We are so close to eliminating cervical cancer in Ireland

Vaccinations, screening and vigilance have brought us to the cusp of eliminating cervical cancer — it's an incredible achievement, writes Sarah Fitzgibbon

Dr Sarah Fitzgibbon: 'Being told you have cancer is one of the worst experiences that can happen to you, because at that moment you automatically think about all the worst-case scenarios.' Picture: Chani Anderson

No one is sure why so many people like me, under the age of 50, are being diagnosed with bowel cancer. The numbers are increasing rapidly and for most of us, it is not easily treated. Young people are dying from bowel cancer in higher numbers than ever before.

But there is a cancer the numbers of which are diminishing rapidly. A cancer that has always affected younger women more than older ones, and that has invariably been deadly once it reaches a certain stage.

Cervical cancer kills more young women worldwide than any other cancer, frequently leaving families without their main carer and a breadwinner. The economic and social costs of these tragic deaths ripple outwards through entire communities. 

The treatments for cervical cancer (where people are lucky enough to be able to access them) are brutal and gruelling, with disabling and embarrassing side-effects.

About 250 women in Ireland are diagnosed with cervical cancer each year, about a tenth of the number of people who get bowel cancer. About half of these women have their cancer found through screening, which usually means it is caught at a very early stage when it can be surgically removed and they do not require any further treatment. 

For women whose cancer is found once they have developed symptoms, additional therapies such as chemo and radiotherapy are often necessary, and even then, they may not survive.

Dr Sarah Fitzgibbon and the Irish Examiner’s Irene Feighan collaborate on a special edition highlighting the realities of living with bowel cancer earlier this year. Picture: Chani Anderson

Not a single one of those 250 women would wish any other person to go through the same experience, even if they “only” require the minimum amount of treatment.

Being told you have cancer is one of the worst experiences that can happen to you, because at that moment you automatically think about all the worst-case scenarios. What if we could eliminate a cancer, which means it would affect fewer than four women in 100,000? What if fewer than 100 women per year were given this awful news, and nearly every one of them was told it was at an early stage, which would respond well to treatment?

That goal is well within our sights, and in fact we know we can achieve this in Ireland within the next 15 years.

The World Health Organization has acknowledged scientific breakthroughs in the past 40 years have created the possibility we could eliminate this cancer as a public health issue in every country in the world. 

Unfortunately, “eliminate” does not mean “eradicate”; it is an epidemiological term which means there would be fewer than four cases for every 100,000 women in a country. This would make it extremely rare, but there would still be some people who would be unlucky and develop cervical cancer.

The research that has led to this incredible progress is based on a group of extremely common viruses, the human papillomaviruses, or HPV. There are more than 100 subtypes of HPV, and nearly every one of us will pick up HPV at some point in our lives. It is transmitted through any kind of sexual activity which involves the touching of the skin around the genital area. 

For the majority of us, we will never know we had HPV, and our immune systems will clear it from our bodies before it has done any harm. For a small number of people, the HPV doesn’t clear easily and it persists in our cells for years. This affects the cells’ DNA, and over time (usually about 10-15 years) this can cause pre-cancerous changes, which can then develop into invasive cancer.

By testing women regularly for HPV during their life, we can identify those people who are at risk from persistent infection.

An even better way to protect us from the risk of persistent HPV, is to avoid getting the infection in the first place. We can do that by giving our boys and girls a vaccine against the most common cancer-causing strains of HPV before they become sexually active. 

This means fewer and fewer people in the community will have HPV at any point in their lives, and so they won’t be able to pass it on to others.

The HPV vaccine has been available to every child in first year in Ireland since 2019, and while more than 80% of people are choosing the vaccine, we need this to be higher. 

The vaccine is safe and effective. We have already seen results around the world and in Ireland that show women who received the HPV vaccine when they were in school are much, much less likely to have precancerous cell changes in their cervix as they enter their late 20s and 30s. So let’s use this fantastic scientific breakthrough to help build a world where cervical cancer is rare.

A portrait of cervical cancer campaigner Vicky Phelan, who died from the disease in November 2022. Picture: Colin Shanahan

HPV viruses can cause other cancers too, such as cancer of the penis, anus, mouth and throat, so everyone who gets the vaccine is protecting themselves and their future partners from these diseases too.

The WHO has calculated that if over 90% of girls in a country get the HPV vaccine, more than 70% of women have a HPV screening test at least twice in their lives, and more than 90% of women who are found to have pre-cancer or cancer get the right treatment, then that country will be on course to reduce the cervical cancer rate to the magic “elimination” number.

Based on data from all of the responsible organisations in Ireland, we know Ireland can achieve this by 2040. Babies born in 2026 will get their HPV vaccine in an era when cervical cancer will be extremely rare.

While we continue to struggle with increasing numbers of some cancers, we have an incredible opportunity to get rid of one that has affected so many lives in Ireland. This can be achieved if everyone works together towards elimination. Choose vaccination. Choose screening. Go for early treatment if it is offered. 

Each one of us can commit to at least one act for cervical cancer elimination, and make cervical cancer history.

• Dr Sarah Fitzgibbon is primary care adviser with the HSE's National Screening Service