Sofiat Akinola: Joanna Sickler shared creative solutions for cervical cancer prevention

Sofiat Akinola, Director of Health Policy and External Affairs at Roche, shared a post by Joanna Sickler, Vice-President of Health Policy and External Affairs at Roche, on LinkedIn, adding:

“Cervical Cancer Elimination: Creative Solutions in Action

Eliminating cervical cancer is within reach; however, in today’s evolving global health environment, it will take practical, creative, and collaborative solutions to make elimination a reality.

In this inspiring article my colleague, Joanna Sickler, MBA, MPH, explores what these solutions could look like. Joanna’s comprehensive approach to elimination champions the power of HPV vaccination, regular screening, and timely treatment as cornerstones in our mission to eliminate this disease.

Here are my 3 takeaways:

Expanding access to prevention: Too many women face barriers to preventive care, whether due to cost, healthcare infrastructure, or misinformation. Joanna highlights innovative approaches, such as HPV self-collection and updated care models, that bring care closer to those who need it most, regardless of location.

Focus on practical solutions: Giving women the ability to collect their own sample in a setting that is convenient for them or simplifying healthcare processes to make prevention a reality for all can drive better patient outcomes and help ensure effective use of health system resources.

Removing barriers and creating opportunities: By increasing awareness, simplifying care pathways, and adopting more inclusive healthcare models, we can remove barriers and create opportunities for everyone to have easier access to screening and treatment. Joanna’s insights underscore significant chances to bridge existing gaps and work towards a future free of cervical cancer.

Joanna’s article provides important insights on rethinking cervical cancer prevention and care approaches. I encourage you to read it and engage in the discussion about expanding access and improving outcomes for everyone.”

Quoting Joanna Sickler‘ post:

“Cervical cancer should never be a death sentence. Yet, too many women, especially from economically disadvantaged and underserved communities, continue to face cervical cancer.

In my debut article on this platform, I want to shed light on the power of combining HPV screening and vaccination programs with innovative health policies that change the course of cervical cancer. By focusing on overcoming barriers to access and implementing effective prevention strategies, we have the potential to eliminate cervical cancer for good.

Read my full article to explore how strategic approaches and global collaboration can make a significant impact in the fight against cervical cancer.

No one should ever die from cervical cancer. It can be identified early through Human Papillomavirus (HPV) screening. It’s slow-growing. And vaccines are bringing prevention to younger populations. We have the opportunity to completely shift the trajectory of the disease and eliminate a cancer. Yet, too many people are still dying.

Economically disadvantaged populations face the greatest risk of cervical cancer, particularly in low- and middle-income countries where limited financial resources and poor access to healthcare create significant barriers to prevention and treatment. Even in the United States, factors like lack of awareness, limited access to care, cultural barriers, and past trauma contribute to 11,500 new cases and 4,000 deaths from cervical cancer each year.

As the head of global health policy for Roche Diagnostics, I encourage countries around the world to develop programs to enable cervical cancer elimination via the three-pronged approach recommended by the World Health Organization (WHO) for cervical cancer elimination:

(1) vaccinating to prevent HPV,
(2) screening adult women to protect generations that did not have access to vaccination, and
(3) linking people diagnosed with HPV and cervical cancer to treatment.

In my team’s efforts around the globe, we see a tremendous opportunity working with organizations and governments to ensure HPV vaccination, screening and treatment are part of primary and preventative care. As we drill down in individual countries, we learn about the nuances of health systems and why vaccination, screening and treatment are or aren’t happening. National policies to prioritize and fund within the healthcare system, is critical  to create universal access.

Complexities of care

In the United States, the health system is fragmented and decentralized. Even though there are recommendations about cervical cancer prevention from organizations like the US Preventive Services Task Force (USPSTF), American Cancer Society and American Society for Colposcopy and Cervical Pathology, those recommendations aren’t always implemented similarly. We have many different types of health systems and many different types of insurance.

Here’s an example related to immunization: In the US, immunization against HPV is recommended for most people between the ages of 9 and 26, and people up to age 45 can be immunized. Despite the fact that HPV immunization lowers the chances of developing cancers, the U.S. continues to see an alarming rate of HPV transmission. Many children and adults in the United States haven’t received the two to three shots needed to be protected against cervical cancer.

That’s why, for some groups, screening is the only way to detect and fight cervical cancer. In fact, most cervical cancers occur in people who are never screened or who aren’t screened enough. Screening is essentially a narrowing and triage method that identifies both people who have early signs of cervical cancer and people who are at risk of developing cervical cancer.

