention and ensuring rapid treatment of women who screen positive for HPV or cervical pre-cancer is a fundamental priority.

" Cost-effectiveness of screening tests is important for scaling up programmes, but other aspects of the public health approach to eliminating cervical cancer are also vital," said Dr Nathalie Broutet, WHO Department of Sexual and Reproductive Health and Research and HRP. " What matters most is the coherence of every country's programme in ensuring the continuum of care: that all women have access to screening, health care providers are informed in a timely manner about the results of the screening test and can in turn share this information with their client, and that women can access appropriate treatment or referral if needed."

WHO calls for all women to ensure they get regular cervical cancer screening tests in line with the recommendations of their local health authority.

Summary recommendation for the general population of women

Summary recommendation for women living with HIV

WHO suggests using either of the following strategies for cervical cancer prevention:

HPV DNA detection in a screen-and-treat approach starting at the age of 30 years with regular screening every 5 to 10 years.

HPV DNA detection in a screen, triage and treat approach starting at the age of 30 years with regular screening every 5 to 10 years.

WHO suggests using the following strategy for cervical cancer prevention among women living with HIV:

HPV DNA detection in a screen, triage and treat approach starting at the age of 25 with regular screening every 3 to 5 years.

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New recommendations for screening and treatment to prevent cervical cancer

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Too many women worldwide - particularly the poorest women - continue to die from cervical cancer; a disease which is both preventable and treatable.

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Wordwall - Crie lições melhores mais rapidamente

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1) Assinale a alternativa que NÃO contenha um tipo de HPV alto risco de desenvolver cancer a) 11 b) 18 c) 16 d) 31 2) sobre a transmissão e a infecção do HPV é CORRETO afirmar a) cerca de 80% das mulheres sexualmente ativas serão infectadas a um ou mais tipo de HPV em algum momento da vida b) cerca de apenas 10% da população masculina encontra-se infectada por algum tipo do HPV c) há cerca 3 mulheres infectadas para cada homem infectado no mundo d) a maioria das infecções do HPV tornam-se persistente 3) Sobre a infeção do HPV é CORRETO afirmar a) a maioria das pessoas infectadas com HPV tem sintomas como febre e corrimento b) toda pessoa com infeccao do HPV deve fazer tratamento com medicamento antiviral no local e/ou via horal c) mais de 80% das pessoas infectadas pelo HPV desenvolve a infecção persistente d) entre a infecção e o desenvolvimento de uma lesão tumoral demora em media mais 5 anos 4) o maior fator de risco para desenvolver o câncer de colo uterino é a) Promiscuidade b) infecção persistente pelo virus de alto risco c) idade maior que 60 anos d) infecção conjunta com sifilis 5) Assinale a resposta CORRETA: a) 1 em cada 3 homens (com 18 anos ou mais) sao positivos para algum tipo de HPV alto risco b) Metade das pessoas que tem uma infecção pelo vírus do HPV desenvolverá o câncer c) apenas 20% dos casos de câncer de colo estão relacionados a infeção do HPV d) a infeccao do virus HPV acontece apenas pelo contato sexual vaginal 6) Sobra a trasmissã o do HPV assinale a resposta CORRETA a) Pode ocorrer através de objetos como vibrador b) a camisinha não diminui o risco de trasmissao do HPV

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1) Assinale a alternativa que NÃO contenha um tipo de HPV alto risco de desenvolver cancer 2) sobre a transmissão e a infecção do HPV é CORRETO afirmar

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Virtual Course on Comprehensive Cervical Cancer Control in Latin America and the Caribbean

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This course aims to improve the training of health providers in all aspects related to the prevention and control of cervical cancer, including its natural history, primary prevention through vaccination against HPV, detection and treatment of cervical lesions precancerous, diagnosis and treatment of invasive cervical cancer, and provision of palliative care.