EvidenceCervical cancer

For a patient with a gynaecological cancer, the specialists who would run such a trial say the evidence does not exist yet.

The survival gain turns the earlier progression-free survival result into a clear reason to offer pembrolizumab with and after chemoradiotherapy to women with node-positive or stage III-IVA cervical cancer. Because cervical cancer is concentrated in low- and middle-income countries, the benefit reaches most women only if pricing and access follow.

Women with locally advanced cervical cancer that is node-positive or stage III-IVA can be offered pembrolizumab alongside and after chemoradiotherapy to lower the chance of relapse. The result matters most in countries where cervical cancer is common but immunotherapy access is poorest, so its global impact depends on pricing and health-system capacity. It does not apply to early-stage disease treated with surgery or to lower-risk locally advanced disease without nodal involvement.

This edition supplied two widely quoted signals: the first population-level evidence of HPV vaccination preventing cervical cancer in the United States, and the warning that reduced PSA screening was shifting prostate cancer towards later diagnosis.

School-based vaccination at 12-13 with high uptake nearly abolishes cervical cancer in vaccinated cohorts, even with a vaccine covering only two HPV types. Screening intervals and the future of cervical screening can now be redesigned around vaccination status.

One dose protects. WHO endorsed one- or two-dose schedules in 2022, halving the cost and the logistics of vaccinating girls, which is decisive for India (about 127,500 cervical cancers a year) and for the global elimination target. It also removed the main barrier to India's national programme with its home-made vaccine.

India's cancer problem is a late-diagnosis problem as much as a treatment problem: the same cancers that dominate (oral, cervical, breast) are the ones screening and vaccination can prevent or catch early. The numbers set the priorities of the National Cancer Grid, PM-JAY oncology packages and the national screening programme.

Vaccinating girls before they are exposed to HPV prevents most cervical cancers. Catch-up vaccination in young adults still helps, but less. Combined with HPV screening, elimination of cervical cancer as a public health problem is a realistic goal.

Women can collect their own screening sample at home with no loss of accuracy if the laboratory uses a PCR test. Sending kits directly is the most effective way to reach women who do not attend, which matters because most cervical cancers occur in under-screened women.

This is the efficacy evidence behind the EU (2007) and US (2009) approvals of Cervarix. The gap between near-complete type-specific protection and the 30 percent overall effect in the whole cohort is the argument for vaccinating before sexual debut, where the effect was 70 percent.

HPV DNA testing is the screening test that saves lives in low-resource settings, even when done once. The result underpins WHO's HPV-first screening guidance and India's operational guidelines, and gives the rationale for self-sampled HPV tests as the route to cervical cancer elimination.