Cervical cancer is the fourth most common cancer in women. Last year, the World Health Organisation (WHO) reported that 99% of cases were linked to human papillomavirus (HPV), a highly infectious virus that is transmitted through sexual contact. Cervical cancer is preventable in developed countries due to consistent access to HPV vaccination and regular screening services. Women in developing countries, however, are disproportionately affected by cervical cancer due to having inadequate access to these preventative measures. As a result, 85% of all cervical cancer-related deaths occur in developing countries.
The WHO is now calling for 70% of women worldwide to be screened for the disease, and for all girls to be vaccinated against HPV. Since the start of the Covid-19 pandemic, however, cervical cancer prevention protocols such as HPV vaccination and screening have been disrupted. These disruptions will likely cause delays in diagnosis. GlobalData epidemiologists expect that the number of diagnosed prevalent cases of cervical cancer in Africa will surpass forecast estimates, resulting in more late-stage diagnoses and mortality because of these setbacks.
The Covid-19 pandemic has brought unprecedented challenges to healthcare delivery and has complicated access to HPV vaccinations and cervical cancer screening. Since global lockdowns have restricted access to preventative services and the risk of Covid-19 infection has caused ongoing anxiety around accessing healthcare services, levels of HPV vaccination and cervical screening have been subpar.
A retrospective-based audit by van Wyk and colleagues, published in The South African Medical Journal, took place in a large pathology laboratory in Western Cape Province, South Africa. The objective was to assess the impact of Covid-19 on the new diagnoses of six types of cancer. The audit found that between 1 April and 30 June last year, there were 339 new cancer diagnoses at the clinic, 36.2% less than in the same period in 2019. The decline in overall diagnoses was attributed to the suspension of outpatient health services. This can be used to explain differences in in the decline between specific cancers.
Pancreatic cancer diagnoses decreased by 58.2% because of the substantial de-escalation of routine biopsies. The decline in cervical cancer diagnoses at this clinic was much less, at 7%, and can be explained by the uninterrupted, albeit scaled-down, service at this institution during the study period. This uninterrupted service is, however, unlikely to have been experienced throughout the country, so this percentage is likely much higher and on par with what was observed for other cancers. It is likely that the disruption to routine cervical cancer screening services last year will impact the number of future diagnoses due to delayed diagnosis and the backlog of cases that were not treated during the pandemic.
GlobalData epidemiologists forecast that the diagnosed prevalent cases of cervical cancer in South Africa are expected to reach around 45,800 cases this year and will increase to 48,800 cases in 2028. But since mitigation measures and screenings remain stunted across Africa, GlobalData epidemiologists expect that the number of diagnosed prevalent cases will surpass current forecast estimates over the next five years, with an increase in late-stage diagnoses arising due to the increasing number of women who have missed screening appointments because of the pandemic, and excess demand for services once they resume.
The initial strategies proposed by the WHO have since been revised to make up for the lack of progress during the pandemic. Partners are now working alongside health sectors to make existing policies and projects comply with the national Covid-19 response and the changing healthcare space, with a specific focus on increasing access across the sub-Saharan African region. This suggests that efforts are in place to reduce inequalities in cervical cancer prevention. It is, however, important for these efforts to become more widespread to avoid further geographic inequalities and the subsequent increase in cases.