- Experts have called for the worldwide eradication of cervical cancer, but this is not likely to happen for a long time
- Significant progress has been made to eliminate cervical cancer in developed countries
- The overwhelming burden of cervical cancer falls disproportionately on women in low- to middle-income countries (LMIC)
- LMIC have relatively low levels of awareness of cervical cancer, patchy prevent programs and limited treatment options
- Over 80% of cervical cancer cases and deaths occur in LMIC
- Cervical cancer is the fourth most common cancer in women worldwide
- In 2018 there were an estimated 680,000 new cases and 311,000 deaths from the disease worldwide
- Cervical cancer is caused by sexually acquired infection from high-risk strains of the human papilloma virus (HPV)
- The majority of women will be infected with HPV at some point in their life
- HPV also causes genital warts and cancers of the head and neck and is also linked to cancers of the anus, vulva, vagina, penis and oropharynx
- HPV vaccines protect against 70% of cervical cancers and about 90% of genital warts
- Regular screening is also recommended to reduce the incidence of cervical cancer
Cervical cancer is a killer disease, which only affects women. It affects women of all ages from schoolgirls to grandmothers, but it is significantly more prevalent between the ages of 30 and 45.
The cervix, also known as the neck of the womb, connects a woman's womb and her vagina.
Cervical cancer is the fourth most common cancer in women worldwide and second for women between 15 and 44. In 2018 there were an estimated 680,000 new cases and 311,000 deaths from the disease worldwide. The overwhelming majority of cases are caused by two specific strains of the human papilloma virus (HPV). HPV infection and early cervical cancer typically do not present noticeable symptoms, and cervical cancer may take 20 years or longer to develop after an HPV infection. The overwhelming global burden of the disease falls disproportionately on women in low- to middle income countries (LMIC). There is a significant and growing gap in the incidence and mortality rates of cervical cancer between developed nations and LMIC. Despite international efforts, it seems unlikely that this gap will be narrowed in the medium term.
In this Commentary
About 79m Americans are currently infected with HPV, with roughly 14m people becoming newly infected in the US each year. In the UK, HPV is present in one in three people and 90% of individuals will come into contact with some form of the virus in their lifetime. About 80% of sexually active people are infected with HPV at some point in their lives, but most people never know they have the virus. Whitfield Growdon, a surgical oncologist at the Massachusetts General Hospital and professor at the Harvard University Medical School describes the HPV vaccination as, “one of the most meaningful interventions for reducing cervical cancer”; see video below.
All girls and boys aged between 11 and 12 should get the HPV vaccination. Every year in the US, over 13,000 males contract cancers caused by HPV. Catch-up HPV vaccines are recommended for girls and women through the age of 26, and for boys and men through the age of 21, if they did not get vaccinated when they were younger. HPV vaccination is also recommended for the following people, if they did not get vaccinated when they were younger: (i) young men who have sex with men through the age of 26, (ii) young adults who are transgender through the age of 26 and (iii) young adults with certain immunocompromising conditions (including HIV) through the age of 26.
The HPV DNA test determines the most likely cause of cervical cancer by looking for pieces of DNA in cervical cells and is recommended for women over 30 and not for women under 30. This is because women in their 20s tend to be more sexually active and therefore are more likely (than older women) to have an HPV infection that will go away on its own. Results of an HPV DNA test carried out on a woman in her 20s is not as significant as in and older woman and also may be confusing. The HPV DNA test can also be used in women who have slightly abnormal Pap test results to find out if they might need more testing or treatment.
A research paper about the Australian initiative published in the January 2019 edition of The Lancet Public Health concludes that, “the annual incidence of cervical cancer in Australia is likely to decrease to fewer than six new cases per 100 000 women by 2020 (range 2018–22) and to fewer than four cases per 100 000 women by 2028 (2021–35). The annual incidence of cervical cancer could decrease to one new case per 100 000 by 2066 (2054–77) if the existing HPV-based screening program continues in cohorts who are offered the nonavalent vaccine”; [a nonavalent vaccine works by stimulating an immune response against nine different antigens, such as nine different viruses or other microorganisms]. According to Suzanne Garland, Professor and Clinical Director of Microbiology and Infectious Diseases at the Royal Women’s Hospital, Melbourne, Australia, who led the research, “within 40 years the number of new cases of cervical cancer [in Australia] is projected to drop to just a few”.
