Regions that eliminate cervical cancer

During media reports of the continued spread of sars-cov-2, other viruses are simmering a bit in the background. This includes the human papillomavirus (HPV), which causes cervical cancer. At least 570 million women are affected globally annually. In Sweden, 550 women are diagnosed each year, of whom 150 die.

But if Joachim Dillner, professor of infectious epidemiology at Karolinska Institutet, gets his way, these Swedish numbers will become history in a few years.

– Our goal is to eliminate cervical cancer in Sweden – it’s an opportunity we can and should seize, he says.

He is the research lead for the project, and the project leader is Miriam Elfstrom, an epidemiologist at the Karolinska Institutet. The project covers all 21 regions of the country, which are involved in the work within the framework of the study.

– Some will start already after the holidays, others will start in October or January of next year. The important thing, says Joachim Dillner, is that all regions are involved and that they are motivated.

Resection should be done in two stages. First, women who gave birth between 1994 and 1999 should be arrested and offered vaccinations.

– This is about 356,365 women in the country, says Joachim Dillner.

In the next step, women with increased risk should be identified and test kits sent home (see fact box).

With today’s model, where the HPV vaccination at school is combined with screening in the form of a gynecological swab taken in the midwife’s office, cervical cancer will eventually be eradicated. However, this will take 50 years without additional efforts. According to Joachim Dillner, it is scientifically possible to eradicate cervical cancer in Sweden in less than two years.

— But logistically, with 21 districts that will work together, we added four more years, one of which has already passed since we started in 2021, he says.

Within the framework of the study, HPV vaccination is offered by specially trained midwives. First here is the healthcare district in Stockholm Gotland. Joachim Dillner describes how work to reach women has changed over time.

– Last fall, we reported that it was possible to get vaccinated and thought it would be like being vaccinated against the Coronavirus, when times would end in a flash, but for HPV the urge wasn’t as strong. We have now switched to sending targeted invitations: “You have an appointment booked for HPV vaccination at your midwifery clinic.” He says it’s an acceptable way to communicate and has a lot of support.

About 250 midwives were trained, and by June 24,000 of the 56,000 women had received the vaccine.

In the regions, work is continuous from north to south. Helena Stromqvist is a care developer at the Northern Regional Cancer Center and is responsible for the eradication project for the entire Northern Healthcare District. Here, the Jämtland region of Härjedalen came the furthest, having received a clear management decision to proceed with the project.

In Norrbotten, Westerbotten and Västernorland, we are still awaiting a final decision on funding and choice of strategies so we can move forward. So we can say we’re in the planning stage now, she says.

Anna Erickson is a nurse in vaccination coordination and project manager for the Jämtland region Harjedalen. Most things are prepared for fall in terms of, say, time planning, booking and costing.

In total, we also enrolled seven restaurateurs and a research associate from the Vaccination Coordination for training this fall, she says.

During the fall, the outreach plan to reach women in the target group will also be implemented.

Our hope is that we can make common cause with others in the northern region, she says.

Christer Burgfeldt, chief medical officer and associate professor of obstetrics and gynecology at Lund University, is scientifically responsible for the eradication project in the Scania region. He describes the Blekinge and Kronoberg districts as also making progress with their project plans, with the Medicare and Medicaid Boards awarding financial support for immunizations.

In early fall, midwives will be trained in HPV knowledge and vaccination through a 3.5-hour web-based training, after which they will be mandated to vaccinate against HPV as part of the study, he says.

Logistics related to communication plans, secure cold chain vaccine distribution, and Bank ID records management are supposed to be in place through September, with vaccination starting in early fall.

– We are confident that everything will be in place as soon as possible – but it is certain that many “childhood illnesses” will be found during the flight, says Christer Burjfeldt.

For Joachim Dillner himself, the goal of completely eradicating a form of cancer has been a reality for nearly four decades. Then he demonstrated a lecture by a German research group that showed that the cause of cervical cancer is the human papillomavirus.

I took this insight with me when I started doing research. 36 years ago, I realized it was possible to eliminate cervical cancer by attacking HPV — and within five years it could become a reality, he says.