Preface

Cervical cancer is the fourth most common form of cancer among women worldwide. In 2020, there were 604,000 new cases and 342,000 deaths due to cervical cancer globally. More than 70% of these occurred in the limited-resource settings of developing countries. The causative factor is persistent infections by the high-risk, oncogenic strains of human papilloma virus (HPV) types 16 and 18.

Cervical cancer is preventable and treatable. It is the only cancer targeted for elimination by 2030 by the World Health Organization (WHO). More than 193 member countries are signatories to the WHO's Cervical Cancer Elimination Initiative.

Achieving this lofty goal involves plans, programs, strategies, solutions, research, and revolutions, all of which this book, Cervical Cancer – A Global Public Health Treatise, discusses. According to the WHO, the three key pillars to eliminating cervical cancer are vaccinating 90% of girls by the age of 15 years, screening 70% of women by the age of 35 years and again by the age of 45 years, and treating 90% of women with precancer and managing 90% of women with invasive cancer.

The first chapter on epidemiology describes incidence rates and mortality rates of cervical cancer in many countries. It analyzes the sociodemographic factors responsible for the high number of cases in certain regions as well as prevalence rates of oncogenic HPV infections in different age groups and groups residing in different locations. Sex life, menstrual behavior and hygiene practices, age at which sexual activity began, number of sex partners, condom use, number of unhygienic abortions, intake of oral contraceptive pills, smoking, and family history of carcinoma of the cervix are all postulated risk factors for the high incidence of cervical cancer substantiated by case-control and cohort studies presented in this chapter.

The chapter on HPV vaccination addresses the protective value of the bivalent, quadrivalent, and nanovalent HPV vaccines and their cost-effectiveness. It also discusses problems in vaccinating teenage girls in different societies, cultures, and socioeconomic backgrounds, along with potential solutions.

The chapter on screening and treatment discusses different screening strategies, such as visual inspection methods, cytology screening, and HPV screening, and their protocols and recommendations. It also discusses treatments available for precancerous lesions, including cryotherapy, cold knife conization, loop electrosurgical excision procedure (LEEP), and laser ablation methods.

The chapter on prevention and control emphasizes HPV vaccination for all girls 9 to 14 years old and other eligible women up to 21 years old. "See and Treat" protocols, offered at least once in a woman's lifetime, help prevent cervical cancer, thus they are advocated for limited-resource settings as a cost-effective strategy.

This book reflects the rich experiences of medical professionals and scientists from various countries who are working in challenging and resource-constrained settings. We are proud to offer this resource to healthcare providers as a first step to eliminating cervical cancer worldwide.

### **Dr. Rajamanickam Rajkumar**

Professor, Department of Community Medicine, Meenakshi Medical College Hospital and Research Institute, Meenakshi Academy of Higher Education and Research – MAHER, Kanchipuram, Tamil Nadu, India
