NHS England (NHSE) has published its plan to eliminate cervical cancer in England by 2040. Cervical cancer claims the lives of nearly 700 women in England each year but is now known to be largely preventable through vaccination against human papillomavirus (HPV), a common but symptom-free virus which can develop into cervical cancer if left untreated. Cervical screening and early detection of high-risk HPV infection and pre-cancerous change to the cells of the cervix (cervical intraepithelial neoplasia or CIN), when followed by timely treatment, has also improved outcomes and increased survival rates for those affected by this devastating condition. NHSE’s publication, Cervical cancer elimination by 2040 – plan for England, sets out how the NHS intends to build on the success of the HPV vaccination and cervical screening programmes, to make cervical cancer in England a disease of the past. Could cervical cancer become a disease of the past? According to NHS England, ‘eliminating cervical cancer is more achievable than ever before’. That’s not something we hear often about many forms of cancer, but in the case of cervical cancer, it is quite possible that an end to the disease could be in sight. That’s because, unlike with many other forms of cancer, we now know that HPV causes 99.8% of the approximately 685 deaths from cervical cancer in England each year. We have seen that a national school-age HPV vaccination programme has dramatically reduced the incidence of cervical cancer in girls, women and people with a cervix amongst those who were vaccinated by approximately 90%. We also know that around 5,000 lives a year are saved by early detection of CIN by cervical screening. NHSE reports, however, that despite the proven success of these programmes in reducing cervical cancer, there has been a decline in the number of people taking up the opportunity to safeguard themselves against cervical cancer and its suffering through HPV vaccination and cervical screening. The latest data shows that although progress is being made, there are inequalities in the uptake of HPV vaccination and cervical screening amongst certain communities and variation across the country. This is also reflected in the rates of cervical cancer, which are 65% higher in the most deprived communities, compared with those with the least deprivation. NHS England believes that by increasing equitable uptake of both HPV vaccination and cervical screening, we can make cervical cancer a disease of the past. Recent work towards eliminating cervical cancer in England HPV vaccination is available to all 12 to 13-year-olds in England. This usually takes place during Year 8 at school. Those who miss their vaccination in Year 8 are eligible for catch-up vaccination between the ages of 14 and 25, available through their GP. In addition, cervical screening is offered at regular intervals to women and people with a cervix (including trans men, non-binary and intersex people) aged 25 to 64. In 2021, the UK switched the vaccine used in its HPV vaccination programme to a new type of HPV vaccine which will be 16% more effective in reducing cases of cervical cancer and 9% more effective in reducing HPV-related deaths, compared with the previous vaccine. Since September 2023, children and teenagers receiving HPV vaccination in schools can receive their full HPV vaccination in a single dose, avoiding the need for a second dose and increasing their likelihood of early, full HPV vaccination. In November 2023, NHS England (NHSE) set an ambition to eliminate cervical cancer by 2040, to align with the World Health Organization’s (WHO) global aim to achieve a cervical cancer incidence rate of below four people per 100,000. WHO’s 2040 target requires that by 2030: 90% of girls are fully vaccinated with the HPV vaccine by the age of 15; 70% of women have been screened using a high-performance test, such as HPV primary screening, by the age of 35 and again by the age of 45; 90% of women identified with cervical disease receive treatment. NHS England reports steady progress towards meeting those targets. In the 2023/2024 academic year, 76.7% of girls and 71.2% of boys aged 14 or 15 had been vaccinated against HPV by Year 10, with increased numbers vaccinated in Year 8 compared with the previous year. In relation to cervical screening, 76.9% of women aged 35 to 39 have had a cervical screening test before the age of 35, and 75.9% of women aged 40 to 44 have been screened in the previous five years. Amongst those with cervical cancer, 88.3% received one or more forms of chemotherapy, radiotherapy and tumour removal treatment. This increased to more than 96% for those with stages 1 to 3 cervical cancer. NHS records categorise the remaining 11.7% of cervical cancer cases across all stages as having ‘other care’, with no record of chemotherapy, tumour resection or removal, or radiotherapy within