With over 100 new cases annually, Guyana working to eliminate cervical cancer by 2050 

PRESIDENTIAL COMMISSION ON THE PREVENTION AND CONTROL OF THE NCDs MESSAGE FOR INTERNATIONAL HPV AWARENESS DAY

Today, March 4^th, is International HPV Awareness Day. The Presidential Commission on the Prevention and Control of the NCDs join our sisters and brothers across the world to raise awareness of Human Papilloma Virus (HPV). The Commission is convinced that a fully-HPV literate population is a powerful barrier against cervical cancer.

The Presidential Commission on the Prevention and Control of the NCDs takes the opportunity to commend the MOH and the Government for their aggressive effort to promote knowledge and awareness about Human Papilloma Virus (HPV). Just as Guyana successfully used knowledge about HIV to combat AIDS decades ago, Guyana must use education and awareness to control HPV and its diseases.

There are more than 200 Human Papilloma Viruses (HPV). Most appear harmless (there is no evidence that they cause any disease). However, there is a handful of HPVs which can lead to cancers. The most documented evidence for disease-causing HPVs is for cervical cancer. Among the cancer-causing HPVs are HPV 16 and 18 which are prevalent in Guyana. While most cervical cancers are attributed to some HPVs, there are other cancers which various HPVs contribute to. These include breast cancer, prostate cancer and colon cancer.

More than 80% of us are likely to be infected by an HPV in our lifetime. There are more than 200 different kinds of HPV that are circulating among humans. Most are harmless. But there are several HPVs which cause cancer. More than 90% of cervical cancers are caused by only a handful of HPVs. The main ones that cause cervical cancer are HPV16 and HPV 18, both of which are prevalent in Guyana.

Every citizen should know his or her HPV-status. The Commission commends the Government for its forward- looking policy of offering free testing for HPV. In doing so, Guyana can maintain a register of HPV-positive citizens, especially HPV-positive women, and monitor them for emergence of cancers. The goal is that more than 70% of women are tested for HPV and for cervical cancer by age 35 and again by age 45 by 2030.

Every child and young adult should be immunized against HPVs. Again, the Commission commends the Government for its forward-looking HPV vaccination program. HPV vaccine was first introduced by the PPP Government in 2010 for girls between 9 and 11 years old. Today, the HPV vaccine is available for girls and boys between the age of 9 and 15 and the goal is to vaccinate 90% girls before age 15 by 2030. Presently, Guyana exceeds 60% vaccine coverage, according to the MOH. Of note is that Guyana is among only a handful of developing countries that utilize the most advanced HPV vaccine – Gardasil 9.

In 2017, only 71 countries had introduced HPV vaccines in their national programs. By end of 2023, 143 countries had integrated HPV vaccines in their national programs. But 80% of these countries were either high-HDI or high middle-HDI countries. High-HDI North America and Europe have a range of 40 to 77% HPV vaccine coverage compared to the African region (22%); Western Pacific (11%); South-East Asia (3%), and the Eastern Mediterranean (0%).

The Commission is pleased that treatment options are expanding. With VIA, advance chemotherapy, radiotherapy and with the impending brachytherapy center, Guyana offers a comprehensive treatment program for HPV- related cervical cancer. The goal is for more than 90% of women diagnosed with cervical cancer accessing treatment and care by 2030.

While the Commission is encouraged by the MOH’s vigorous fight against HPV and Cervical Cancer, the Commission urges even more investments and even more robust efforts in the following:

• Rolling out an education and awareness program for an aware and mobilized population. This must include awareness and education in school curriculum, among the sermons and presentations in churches, temples, mandirs, mosques.
• Implementing a robust testing regime for screening and confirmation of persons positive for HPV and with cervical HPV-positive women can be followed-up with further evaluation with diagnostic cytology testing for the presence of cervical cancer.
• Increasing access to effective vaccines against the HPV variants that are most implicated as factors in cervical cancer.
• Ensuring access to quality treatment and care, including access to chemotherapy (medicines), surgery, radiotherapy and brachytherapy.

Guyana is part of a global effort to eliminate cervical cancer, one of the most prevalent forms of cancers in women. The UK, Western Europe and North America are on track to eliminate cervical cancer between 2040 and 2050. The President Irfaan Ali-led PPP Government is positioning Guyana to eliminate cervical cancer by 2050. Minister Frank Anthony and the MOH are working hard to ensure Guyana achieves this milestone.

Cervical cancer is the second most common cancer among women in Guyana, with approximately 121 new cases and 63 deaths reported annually. The disease disproportionately affects women, ranking second for both incidence and mortality among women aged 15–44. High-risk HPV (16/18) is a major factor, with high prevalence rates noted, particularly among indigenous populations. With an incidence rate of more than 20/100,000 women, Guyana’s cervical cancer rate is very high.

