Brotherton Julia M L, Vajdic Claire M, Nightingale Claire
Evaluation and Implementation Science Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia.
National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia.
Expert Rev Pharmacoecon Outcomes Res. 2025 Apr;25(4):487-506. doi: 10.1080/14737167.2025.2451732. Epub 2025 Jan 15.
Cervical cancer is almost entirely preventable by vaccination and screening. Population-based vaccination and screening programs are effective and cost effective, but millions of people do not have access to these programs, causing immense suffering. The WHO Global Strategy for the elimination of cervical cancer as a public health problem calls for countries to meet ambitious vaccination, screening, and treatment targets.
Epidemiological evidence indicates marked socioeconomic gradients in the burden of cervical cancer and vaccination, screening, and treatment coverage. The unacceptable socioeconomic burden of cervical cancer is largely a function of inequitable access to these programs. We discuss these inequities, and highlight strategies enabled by new evidence and technology. Single dose HPV vaccination, HPV-based screening, and the rapidly moving technology landscape have enabled task-shifting, innovation in service delivery and the possibility of scale. Equitable access to optimal care for the treatment of invasive cancers remains a challenge.
Cervical cancer can be eliminated equitably. It will require global political will, sustained public and private investment, and community leadership to safely and sustainably embed proven tools, technology and infrastructure in local health and knowledge systems.
宫颈癌几乎完全可以通过疫苗接种和筛查来预防。基于人群的疫苗接种和筛查计划是有效且具有成本效益的，但数百万人无法获得这些计划，这造成了巨大的痛苦。世界卫生组织消除宫颈癌作为公共卫生问题的全球战略呼吁各国实现宏伟的疫苗接种、筛查和治疗目标。
流行病学证据表明，宫颈癌负担以及疫苗接种、筛查和治疗覆盖率存在明显的社会经济梯度。宫颈癌不可接受的社会经济负担在很大程度上是由于获得这些计划的机会不平等所致。我们讨论了这些不平等问题，并强调了新证据和技术带来的策略。单剂量人乳头瘤病毒（HPV）疫苗接种、基于HPV的筛查以及迅速发展的技术格局实现了任务转移、服务提供方面的创新以及扩大规模的可能性。公平获得侵袭性癌症最佳治疗护理仍然是一项挑战。
宫颈癌可以公平地消除。这将需要全球政治意愿、持续的公共和私人投资以及社区领导，以便将经过验证的工具、技术和基础设施安全且可持续地融入当地卫生和知识体系。