the relevant time frame, possibly reflecting patients who opted for private or alternative treatments, or the result of missing data. The incidence of cervical cancer in England is currently five women per 100,000 women of all ages. How does NHS England (NHSE) plan to eliminate cervical cancer? NHSE’s plan to eliminate cervical cancer by 2040 is focussed on increasing the number of girls, women and people with a cervix who participate in HPV vaccination and cervical screening, and increasing uptake of HPV vaccination amongst boys and young men. NHSE plans to encourage action around five themes, designed to communicate the importance of HPV vaccination and cervical screening, and increase engagement with higher risk populations or groups who are missing out on screening or vaccination. These themes are: Increasing access - to ensure that people can have their HPV vaccination and screening when and where it suits them and in a way that meets their individual needs. Suggested measures include strengthening the provision of catch-up vaccinations, reducing challenges associated with delivering vaccinations in schools (such as data sharing restrictions), offering vaccinations in other settings (such as community pharmacies), and introducing HPV self-sampling. Raising awareness – to ensure that people are aware of and understand the benefits of HPV vaccination and cervical screening, as this is crucial for informed decision making. This involves creating a range of research-based, effective, nuanced and culturally sensitive health communications in collaboration with charities, faith groups and local communities, including the sharing of personal, lived experience from patient advocates. A national cervical cancer elimination campaign will help raise awareness and understanding of the importance of HPV vaccination (for men as well as women) and cervical screening, with support from GPs, community pharmacies, charities and the Department of Education in schools, universities and colleges. Reducing inequalities – to remove barriers to HPV vaccination and cervical screening for communities and people who experience health inequalities. Proposed action includes gaining understanding of the barriers and perceptions of HPV vaccination and cervical screening amongst school-age vaccination providers, parents or guardians of children eligible for their HPV vaccination and women due to receive their first cervical screening invitation, as well as developing inclusive, culturally sensitive and translated communication materials. NHSE also plans to use available data to identify and encourage vaccination or screening participation from groups at higher risk of developing cervical cancer, and to use the new call and re-call IT system to facilitate routine screening invitations for trans men and non-binary people with a cervix who are not registered as female with their GP practice and do not receive automatic invitations. Improving digital capabilities - NHSE plans to develop a digital-first approach to HPV vaccinations and cervical screening invitations through the NHS App and other digital channels, with letters used to reach those who are digitally excluded. Digital systems such as ‘Manage Vaccinations in Schools (MAVIS)’ will centralise information and streamline consent processes for parents, with IT also being used for screening invitations and reminders, increasing access to catch-up HPV vaccinations in alternative settings, and to design and target interventions based on patient-level HPV vaccination data. Strengthening workforce capacity - to deliver the cervical cancer elimination plan by the retention and maximisation of the skills of existing NHS staff. Improving earlier diagnosis of cervical cancer NHS England reiterated that alongside the new cervical cancer elimination plan, improving earlier diagnosis of cancers continues to be a priority for cancer services. Suggested measures to improve earlier diagnosis included encouraging people with unusual or persistent symptoms to contact their GP, making funding available to support the whole system to promote early diagnosis, and attendance for cervical screening, and reviewing referral practice. Delayed diagnosis of pre-cancerous cervical intraepithelial neoplasia (CIN) or early-stage cervical cancer can result in life-threatening development of the disease, and life-changing disability from invasive treatment, such as chemoradiation, radiotherapy or brachytherapy. If the patient’s injury and disability was caused by negligent delays or errors in diagnosis, referral or treatment, they may be entitled to substantial compensation. If you or a family member have suffered severe injury as a result of medical negligence or have been contacted by HSSIB/MNSI or NHS Resolution you can talk to a solicitor, free and confidentially, for advice about how to respond or make a claim by contacting us.