The expansion of screening programs for cervical cancer in LMIC is only part of the answer to closing the gap with developed nations and eradicating cervical cancer globally. It is imperative that screening is linked to increased access to effective treatment for women with cervical cancer, particularly in its early stages when it is still curable. In LMIC there is often not only reduced access to preventive HPV vaccines and screening, but limited access to treatment and trained personnel. Notwithstanding, there is evidence to suggest that, in LMIC less-invasive and less–resource-intensive treatment options can be effective and are increasingly being made available.
According to Danielle Rodin, lead author and Radiation Oncologist at the Princess Margaret Cancer Centre, University of Toronto, Canada, "Vaccination is hugely important, but we can't neglect the millions of women who are contracting cervical cancer and dying in pain without access to treatment. These are women who have curable cancers: even advanced cervical cancer can be cured with radiotherapy. The possibility exists to make this treatment universally available". Radiation therapy makes small breaks in the DNA inside cells. This stops cancer cells from growing and dividing and causes them to die. Unlike cisplatin therapy, [an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy], which usually exposes the whole body to cancer-fighting drugs, radiation therapy is usually a local treatment.
“We know that when administered together (chemoradiation) you can give lower doses of both and get a better kill-rate on the tumour. This is now the backbone of cervical cancer therapy”, says Growdon; see video below.
Although the UAE is among the few countries to have relatively low incidence rates of cervical cancer, the disease still ranks as the third most frequent cancer among women in the UAE and the third most frequent cancer among women between 15 and 44. Estimates suggest that every year, 93 women are diagnosed with cervical cancer and 28 die from the disease in the UAE. Although Abu Dhabi is successfully leading the fight against cervical cancer and provides a roadmap for others to follow, the incidence of cervical cancer in the Middle East generally is expected to more than double by 2035 (>33,000 cases) and be responsible for more than 18,000 deaths. In some countries including Morocco and Saudi Arabia, low societal awareness and relatively low levels of screening results in about one in four women with HPV.
- AstraZeneca has turned traditional biopharma R&D on its head and is targeting early stage cancer
- This strategy benefits from some of AstraZeneca’s R&D endeavours
- But the strategy faces strong headwinds, which include significant technological and market challenges and substantial Competition from at least two unicorns
Baselga is AstraZeneca's new cancer research chief who has turned traditional biopharmaceutical drug development on its head by announcing AstraZeneca’s intention to target early- rather than late-stage cancer. “We need to spend our resources on those places where we can cure more people and that’s in early disease”, says Baselga, who knows that early detection can significantly improve patient survival rates and quality of life, as well as substantially reducing the cost and complexity of cancer treatment. Baselga also must know his strategy is high risk. Will it work?
In this Commentary we discuss the drivers and headwinds of AstraZeneca’s strategy to increase its R&D focus on early stage cancer. But first we briefly describe cancer, the UK’s situation with regard to the disease and explain why big pharma targets advanced cancers. Also, we provide a brief description of AstraZeneca’s recent history.
Cancer occurs when a normal cell’s DNA changes and multiplies to form a mass of abnormal cells, which we refer to as a tumour. If not controlled and managed appropriately the tumour can spread and invade other tissues and organs. In the video below Whitfield Growdon, a surgical oncologist at the Massachusetts General Hospital in Boston US, and a Professor at the Harvard University Medical School explains.
Why big pharma targets advanced cancers?
Studies in developed economies suggest that treatment costs for early-diagnosed cancer patients are two to four times less expensive than treating those diagnosed with advanced-stage cancer. Notwithstanding, there are physical, psychological, socio-economic and technical challenges to accessing early cancer diagnosis and these conspire to delay cancer detection. Thus, big pharma companies have traditionally aimed their new cancer drugs at patients with advanced forms of the disease. This provides pharma companies access to patients who are willing to try unproven therapies, which significantly helps in their clinical studies. And further, big pharma is advantaged because regulators tend to support medicines that slow tumour growth and prolong life, albeit by a few months.
