Molly Delaney, Class of 2022
The cervix is located underneath the uterus and right above the vaginal canal and is prone to many health complications such as “chronic inflammation, polyps, dysplasia, and cancer” (Very Well Health). Cervical cancer usually develops as a result of human papillomavirus, or HPV. HPV has been the “cause 70% of cervical cancers and pre-cancerous cervical lesions” (World Health Organization). Two types of HPV have been the primary culprits of this 70%: types 16 and 18. Cancer, in general, develops due to an accumulation of mutations in a cells’ DNA. These mutations lead to the loss of apoptosis and the cells will continue to divide and invade other tissues and organs. Apoptosis is the “process of programmed cell death…[and] is considered a vital component of various processes including normal cell turnover” (NCBI). There are many misconceptions about HPV in the United States particularly; “HPV has been estimated to infect more than 90 percent of the U.S. population, with about 12,000 Americans ages 15 to 24 being infected daily. It's the most commonly diagnosed sexually transmitted disease (STD) in the United States and abroad” (Everyday Health). The stigma against HPV and other sexually transmitted diseases prevents many Americans from receiving timely check-ups which can lead to a late diagnosis for cervical cancer. There are two main types of cervical cancer: squamous cell carcinoma and adenocarcinoma (Mayo Clinic). Squamous cells are the skin cells in the cervix, and “between 70 and 80 out of every 100 cervical cancers (70 to 80%) are squamous cell cancers” (Cancer Research UK). Adenocarcinoma is slightly less common than squamous cell carcinoma, affecting “around 20 in every 100 cervical cancers (20%)” (Cancer Research UK). Adenocarcinoma develops in the mucus-producing gland cells in the cervix. Some of the current literature regarding cervical cancer has predicted its eradication within the next 100 years (Medical News Today) whereas other sources have labeled this prediction as unlikely (The BMJ). Analyzing this contrasting literature and opinions may aid in understanding the future of cervical cancer treatments and diagnoses.
Medical News Today claims that “specialists and the World Health Organization (WHO) argue that within the next 100 years, we may be able to eradicate this form [cervical] of cancer altogether”. The WHO Cervical Cancer Elimination Modelling Consortium led by Professor Marc Brisson has outlined several paths that countries can take and apply that may lead to the eradication of cervical cancer within the next 100 years. The first strategy to be applied concerns vaccinations at an early age, particularly young girls in low and middle-income countries. By doing this, the Consortium predicts an “89.4% reduction in cervical cancer cases over the next century”. The National Cancer Institute suggests vaccinations around ages 11 and 12. Along with the strategy of vaccinations, frequent screenings are necessary. With these two strategies employed, “Prof. Brisson and his colleagues...argue that...low- and middle-income countries could avert an estimated 61 million cases of cervical cancer up to 2120”.
These strategies may seem simple and obvious to employ to main, but the following statistics presented by WHO proves otherwise: “an estimated 21.8 million infants worldwide are still not being reached by routine immunization services”. Reasons for a lack in immunizations in many countries across the world are a “lack of parental education, low income, poor access to health facilities,...traditional beliefs,...socioeconomic status, urban/rural residence and sex of the child” (WHO). The availability and cost of immunizations that are basic and fundamental to the health of citizens in other countries, such as the United States, Canada, and England, prove to be unsustainable and insurmountable in other countries such as India, Afghanistan, and Somalia. There is an obvious bias in countries classified as first-world who often are unaware of the height of these obstacles and barriers, and this leads to discrimination, inequality, and bigotry. WHO is undergoing studies that are attempting to minimize the height of these obstacles, but “despite progress, much remains to be done if the benefit of routine childhood immunization is to be maximized”.
On the other hand, the BMJ, a medical journal, does not believe that the solutions presented by Medical News Today are adequate and encompassing enough to fully eradicate cervical cancer around the world. This belief is derived from the fact that “there are at least 100 serotypes of HPV. The two vaccines currently used in the UK, Gardasil and Cervarix, cover the two strains of HPV that are most likely to cause cancer”. However, other strains of HPV are also likely to cause cancer; “Some cases of cancer will continue to be caused by strains that are not covered by the vaccine”. The eradication of some diseases such as measles and polio is possible and has been achieved in many countries due to the concept of herd immunity which is defined by Manish Sadarangani as “how a population is protected from a disease after vaccination by stopping the germ responsible for the infection being transmitted between people” (Oxford Vaccine Group). Herd immunity does not apply to cervical cancer, which is why even an incredibly diverse vaccine that could target more strains of HPV would not be able to fully eradicate cervical cancer.
