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Cervical cancer elimination project

Cervical cancer elimination project

In August 2018, the World Health Organization issued a call to countries around the world: it is entirely possible to eliminate cervical cancer, and it is time to act. Sweden accepted the challenge and since then the work has continued.

– The WHO's call to eliminate cervical cancer globally was based on three parts: vaccination, screening and treatment of changes in cells found during screening, explains Miriam Elfström, project coordinator of the study that supports the regions in their work to eliminate the incidence of cervical cancer. . cancer.

This project is a collection of rare type powers.

– On the Swedish side, we focused our energy mainly on the first two because focusing on treatment is not appropriate here. Those we arrest are already receiving the necessary treatment today.

Cervical cancer should disappear

Miriam Elfström is an epidemiologist at Karolinska Institutet and project coordinator of the study working to support the so-called Elimination in the 20 Regions Project.

This is exactly what it sounds like: cervical cancer will disappear. A perfectly reasonable ambition, according to the research. Because it is possible to overcome what is classified as the third most common form of cancer in women between the ages of 20 and 49 years.

Cervical cancer should be eliminated in Sweden by 2027 at the latest. According to Meryem Elfström, Sweden has good conditions to be the first in the world to succeed. Photo by Theresia Cullen.

98 percent of all cervical cancer cases are caused by the sexually transmitted human papillomavirus (HPV) and can be vaccinated against. This has been happening since 2012 within the school vaccination program and the stated ambition of the eradication project is to vaccinate those born in 1994-1999 as well.

The vaccine we are offering today protects against 90 percent of cases, and if we are able to raise the coverage rate and reach the categories we want, the number of infections will decrease significantly. In the long term, this also reduces the number of cervical cancer cases, says Miriam Elfström.

Belongs to the risk group

At the same time, work on vaccinating those born in 1994-1999 was intensified. The selection is due to the fact that, in terms of age, they belong to a risk group that missed the opportunity to receive the HPV vaccine within the school vaccination program introduced in 2012.

– Now that all regions have participated, we can say that we have vaccinated approximately 120,000 women born between 1994-1999. It's a very large shared investment that made this possible. Miriam Elfström says the coronavirus vaccination was huge, but it was about healthcare, and this is a coming together of forces with many different companies involved.

The vaccine we offer today protects against 90 percent of cases.

So where does the business stand today? The study, coordinated by Miriam Elfström, shows that four regions, if the vaccination rate remains high, will reach the eradication target by the end of the year, and today there are more than 2,000 trained people who can vaccinate in more than 600 clinics in the country.

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This is the judiciary project

The World Health Organization has announced a global goal of completely eliminating cervical cancer. Sweden could be the first in the world to eliminate cervical cancer through vaccination. To achieve success, free vaccines are being provided to women born in the period 1994-1999. In addition, regions of Sweden are working to increase participation in gynecological Pap smear screening.

In the final year

However, the disease eradication project will have to struggle hard to succeed. The project is now in its final year of staffing for screening and vaccination and the focus is on keeping up the pace.

Miriam Elfström talks about her work at KI.  Photo: Theresia Cullen.
Miriam Elfström is the project coordinator of the study working to support the so-called Eradication Project, to eliminate the incidence of cervical cancer. Photo: Theresia Cullen

-We have worked a lot to lower the vaccination barrier, to make it easier for girls to search for us. After all, this is a group that is available at different times of the day, studies and travels a lot, and we have to adapt there in every possible way to be on hand when they can come and get vaccinated. At the same time we emphasize that this is completely free, says Miriam Elfström.

In addition to the role of project coordinator, which includes leading the day-to-day work of the study, Miriam Elfström is also involved in training on vaccination skills expansion.

-We are a team that works closely together, I act as the project manager while the others work hard regarding the actual implementation and logistics of running the Extinction Project.

I don't want to scare you

Miriam Elfström also manages communication between project managers in the regions, as well as with communicators based there. Communication is key.

Miriam Elfstrom.  Photo: Theresia Cullen.
Miriam Elfström emphasizes that the more people are protected, the stronger society becomes in the face of HPV. Photo by Theresia Cullen.

– She says that the spread of the campaign is the key to success. It's a balancing act on how hard it is to get there. Working to communicate about an illness that is a little far on the horizon is always difficult for most people.

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The way forward is one of caution and clarity.
– We try to find a tone that does not scare people but at the same time conveys seriousness, says Miriam Elfström.

The spread of the campaign is the key to success.

Another important message is the solidarity responsibility to get vaccinated. Because the more people are protected, the stronger society will be against HPV. Knowledge that has proven easier to transfer since the pandemic has taught the Swedish people more about herd immunity against viruses.

The tools we have today – such as testing and vaccines – are incredibly powerful. Therefore, if we can invest together, we will at the same time achieve strong protection in society, and not only individuals get protection, but entire groups. This has been talked about a lot during the pandemic, says Miriam Elfström.

Vaccination fatigue

The COVID-19 pandemic is something the Elimination Project has also had to deal with in other ways. This is partly because screening had to be paused for a period in some areas during the first year of the pandemic, and partly because the effects of mass vaccination against Covid-19 affected the project's work indirectly through the fact that people know a lot more about vaccines. Today than before.

Miriam Elfström talks about her work at KI.  Photo: Theresia Cullen.
– It's always difficult to communicate about a disease that is still looming large for most people, says Miriam Elfström. Photo: Theresia Cullen.

-It is two-fold. During the pandemic, people have gained more knowledge about viruses and a lesson in how important it is to vaccinate ourselves, which of course is beneficial to the project of eliminating the disease. At the same time, it can be difficult because people today may suffer from fatigue due to vaccination and diseases. But we are working to overcome this by emphasizing the seriousness of this.

Today, people can feel tired due to vaccination and diseases.

One of the most important tools for successfully achieving a high goal is related to the idea of ​​​​raising it from the individual level to the group level. To get the information to the individual in all its glory, the message spread among the people has proven to be very effective.

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– The whole project is actually something we have to do together. Spreading information among friends and colleagues, encouraging people to join networks and talk openly about cervical cancer are all things I believe will lead to our success in this. We need to keep up the pace – and we will.

Project Extinction years ago

  • 2018: The World Health Organization calls on countries around the world to contribute to eliminating cervical cancer caused by the human papilloma virus, a goal that can be considered achieved when four or fewer cases occur per 100,000 women annually in all countries.

  • 2019: A pilot project is being launched in the Skåne region targeting women who have not been reached by screening and who are considered to be at higher risk of infection – for example due to signs of cell changes in previous samples or not appearing during sampling.

  • 2020: The pilot project is expanding to more regions of the country, and at the World Health Assembly, 194 countries unanimously adopted the elimination of cervical cancer as a “priority health goal.”

  • 2021: The Swedish Parliament decided to accelerate the elimination of cervical cancer, which is why free vaccinations were offered to all people born between 1994 and 1999. The media campaign “Take a shot against HPV” is being launched with the aim of eliminating cervical cancer by 2027, in parallel with the launch of a research study that will follow up and assist work in the regions. This study is led by Professor Joachim Dillner at Karolinska Institutet.

  • 2022: The Elimination Project is now being expanded, and all regions of Sweden are being asked to spread the message about free HPV vaccinations, in parallel with increased screening.

  • 2023: In December, the threshold of 100,000 participants was surpassed – and around 2,000 additional people are being reached each week.

  • 2024: The project is ongoing, with a focus on keeping up with the pace of vaccination and testing. Projections indicate that four regions – Blekinge, Halland, Jumtland/Harjedalen and Kalmar – will reach the disease elimination target before the end of the year.