Millions of Women in Low- and Middle-Income Countries will Need Radiotherapy for Cervical Cancer Despite Vaccination

A new study from the University of Toronto and the Princess Margaret Cancer Centre reports that millions of women in low- and middle-income countries will need life-saving radiotherapy to treat their cervical cancer, despite the growth of essential human papilloma virus (HPV) vaccination programs. 

The availability of radiotherapy in these regions would generate millions of productive life years and billions of dollars in economic benefits for their families and communities.

“These are women in their prime who are working, caring for children, and contributing to their communities,” says lead author Danielle Rodin, an assistant professor of radiation oncology at U of T, and clinician-investigator and radiation oncologist at PMCC. “We have made huge progress in tackling other infectious disease and in reducing maternal mortality, so that women are now living long enough to develop diseases such as cancer and heart disease.” 

The study modeled the long-term demand, benefit and cost of implementing a 20-year strategy for radiotherapy to treat cervical cancer in low- and middle-income countries between 2015 and 2035, alongside a simultaneous vaccination program. 

The senior author on the paper is Michael Milosevic, a professor of radiation oncology at U of T and the director of research for the radiation medicine program at PMCC. Low-income and middle-income countries in the study included those with a per capita gross national income of less than $12,000 USD a year. The study results were published online yesterday in The Lancet Oncology.

In the designated 20-year-time span, the study estimated that 9.4 million women in these countries will require radiotherapy — the gold standard for curing women with more advanced cervical cancer. This would result in a net benefit to the economies of these countries of $151.5 billion over the same time period as a direct result of women living longer, more productive lives.

HPV vaccination would result in a 3.9% reduction in cervical cancer incidence over the study period — assuming a best case scenario of vaccinating every 12-year-old girl in the world starting in 2014. By 2072, when the first vaccinated cohort reaches 70 years of age, there would be a 22.9% reduction in incidence, still leaving 41.6 million in need for radiotherapy over that time period.

Almost all cervical cancers are caused by human papillomavirus, a sexually transmitted infection. There are more than 100 types of HPV, of which more than 40 can cause cervical cancer. Persistent HPV infections can sometimes develop into cervical cancer if not treated.

“Vaccination is hugely important, but we can’t neglect the millions of women who are contracting cervical cancer and dying in pain without access to treatment,” says Rodin. “These are women who have curable cancers — even advanced cervical cancer can be cured with radiotherapy. The possibility exists to make this treatment universally available.” 

Fast Facts

• Global cervical cancer burden falls disproportionately upon women in low and middle-income countries: approximately 90% of deaths from cervical cancer occur in low- and middle-income countries

• Cervical cancer is the most commonly diagnosed cancer in 28 countries and the leading cause of cancer death in 42 countries, many of which are in Sub-Saharan Africa and South-East Asia

• World-wide cervical cancer deaths are expected to rise to more than 440,000 deaths a year by 2030 – up from about 260,000 deaths currently – roughly a 60% increase and double the expected maternal mortality from pregnancy complications 

• Incomplete vaccine coverage, the long lag time for cancer growth after HPV infection, and a growing population mean that millions of women will require radiotherapy to prevent death

• Study demonstrates the need for a comprehensive approach to cervical cancer prevention and treatment, which includes both vaccination to prevent the disease and radiotherapy to cure woman who already have the disease

• Seven UN agencies under the United Nations Task Force on noncommunicable disease (NCDs) have established a Joint Program to prevent and control cervical cancer through global leadership and technical assistance to support governments and their partners build and sustain programs for prevention and treatment 

• The Joint Program will build on the world’s collective endeavours so that in a generation, death from cervical cancer ceases to be a public health issue