Imfinzi: the only immunotherapy to demonstrate survival at three years
Findings presented at the June 2019 meeting of the American Society of Clinical Oncology (ASCO), build on a clinical study of Imfinzi reported in the September 2018 edition of The New England Journal of Medicine, and suggest that Imfinzi is the only immunotherapy to demonstrate survival at three years in unresectable stage-III NSCLC. AstraZeneca has begun a phase-3 clinical study of the PD-L1 inhibitor protein in stage II NSCLC patients.
- People are living longer, the prevalence of age-related degenerative disc disease is increasing and sufferers are more and more turning to spinal implant surgery as a solution
- As this significantly raises the burden on over-stretched healthcare systems, so is spine surgery increasingly becoming a key target for cost reduction within healthcare systems
- This intensifies the pressure on manufacturers to innovate and make spinal implants more cost effective
Can 3D printing and the use of new alloys reduce the high costs of producing and marketing spinal implants?
On January 8th 2019 surgeons at Joseph Spine, a specialist surgery centre based in Tampa Bay Florida, were the first in the US to implant a 3D printed interbody fusion device, which was produced by Osseus Fusion Systems. The company uses its proprietary 3D printing technology, also known as additive manufacturing, to build spinal implants from titanium material that is optimized for bone fusion and biological fixation. In August 2018, a suite of Osseus’s devices received clearance from the US Food and Drug Administration (FDA) for a range of heights and lordotic (inward spinal curvature) angles, which make them adaptable for a variety of patient anatomies. The interbody fusion devices work by being packed with biomaterials and bone grafts and inserted in between two vertebrae, where they fuse with the spine and work to prevent back pain.
Spine surgery increasing significantly
Findings of a study published in the March 2019 edition of Spine, entitled, “Trends in Lumbar Fusion Procedure Rates and Associated Hospital Costs for Degenerative Spinal Diseases in the United States 2004 to 2015”, report that the rate of elective lumbar fusion surgeries in the US has increased substantially over the past decade. Such trends are indicative of most advanced industrial societies, which are changing and ageing, primarily driven by improvements in life expectancy and by a decrease in fertility. This results in people living longer, reaching older ages and having fewer children later in life. Over the next decade, these market drivers are expected to make spine surgery a key target for cost reduction within healthcare systems and this, in turn, is likely to increase pressure on manufacturers of spinal implants to make spine surgery more cost effective.
- Two Boston Consulting Group studies say MedTech innovation productivity is in decline
- A history of strong growth and healthy margins render MedTechs slow to change their outdated business model
- The MedTech sector is rapidly shifting from production to solutions
- The dynamics of MedTechs' customer supply chain is changing significantly and MedTech manufacturers are no longer in control
- Consolidation among buyers - hospitals and group purchasing organisations (GPO) - adds downward pressure on prices
- Independent distributors have assumed marketing, customer support and education roles
- GPOs have raised their fees and are struggling to change their model based on aggregate volume
- Digitally savvy new entrants are reinventing how healthcare providers and suppliers work together
- Amazon’s B2B Health Services is positioned to disrupt MedTechs, GPOs and distributors
- MedTech manufacturers need to enhance their digitization strategies to remain relevant
According to the BCG’s 2017 study, “Overall, innovation productivity [in the MedTech sector] is in decline. In some product categories, low-cost competitors - including those from emerging markets - have grown rapidly and taken market share from established competitors. At the same time, purchasers are becoming more insistent on real-world evidence that premium medical devices create value by improving patient outcomes and reducing the total costs of care”. The growth and spread of value-based healthcare has shifted the basis of competition beyond products, “toward more comprehensive value propositions and solutions that address the entire patient pathway”. In this environment, MedTechs have no choice but to use data to deliver improved outcomes and a better customer experience for patients, healthcare providers and payers.
