Project to Eliminate Cervical Cancer
A pilot project to investigate the feasibility of supporting implementation of strategies, as advocated by WHO, for increasing vaccination against HPV and engagement of women with cervical screening
Project leads: Professor Sean Kehoe, Chair of the FIGO Gynecological Oncology Committee; Professor Joanna Cain, Past Chair and current member of WHO Guidelines Development Group (GDG) for elimination of Cervical Cancer; Professor Neerja Bhatla, member of FIGO Committee and WHO GDG; and Professor Mary Ann Lumsden, CEO FIGO
Project Contact: Francesca Hearing
Introduction and context
Each year over 500,000 women are diagnosed with cervical cancer, and over a quarter of a million die. More than 85% of these deaths occur in low- and middle- income countries and it is estimated that this will rise to 95% over time. Most LMICs do not have access to cervical cancer screening programmes or robust HPV vaccination, and the majority of women in these countries present with advanced disease not amenable to surgery.
The WHO, along with FIGO and many global partners, now sees a path to the eradication of this deadly disease through an emphasis on vaccination and screening. However, gaps exist in both professional and community education, sustainability of prevention strategies, and coordination of implementation in-country.
Strategies targeting Cervical Cancer
In-country implementation and education targeting cervical cancer elimination must focus on two key elements:
Primary prevention: The high efficacy of HPV vaccine in preventing pre-invasive disease is accepted as the best primary preventative strategy and has been identified by WHO and other global health leaders as the key for future elimination. A successful vaccination programme depends upon political support, education, infrastructure, knowledge and training, plus support from and collaboration with other organisations.
Screening: The value of screening by cervical smears, HPV testing or other means are also major contributors to the reduction in cervical cancer. Research shows variable efficacy with a wide range of screening strategies. Implementation of the most efficacious strategy for the country or region is the goal, whether increasing access or shifting strategy to cover more women.
Three quarters of women in LIC will present with advanced disease (stage 3 and 4) invasive cervical cancer without surgical options and limited access to chemo-radiotherapy or palliative care. Given these limited treatment options, prevention, whether primary or screening, is a priority in order to eliminate cervical cancer.
FIGO aims to develop evidence-based models on successful collaborative structures to facilitate the sustainable implementation of the WHO evidence-based guidance for vaccination and screening. The project will focus on three key aims:
Aim 1: Identify common educational and professional gaps impacting the implementation of present HPV vaccination strategies though experience in select low-middle income countries
Aim 2: Develop reproducible projects working with FIGO National and/or regional organisations that target collaboration/education/facilitation of introducing a vaccination programme where none exists and/or addresses underlying educational or professional gaps that have hindered roll out of programs.
Aim 3: The countries, represented by their national society, will expand the knowledge of addressing diverse issue for implementation globally with special but not exclusive interest in non-GAVI LMICs.
The project will consist of two phases: assessment and design, followed by initial implementation.
Assessment and Design Grants will identify gaps that exist in-country and provide an assessment and design proposal to address these educational/ professional/ or collaborative challenges. The design will include identification of outcome measures and in- country collaborators. Individual countries and Member Societies, including National Societies and Regional Federations, are invited to apply for funding in order to identify in-country gaps in vaccination and screening, whether educational, professional or collaborative.
The Request for Proposals (RFP) and information about the submission process for Assessment and Design grants can be found below.
Initial Implementation Grants, based on successes, needs, and available funds, may be subsequently available to enable grantees to secure sustainable implementation of the project.
In the longer term, FIGO will support and work with WHO to implement their guidelines and to increase uptake of vaccination and screening programmes. The WHO revised evidence-based guidelines are being launched in the near future, offering FIGO and our member societies the opportunity to demonstrate the added value we bring to the implementation work with deep and expansive reach into the gynecological community.