Ending cervical cancer in Modern Zealand is within our lifetime – but not without funding and a plan

After committing to a global plan to end cervical cancer, Modern Zealand is lagging behind Australia and other countries in tackling this preventable disease.

Every year approx 175 New Zealanders were diagnosed cervical cancer and 55 people die from it.

Human papillomavirus (HPV) causes 95% of cervical cancers and some throat and anal cancers. Modern Zealand has a very effective vaccine against this cancer. HPV screening can detect changes in the cervix before cancer occurs.

Thanks to vaccinations and screening, it is now realistic to aim to eliminate cervical cancer in our lifetimes, but this requires strategy and investment.

Global goals

World Health Organization global elimination strategy cervical cancer is based on three goals:

• 90% of girls were fully vaccinated with the HPV vaccine by the age of 15
• 70% of women were screened with high-throughput tests (e.g. HPV test) before age 35 and again after age 45
• 90% of women with pre-cancerous disease and 90% of women with invasive cancer were cured.

However, to achieve this goal in Aotearoa Modern Zealand, the government must commit to developing and providing the means for an eradication strategy.

This is not happening currently. Despite some progress, women are still dying.

Increased self-testing

Self-testing for HPV was introduced in September 2023 as part of a nationwide screening program. 60-70% more protection against the development of invasive cervical cancer compared to cervical cytology (“smear” – which involves examination with a speculum by a trained doctor).

This is such a good test that after a negative result (and no symptoms) another test is not needed for five years.

Switching to HPV testing has the potential to reduce the annual number of cervical cancer cases by 15%. Women can do the test themselves, and under the novel program, 80% decide to do the test themselves.

There was also a high percentage of women who did not undergo follow-up examinations or were not subjected to such examinations. This is critical because over 85 percent ours cervical cancer occurred in people who were not regularly screened.

Before the introduction of the HPV self-test, only 67.1% of eligible people were screened. Over the past year, this percentage has increased to 70.8%, reaching the WHO target. However, the Māori percentage remains lower, rising from 56.3% to just 61.9%.

Low vaccination rate

Although overall screening rates have increased to 70.8%, HPV vaccination rates in Modern Zealand are low (45-60%) – falling tiny of the 90% target that Australia is close to.

Australia is about to become was the first to reach eliminationafter the government committed A$48.2 million to support the National Elimination Strategy and its implementation.

Vaccination against HPV is an critical pillar of cervical cancer prevention.

AND recent research found no cases of cervical cancer in a cohort of girls vaccinated aged 12 to 13 (born 1996–1998) as part of the Scottish school vaccination programme. However, there were cases of cervical cancer in the unvaccinated group.

More work is needed

Champions, researchers, clinicians and whānau campaigned and contributed to our novel (albeit belated) Cervical screening program for HPV. But more action is needed.

This is especially the case funds for health care are cut.

To achieve the elimination goals we have committed to, three things must happen:

1. Free cervical screening (unlike breast and bowel screening, Modern Zealand’s cervical screening program is not fully funded).
2. Cervical cancer elimination strategy with dedicated funding.
3. Increasing the number of vaccinations against HPV.

To achieve elimination, everyone must be involved. WHO’s global targets – aimed at addressing the differential burden of cervical cancer across countries – do not recognize the rights of indigenous peoples to be included in elimination targets. Within-country inequalities can remain hidden because a country can claim to eliminate them based on data that does not do so separate different ethnic groups.

Countries, including Aotearoa Modern Zealand, must do this achieve elimination goals for all women.

Aotearoa has the tools (HPV self-monitoring, vaccinations and treatment for cellular lesions) to make eliminating the virus a reality. But without an equitable strategy and funding to drive progress, the end of cervical cancer for Modern Zealanders will not be as close or as equitable as it should be.