Cervical Cancer Elimination in Scotland Expert Group Final Report

2. Foreword

From Scotland’s Women’s Health Champion - Professor Anna Glasier

In 2024 the Scottish Government established an Expert Group (the Group) to consider how Scotland can reach the World Health Organisation (WHO) targets for the elimination of cervical cancer. I was honoured to be asked by the Minister for Public Health and Women’s Health to chair the Group. Twenty months since its inception, this final report outlines where we are currently, where we need to get to and how we need to do it.^[1]

In 2023, 319 women were newly diagnosed with cervical cancer in Scotland. We know the cause of most of the cases – Human Papillomavirus (HPV). We can vaccinate against HPV and have been doing so since 2008. Since 1988 we have had a national cervical screening programme, aimed at detecting cervical cancer early so that it can be treated effectively. And yet, each year in Scotland, almost 100 women die of the disease. This is avoidable.

The World Health Organisation (WHO) has set targets for the global elimination of cervical cancer, resting on the three key pillars of vaccination, screening and treatment. WHO advises that at least 90% of girls are fully vaccinated against HPV by the age of 15, at least 70% of eligible women have cervical screening by age 35 and again by age 45; and at least 90% of women diagnosed with cervical disease should be treated.

As this report shows, these targets should be within our grasp and elimination a realistic possibility. But there remain significant challenges. We need to eliminate cervical cancer equitably across Scotland and, worryingly, we have an increasing deprivation gap in both vaccination and screening uptake. Only around 75% of pupils in deprived areas of the country will have been vaccinated by the time they leave school compared with over 90% of pupils who attend schools in affluent areas^[2]. Additionally, women living in deprived areas are less likely to have had cervical screening. In fact, recent data have shown that screening uptake in fully vaccinated women (24-29yrs) is 68.2%, compared to only 32.2% in unvaccinated women of the same age. As a result, women living in the more deprived areas of Scotland are more likely to present late with the disease and so they are four times more likely to die from cervical cancer than women living in the most affluent areas. This is unjust.

What do we need to do? It should be straightforward: we need to do what we are already doing but do it better. We need, for example, to be better at telling the public that HPV vaccination really does significantly reduce their risk of getting cervical cancer. It is not widely known that, since the introduction of the national HPV vaccination programme in 2008, there have as yet been no cases of cervical cancer caused by HPV types targeted in the vaccine among women in Scotland who were fully vaccinated at age 12 or 13. Moreover a recent Scottish study shows that, in women who came forward for cervical screening, the vaccine continues to be effective more than 12 years after it was given^[3]. It is vital to explain to the public why it is important for women to be fully vaccinated, but also the importance of being vaccinated in the first year of secondary school. We need everyone to know that vaccination really does work best when given in the first year of secondary school.

We also need to do much better at explaining why boys need to be vaccinated. Although men do not get cervical cancer, by being vaccinated they can protect their partners from getting the disease. Importantly too, HPV causes other cancers which men do get: cancer of the anus, the penis and the throat. A large component of these diseases are associated with HPV. In Scotland each year over 500 people die from head and neck cancer. Many of these cases are due to HPV. Perhaps more immediately compelling to teenagers themselves, boys – and girls – need to know that HPV vaccination also protects them from getting genital warts.

As the national HPV vaccination programme did not start until 2008, women born before 1990 have never had the chance to be vaccinated. Immediate action must therefore focus on screening and early diagnosis, particularly among younger women and women living in the most deprived areas of Scotland. The treatment of pre-cancerous changes identified through screening is highly successful, making early diagnosis a critical tool in preventing cervical cancer, but it depends on women being appropriately informed and supported to accept their invitation to be screened.

We have a huge opportunity to eliminate cervical cancer in Scotland and to save the lives of hundreds of women over the years to come. We know what to do, now we need to get on and do it.