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Societal costs of pre-cancerous lesions and Cervical Cancer
The cost to society of pre-cancerous lesions and cervical cancer is high and growing steadily around the world. This disease has a serious impact on the medical system and society at large as well as on the individuals affected.
- Premature death from cervical cancer affects women in the prime of their lives, often while they are working and also still responsible for their children and their wider family (Yang et al 2004).
- The cost of treatment for those who develop cervical cancer is also high and, in many countries, treatment may be unaffordable (Jacob et al 2005).
- Where cervical screening programmes are in place, these costs extend to the diagnosis and treatment of pre-cancerous lesions (Mandelblatt et al 2002; Patnick 2000).
Screening programmes are an important early detection system of repeated tests that have successfully reduced the incidence of cervical cancer by 80% (Schiller and Davies 2004). The cost of implementing an effective system of repeated screenings can be enormous. For example, it is estimated at £150 million a year in England (UK Government Statistical Services 2004) and more than $6 billion in the US when the costs of follow-on treatment are taken into account (Schiller and Davies 2004). Nevertheless, although screening programmes can identify abnormal and pre-cancerous cells on the cervix, they do not prevent HPV infection, which can lead to cervical abnormalities and, if infection is persistent, may cause cervical cancer.
(Reference: UK Government Statistical Sources 2004)
- An effective screening programme requires repeated screening of the woman. This requires trained personnel, clinical and laboratory facilities, and effective call and recall systems to keep track of the women involved.
- In the US approximately 50 million cervical screening tests are performed every year (National Cancer Institute 2005; Solomon et al 2001). The finding of abnormal cervical cytology is actively managed, resulting in significant costs to the healthcare system (Mandelblatt et al 2002; Patnick 2000).
- Even in countries with well-established screening programmes, there are women in whom cervical abnormalities are not picked up for example because they fail to attend, and who eventually develop cervical cancer (Leyden et al 2005; Stuart et al 1997). Therefore, screening alone cannot eliminate cervical cancer.
- In countries with established screening programmes, a significant decrease in the number of abnormal cervical screening test results following vaccination may significantly reduce the number of patients needing further treatment. As well as reducing the emotional and psychological burden on women, this may result in significantly reduced costs (Goldie et al 2004).
- For many countries without screening programmes, the infrastructure to establish and maintain a cytology-based screening programme is too expensive. However, most of these countries already have a history of establishing vaccination programmes.
In the future, whether screening is established or not, the development of vaccines against oncogenic HPV means that vaccination against this devastating disease may soon become a reality (Harper et al 2004; Lehtinen and Paavonen 2004; Schiller and Davies 2004) with the potential to reduce the overall economic burden of cervical cancer (Goldie et al 2004).