A pap smear, or cervical cytology test, removes cells from the surface of the uterus to look for cancer. This kind of test can only identify cancer or precancerous growth if they’re already there. High-performance molecular testing (HPV testing) is more targeted. It looks for the pathogen — the cause of the cancer, which in the case of cervical cancer is HPV types 16 and 18.

The bottom line is: In the US we have vaccines and screening tests that work extremely well, but those tests can’t help people if they don’t understand why they need them and if they don’t have access to them. Unlocking access in the US is not just about availability, it is also about flexibility. In the case of screening, that flexibility has to do with how we collect samples and the process of collecting them within specific healthcare systems.

An issue of access

From a patient perspective, access to healthcare and screening in the US is often seen through the lens of insurance. Much has been done in the past few decades to expand health insurance in the US, and that’s important, but having high-quality health insurance doesn’t necessarily equal access.

Even if healthcare is free, there are still barriers to HPV vaccination and screening. If someone has limited resources, works, or has children, it can be difficult to get to that regular checkup. Basic logistics can be a barrier: Being able to carve out the time, find someone to watch your child, and get time off work. Sometimes transportation can be an issue, especially for people in rural areas. Then there are personal barriers: embarrassment, past trauma, fear of pain or just not wanting to do it.

More access, more screening

I’ve found that populations in hard-to-reach and low-income settings face similar challenges whether we’re talking about people in the Amazon, Kenya or a rural part of the United States. For screening, there’s an infrastructure required for a traditional physician-collected sample: a building, a room, a table, stirrups — things that just don’t exist in a lot of places. Traditional screening also presents cultural and social barriers.

What would happen if screening could happen another way?

We already know: More women get screened. HPV self-collection, where a woman collects her own sample privately in a clinical setting, can increase access for people with logistical, emotional and other barriers to screening. Women are interested in this option. A 2024 global GWI survey commissioned by Roche across 12 countries in Latin America and Europe showed that over 70% of respondents expressed a willingness to collect their own samples if given the option.

In Australia, self-collection led to increases in the proportion of women aged 35-39 who had at least one HPV test, even in remote and disadvantaged areas. In remote areas of Peru, where more women die from cervical cancer than any other cancer type, 80% of women in a self-collection pilot program preferred self-collection over traditional screening procedures.

Policy recommendations

Clearly, there’s interest in new ways of screening for HPV from both patients and providers. With that in mind, here are a few recommendations for healthcare providers and policymakers that could protect more Americans from HPV and cervical cancer:

1. Build awareness.

There’s a fundamental lack of education and awareness about the link between HPV and cervical cancer. Many people don’t even know what the HPV test is for. The global GWI survey showed that nearly one-third of respondents were either unsure about or unaware of the virus.  Often, once people do know, it suddenly seems like a no-brainer to get the screening done. There’s a need to help women really understand why they should do the test and drive them to care. Roche offers free educational materials that could be helpful, including this video about self-collection.

2. Make it easy for healthcare providers.

Healthcare systems could put policies in place that make it easier to get screened for cervical cancer, and HPV self-collection could be a huge part of that equation. Implementation is the key: Self-collection would need to fit into the workflow, making the provider’s life easier by simplifying patient appointments, freeing up time and helping clinicians stay on track.

3. Be aware of the barriers.

Even though many Americans have insurance that removes financial barriers to testing, there are still many other geographic and cultural barriers for a significant proportion of the population. I’d like to see health systems get more creative about overcoming those barriers. There’s a suite of new tools that can help, including HPV self-collection.

4. Consider new care models.

The pandemic showed us new ways to serve patients while reducing the cost of care, such as telemedicine and remote diagnostic screening. It’s time for such concepts to be infused into the core of the healthcare system. Innovative solutions with the patient in mind can help us overcome access challenges. It’s also important to ensure that screening programs are properly funded. After all, a basic fact about preventative services is that they save healthcare systems money while also saving lives.

We have an opportunity to eliminate cervical cancer in the US and around the world by rethinking how we provide preventative services and healthcare, overcoming very real barriers for a significant proportion of the population. We have an opportunity to empower women to take their health into their own hands, make healthcare providers’ jobs easier and reach hard-to-reach populations, especially in the United States, where vaccines, diagnostic tests and treatments are readily available. Let’s work together, and independently within our healthcare systems, to find solutions that work for both patients and providers.”

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