- Each year unhealthy diets are linked to 11m deaths worldwide a global study concludes
- Red and processed meat not only cause disease and premature death from chronic non-communicable diseases (NCD) but also put the planet at unnecessary risk
- Evidence suggests that the health benefits of a Mediterranean diet reduces the risk of NCDs and is better for the Planet
Eat like Greeks, live healthier lives and save our planet
What is HIV?
HIV (the human immunodeficiency virus) is a serious viral infection that is spread through body fluids, including through sexual intercourse, and this includes vaginal, anal and sometimes oral sex. HIV can also be spread by needle stick contamination, by sharing needles, receiving surgical treatment in foreign countries (where sterilization of equipment may not meet the standards of developed countries) and sometimes it can be passed from the mother to a child during the birth process or through breast feeding.
HIV is found in the bodily fluids of an infected person which includes semen, vaginal and anal fluids, blood and breast milk. HIV cannot be transmitted through sweat or urine. It thrives inside a persons body, however does not survive long outside the body.
What are the symptoms of HIV?
Not everyone that is infected by HIV will show signs or symptoms of the infection. At first individuals may experience flu-like symptoms, these can include:
- sore throat
- muscle aches and pains
If these symptoms do occur they can subside for a number of years and the HIV can go undetected in the body, but during this time the virus will multiply and can be passed on to other people.
What's the big deal with HIV?
If left alone and not managed or treated with antiviral tablets, the infection can lead on to a condition called AIDS (acquired immunodeficiency syndrome), where the immune system becomes weakened and this could eventually lead to life threatening infections and even cancers.
AIDS is the last and final stage of the HIV infection; this is when your body can no longer fight the infection.
However, if caught early through testing, with the correct antiviral medication, most people with HIV will not go on to develop AIDS.
Around 20% of people living in the UK with HIV are thought to be undiagnosed and are unaware that they are carrying the infection. This increases the risk to their partners and themselves of developing serious ill-health problems.
If you have have had sex with someone who may be HIV positive you can reduce your chances of infection by starting a PEP (post-exposure prophylaxis) treatment within 72 hours of exposure to the virus. You will need to attend your local A&E department for this treatment.
HIV home testing
A discreet Test kit is provided simply at home & sample then forwarded to the laboratory using our self addressed envelope.
If you think you have been exposed to the risk of HIV then you should get tested immediately.
TESTD™ offers the latest in HIV testing technology. If you are generally concerned for your health and would like total peace of mind we offer a next day 5th Generation HIV Duo test. This is the most advanced method of testing for HIV and can be done from day 28 onwards following a potential exposure.
The 5th generation HIV Duo test looks for both antibodies and the p24 antigen for HIV and is incredibly accurate (over 99.9% sensitivity).
Please note that it is possible to test for HIV from day 10 after a potential exposure by taking an early detection screen, however it should always be followed up with a 28 day HIV Duo test.
The hayfever injection – help for severe sufferers
Severe hayfever symptoms can ruin peoples’ summers and have a detrimental effect on quality of life and ability to work optimally.
Certain parts of the UK are particularly affected by pollens and allergens likely to give severe symptoms, with the most likely culprits being a mixture of flower and tree pollen such as silver birch and rape seed.
If you have severe symptoms that fail to respond to other treatments, such as oral antihistamine medications, topical eye drops and so on, it is possible to request an appointment to discuss the hayfever injection at our clinics in Nottingham, Derby, Leicester, Sheffield, Leeds and Watford.
The hayfever injection is a corticosteroid injection which has anti-inflammatory properties. It suppresses the immune system and stops the natural pollen response from going ‘haywire’. This is the same medication given by doctors regularly for tennis elbow, various ligament and muscular strains, osteoarthritis and other joint conditions.
As with all injected medications, and in line with good medical practice, the doctor will undertake a careful risk assessment to make sure that you are a good candidate for treatment, and will explain the potential side effects and likely benefits in detail.
In our twenty-year experience of administering the hayfever injection, we have seen virtually nothing in the way of even mild ‘side effects’ with two people reporting a dimpling of the skin at the site of the injection (the buttock).
This dimpling is uncommon, however patients are always advised that it may occur and like all administered medications, the risks of any treatment must be balanced against the potential benefit of the treatment given.