WHO launches new guide for cervical cancer prevention and control

Health agency says the disease can be beaten by vaccinating girls against HPV, putting spotlight on whether Hong Kong should begin doing so

PUBLISHED : Thursday, 04 December, 2014, 2:42am
UPDATED : Thursday, 04 December, 2014, 2:42am

New guidance from the World Health Organisation aims to help countries better control cervical cancer, one of the deadliest - yet most preventable - cancers.

The Pink Book, a comprehensive cervical cancer control guide, was launched today at the World Cancer Leaders' Summit in Melbourne, Australia.

The foundation of the recommendations is vaccinating girls aged nine to 13 years with the human papillomavirus vaccine to prevent infection with HPV, the virus responsible for most cases of cervical cancer.

Though girls in more than 55 countries are protected by routine administration of the HPV vaccine, it is not part of the public health vaccination programme in Hong Kong.

More than one million women worldwide are estimated to be living with cervical cancer. The disease is responsible for more than 270 000 deaths annually, 85 per cent of which occur in developing countries.

In Hong Kong, cervical cancer was the ninth most common cancer among females in 2011, with 391 new cases diagnosed. In 2012, 133 women died from this cancer, making it the ninth leading cause of female cancer deaths.

The WHO's Dr Andreas Ullrich insists a better control system for cervical cancer is needed.

"[The figures are] not acceptable because we know how to prevent cervical cancer and how to detect the cancer early, in which case it can be easily treated," Ullrich said. "So in theory, we could prevent every case of this type of cancer."

On the primary level, this means vaccinating girls before they're sexually active. The vaccines prevent about 70 per cent of HPV cases.

There are no official figures on the HPV vaccination rate among girls in Hong Kong. In a survey by Chinese University of more than 3,000 parents of students from about 30 secondary schools, only 5 per cent of schoolgirls had received the HPV vaccine, said microbiology Professor Paul Chan Kay-sheung.

Cost is a factor. The vaccine required three doses over a period of six months, and each dose cost up to HK$1,500, Chan said. The vaccine offered protection from the HPV virus for more than 10 years, Chan added.

With the new WHO guidelines, however, costs have been reduced. It now recommends a two-dose schedule over six months, which has shown to be as effective as the current three-dose schedule.

"It's a good time for the government to revisit this question on whether public money should be used to support Hong Kong-wide HPV vaccination," Chan said.

"There's no doubt that the vaccine should be recommended. The only question is, who should pay for it?"

Both Chan and Ullrich point out, however, that many women develop pre-cancer lesions, and their treatment takes up medical resources.

"This is also a burden for the health system," Chan said. "If you consider the whole picture, maybe it is cost-effective for the government to provide the vaccine."

In relation to the duration of protection, Ullrich argues that because the vaccine is "still very new", it is not known yet exactly how long the protection lasts. "It's very likely that the protection is much longer," he said.

The Health Department said yesterday that the government had no plan to implement a population-based HPV vaccination programme, but would continue to study the development of scientific evidence for one.

Other guidelines in the WHO's Pink Book include the use of HPV testing - rather than a pap smear - to screen women for cervical cancer.