Question 1

What causes cervical cancer?

Accepted Answer

Virtually all cervical cancers (>99%) are caused by persistent infection with high-risk human papillomavirus (HPV) — a sexually transmitted virus. HPV-16 and HPV-18 are responsible for approximately 70% of cases; HPV types 31, 33, 45, 52 and 58 for a further 20%. Most HPV infections clear spontaneously; persistent high-risk HPV infection leads to pre-cancerous changes (CIN) that can progress to invasive cancer over 10-15 years.

Question 2

How effective is the HPV vaccine?

Accepted Answer

The HPV vaccine (Gardasil 9) is up to 97% effective at preventing infection with the HPV types causing 90% of cervical cancers. It is most effective when given before first sexual exposure — typically to girls aged 9-14. One or two doses are recommended depending on age. The vaccine does not treat existing HPV infections, so vaccinated women still need cervical cancer screening.

Question 3

What is the WHO 90-70-90 strategy?

Accepted Answer

WHO's cervical cancer elimination strategy calls for: 90% of girls vaccinated with HPV vaccine by age 15; 70% of women screened twice with a high-performance test by age 45 (at 35 and 45); and 90% of women identified with cervical disease treated. Countries achieving all three thresholds can eliminate cervical cancer as a public health problem (incidence below 4 per 100,000 women). The 2023 UN Political Declaration endorsed this target.

Question 4

What is HPV DNA testing?

Accepted Answer

HPV DNA testing — detecting high-risk HPV DNA in cervical cells — is the most sensitive cervical screening method. WHO recommends it over cytology (Pap smear) for LMIC settings because it is more accurate, can be done by a health worker without laboratory infrastructure, and enables screen-and-treat programmes. Self-sampling for HPV DNA testing is increasingly used to reach women who would not attend clinic-based screening.

Question 5

What is VIA and why is it used?

Accepted Answer

Visual Inspection with Acetic Acid (VIA) involves applying dilute acetic acid to the cervix and looking for acetowhite areas that indicate pre-cancerous changes. A trained health worker can perform VIA and treat CIN 2/3 with thermal ablation in a single visit — a "screen-and-treat" approach that dramatically improves effectiveness in LMICs by eliminating loss to follow-up. WHO endorses VIA as an alternative when HPV DNA testing is unavailable.

Question 6

Why do 90% of cervical cancer deaths occur in LMICs?

Accepted Answer

Cervical cancer is a disease of inequality. In high-income countries, HPV vaccination and organised screening programmes have reduced incidence dramatically. In LMICs — particularly Sub-Saharan Africa, South Asia and parts of Latin America — HPV vaccine rollout is incomplete, screening is largely unavailable, and treatment (surgery, radiotherapy) is inaccessible or unaffordable. The same woman who would receive treatment in a high-income country dies of a preventable cancer in an LMIC.

Question 7

How is cervical pre-cancer treated?

Accepted Answer

High-grade cervical pre-cancer (CIN 2/3) is treated with: thermal ablation (cold coagulation using heat) — recommended by WHO for eligible lesions; cryotherapy (freezing); or LEEP (Loop Electrosurgical Excision Procedure — removing the transformation zone under local anaesthesia). All are highly effective outpatient procedures. Screen-and-treat programmes combining VIA or HPV test with same-day thermal ablation are highly cost-effective in LMICs.

Question 8

What is the link between HIV and cervical cancer?

Accepted Answer

Women living with HIV have a 6-fold higher risk of cervical cancer than HIV-negative women — HIV-related immunosuppression allows HPV to persist and progress more rapidly. Cervical cancer is an AIDS-defining illness. HIV programmes must integrate HPV vaccination and cervical cancer screening. PEPFAR and GAVI funding has accelerated HPV vaccine access in high-HIV-burden countries.

Question 9

How does Georgia's cervical cancer programme compare?

Accepted Answer

Georgia has made progress in HPV vaccination rollout and has organised cervical cancer screening programmes, but coverage remains below WHO's 90-70-90 targets. The Georgian Medical Journal has published on cervical cancer epidemiology in Georgia and the South Caucasus. PHIG's public health work includes cervical cancer prevention through women's health initiatives.

Question 10

Can men get HPV-related cancers?

Accepted Answer

Yes. The same high-risk HPV types that cause cervical cancer also cause oropharyngeal cancers (tonsil and base of tongue — now the most common HPV-related cancer in men in high-income countries), anal cancer, penile cancer, vaginal and vulvar cancers. HPV vaccination of boys as well as girls prevents these cancers and reduces HPV transmission. WHO recommends gender-neutral HPV vaccination.

Question 11

What is the PAHO ETMI-Plus initiative?

Accepted Answer

PAHO's ETMI-Plus (Elimination of Transmission of Mother-to-Infant HIV/syphilis/hepatitis B/Chagas) integrates cervical cancer screening into maternal health services — recognising that pregnancy is often the only healthcare contact for women in LMICs. WHO's maternal and newborn care guidelines increasingly integrate cervical cancer screening into antenatal care.

Question 12

How does GMJ News cover cervical cancer?

Accepted Answer

GMJ News covers WHO 90-70-90 progress, HPV vaccine coverage data, screening programme developments and the cervical cancer equity gap. GMJ's women's health editorial desk links cervical cancer to broader reproductive health coverage. Georgia's cervical cancer epidemiology is a direct GMJ and PHIG priority.

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