The Commission urges that citizens join the MOH to change this status. The WHO considers a rate of 4/100,000 to achieve elimination. With a rate of more than 20/100,000, Guyana has a massive mountain to climb.

On March 13^th, the Commission, together with Guyana’s Permanent Mission in Geneva will join Permanent Missions from different countries around the world to push for global elimination by 2080. Guyana’s Permanent Representative in Geneva has been a lead proponent for a global push to eliminate cervical cancer by 2080. The elimination of cervical cancer before or by 2080 will mark only the second time that the world would have achieved the end of a disease. It will also mark the first time we would have ended a cancer.

While the WHO global strategy envisages global elimination of cervical cancer by 2120, a growing number of public health experts have joined Guyana’s Permanent Representative in Geneva who is also Chair of the Commission to urge acceleration to end cervical cancer by 2080, 40 years before the WHO’s global elimination deadline. With the robust strategy in Guyana, our country can play a leading role by trying to achieve national elimination by 2050.

The latest available global data reveal approximately 600,000 new cases of cervical cancer and 338,800 deaths annually, constituting 6.5% and 7.7% of total new cancer cases and deaths in women, respectively. Low-Human Development Index (HDI) countries have the highest incidence and mortality rates of cervical cancer, with incidence rates three times higher than that in countries with high-HDI, and mortality rates six-times higher.

In a Lancet Report, as of 2022, the following ranking was established: Asia has the highest cervical cancer incidence (60%) and mortality (57.3%), followed by Africa (19%, 23.1%); Latin America and the Caribbean (9.5%, 9.6%);

Europe (8.8%; 7.7%), North America (2.4%; 1.9%) and Oceania (0.37%; 0.38%). This ranking is consistent with high rates in low-HDI countries and low rates in high-HDI countries.

With vaccines on hand, and remarkable scientific and technological advancements, the world can duplicate the lessons of Smallpox eradication to eliminate cervical cancer. Several Ambassadors in Geneva, led by Guyana’s ambassador, have issued a call to action. These ambassadors argue that just as the world, working together, eradicated smallpox, we can together, today, eliminate cervical cancer. These ambassadors urge nations to strive as ONE WORLD to end Cervical Cancer before May 8, 2080, when we celebrate the 100th anniversary of the eradication of Smallpox.

Over thousands of years, from as early as 1350 BC, Smallpox, a highly infectious, deadly disease, killed hundreds of millions around the world. But today, it remains the only human infectious disease to have been eradicated. The beginning of the end was when the World Health Assembly in 1958 issued a call for the eradication of smallpox, a global call to action. In 1959, the WHO launched the Smallpox Eradication Program, with mass vaccination as the foundation of the eradication strategy. In the height of the Cold War, British, Canadian, Cuban, French, Russian, and US vaccines were given freely to WHO and distributed onwards, sometimes with the strategic financial support of Sweden. The result was that the WHO declared zero case of smallpox in the world as of October 26, 1979; a Global Commission of Scientists certified the eradication of Smallpox on December 9, 1979; and on May 8, 1980, the WHO at WHA33 declared Smallpox officially eradicated.

National, regional and global investments in the fight against HPV and cervical cancer is a “best buy”, an option we ignore at great peril for people, particularly for women in resource-poor settings. Remarkable advancements in science and technology, an armament of tools, provide countries with the real possibility for ending cervical cancer before 2050 in many countries and before 2080 in all countries. Guyana can be a leading light by ending cervical cancer by 2050.

Ending a cancer for the first time will be monumental. The progress we have made in the fight against cervical cancer in the past two decades must motivate us to reach the finish line in eliminating cervical cancer. The question must not be “ïf” we can; it must be “when”.

On November 17th, 2020, Member States of the WHO adopted the Global Strategy for Cervical Cancer Elimination. An important outcome of the strategy is for countries to achieve an incidence rate of below 4 per 100,000 women. As a first step towards reaching this goal, countries must achieve the “90-70-90” targets by 2030. The 90-70-90 targets are 90% of girls vaccinated with the HPV vaccine before the age of 15; 70% of women screened using a high-performance test by the age of 35 years and again by the age of 45; and 90% of women with pre-cancer treated and 90% of women with invasive cancer managed.

Although daunting, the global ambition to eliminate cervical cancer before the 100^th anniversary of the eradication of smallpox is possible. We, the world, must not abdicate this responsibility. It will be reckless and immoral for us not to grab the opportunity for a public health milestone that is staring at us.