In total, many different sources and organizations have held conflicting views, but the inequality within healthcare and the devastation of cervical cancer remains the same. The ideas presented by Medical News Today and the World Health Organization are encouraging, but the BMJ presents a more realistic picture regarding the possibility of the eradication of cervical cancer within the next 100 years. However, understanding the possibly hypothetical paths to eradication can encourage efforts in the right direction of eradication, possibly raising standards of healthcare and living around the world.
Sources
Medical News Today claims that “specialists and the World Health Organization (WHO) argue that within the next 100 years, we may be able to eradicate this form [cervical] of cancer altogether”. The WHO Cervical Cancer Elimination Modelling Consortium led by Professor Marc Brisson has outlined several paths that countries can take and apply that may lead to the eradication of cervical cancer within the next 100 years. The first strategy to be applied concerns vaccinations at an early age, particularly young girls in low and middle-income countries. By doing this, the Consortium predicts an “89.4% reduction in cervical cancer cases over the next century”. The National Cancer Institute suggests vaccinations around ages 11 and 12. Along with the strategy of vaccinations, frequent screenings are necessary. With these two strategies employed, “Prof. Brisson and his colleagues...argue that...low- and middle-income countries could avert an estimated 61 million cases of cervical cancer up to 2120”.
These strategies may seem simple and obvious to employ to main, but the following statistics presented by WHO proves otherwise: “an estimated 21.8 million infants worldwide are still not being reached by routine immunization services”. Reasons for a lack in immunizations in many countries across the world are a “lack of parental education, low income, poor access to health facilities,...traditional beliefs,...socioeconomic status, urban/rural residence and sex of the child” (WHO). The availability and cost of immunizations that are basic and fundamental to the health of citizens in other countries, such as the United States, Canada, and England, prove to be unsustainable and insurmountable in other countries such as India, Afghanistan, and Somalia. There is an obvious bias in countries classified as first-world who often are unaware of the height of these obstacles and barriers, and this leads to discrimination, inequality, and bigotry. WHO is undergoing studies that are attempting to minimize the height of these obstacles, but “despite progress, much remains to be done if the benefit of routine childhood immunization is to be maximized”.
On the other hand, the BMJ, a medical journal, does not believe that the solutions presented by Medical News Today are adequate and encompassing enough to fully eradicate cervical cancer around the world. This belief is derived from the fact that “there are at least 100 serotypes of HPV. The two vaccines currently used in the UK, Gardasil and Cervarix, cover the two strains of HPV that are most likely to cause cancer”. However, other strains of HPV are also likely to cause cancer; “Some cases of cancer will continue to be caused by strains that are not covered by the vaccine”. The eradication of some diseases such as measles and polio is possible and has been achieved in many countries due to the concept of herd immunity which is defined by Manish Sadarangani as “how a population is protected from a disease after vaccination by stopping the germ responsible for the infection being transmitted between people” (Oxford Vaccine Group). Herd immunity does not apply to cervical cancer, which is why even an incredibly diverse vaccine that could target more strains of HPV would not be able to fully eradicate cervical cancer.
In total, many different sources and organizations have held conflicting views, but the inequality within healthcare and the devastation of cervical cancer remains the same. The ideas presented by Medical News Today and the World Health Organization are encouraging, but the BMJ presents a more realistic picture regarding the possibility of the eradication of cervical cancer within the next 100 years. However, understanding the possibly hypothetical paths to eradication can encourage efforts in the right direction of eradication, possibly raising standards of healthcare and living around the world.
Sources
- https://www.medicalnewstoday.com/articles/could-we-say-goodbye-to-cervical-cancer-by-2120#Vaccines-and-screenings-are-a-must
- https://www.verywellhealth.com/what-you-need-to-know-about-your-cervix-513843
- bmj.com/content/366/bmj.l4953
- https://www.who.int/news-room/fact-sheets/detail/human-papillomavirus-(hpv)-and-cervical-cancer
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2117903/
- https://www.everydayhealth.com/hpv/what-are-hpv-16-18/
- https://www.mayoclinic.org/diseases-conditions/cervical-cancer/symptoms-causes/syc-20352501
- https://www.cancerresearchuk.org/about-cancer/cervical-cancer/stages-types-grades/types-and-grades
- Picture: https://www.healthymepa.com/2019/01/11/cervical-cancer-awareness-month-spreading-word-prevention/
- https://www.who.int/bulletin/volumes/94/11/15-162172/en/
- https://www.ovg.ox.ac.uk/news/herd-immunity-how-does-it-work
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