Nicola was 33 and had recently given birth to her second child when she went for her first cervical screen since becoming a parent.
“I expected the all-clear as usual, so was surprised to receive a letter telling me I had HPV and some abnormal cells,” says Nicola, now 37. “I went for a colposcopy, which I didn’t realise was going to involve a biopsy. A month later I was called back to the hospital and told I had stage I [cervical] cancer.”
The progression of the cancer required that she have a hysterectomy, a surgical procedure that involved removing her womb. At the time, she found herself relying on the Cancer Research UK information pages to process and understand what she was going through.
“They helped me decipher the letters from the consultant,” she says. “I thought I didn’t have any symptoms, but now I realise I did. I had put it down to being a new mum.”
Six to eight weeks later, she had recovered from the operation and was given the all-clear. “It was mind-blowing to go through so much so quickly,” she says. “I think it is so important for women to know that cervical cancer, if caught at an early stage, can be successfully treated.”
Cases such as Nicola’s still occur – around 3,300 women in the UK are diagnosed with cervical cancer each year. While there has been a substantial drop in incidence rates since the early 1990s, the rate of improvement has slowed since the early 2000s. It is hoped that progress will continue through further research.
The individual impact of every cancer diagnosis for patients and their communities can be devastating, which is why Cancer Research UK puts prevention research at the heart of its strategy. A third of all its work is funded by gifts in wills – support that is vital to increasing researchers’ understanding of cancer, and has so far allowed them to understand how factors such as human papillomavirus (HPV) can cause cancer.
The reduction in UK cervical cancer cases each year is almost entirely thanks to the success of the NHS cervical screening programme and a large-scale rollout of the vaccine against HPV, which causes 99% of cervical cancer cases.
In November 2021, a groundbreaking study, funded by Cancer Research UK, demonstrated that the HPV vaccine had reduced cervical cancer rates by almost 90% in women in their 20s who were offered it at age 12 to 13. In the UK, the HPV vaccine is freely available to all children aged 11 to 13.
Prof Peter Sasieni, director of the Cancer Research UK Cancer Prevention Trials Unit at Queen Mary University of London, who was lead author on the paper, was blown away by the findings. “I thought that we might be reducing cases of cancer by 50%,” he says. “And then to see over 80% reduction is just remarkable.”
This success is underscored by the fact that, not so long ago, the idea that HPV might play an important role in the development of cervical cancer was far from widely accepted. The theory was first put forward in the mid 1970s by German virologist Harald zur Hausen, but it would take more than two decades for it to be proven conclusively; a 1999 study by a team of Cancer Research UK researchers, led by Prof Julian Peto, demonstrated that HPV strains were present in 99.7% of a collection of cervical cancer samples taken from around the world. For his part, zur Hausen was vindicated by receiving the 2008 Nobel prize in physiology or medicine.
“People went from not being convinced that HPV was a cause of cervical cancer, to establishing beyond any doubt that it’s a cause,” says Sasieni. “Understanding that HPV was the cause of cervical cancer led to two important lines of research. First, people developed accurate and reliable tests for the virus. These tests have transformed cervical screening. Secondly, it led to the development of extremely effective vaccines to prevent HPV infection.”
As soon as HPV had been shown to be the main cause of cervical cancer, work began in earnest on the development of a vaccine. Building on research conducted in the 1950s by vets looking to develop a vaccine for bovine papillomavirus, which can cause tumours in cows, Prof Ian Frazer and Dr Jian Zhou ultimately discovered the scientific basis of a human HPV vaccine, which was then developed and brought to the clinic by the pharmaceutical industry.
Leave Cancer Research UK a gift in your will
Gifts in wills fund one third of Cancer Research UK’s work, and are vital to accelerating progress. These legacy commitments enable the charity to plan for the future, allowing it to commit to the large-scale, long-term research projects that yield its biggest breakthroughs. The advantage of pledging gifts in wills is that it means this income stream is guaranteed, and enables Cancer Research UK to invest in the most cutting-edge science with the potential to make the biggest difference to future generations in the UK and around the world.
With studies, including those conducted by Cancer Research UK scientists, confirming that this vaccine was both effective at preventing HPV infection and precancerous cell changes in the cervix, the fightback against cervical cancer had been strengthened. But the significance of HPV in driving the disease had also illustrated another important point – the opportunity to adapt the national cervical screening programme.
The cervical smear test, which looked for the presence of abnormal cells in the cervix, had been formally introduced in 1964, but the initial version of the programme faced teething issues. “Prior to 1988, cervical screening was not properly organised,” says Sasieni. “I don’t think there was any guidance on how to take a smear.”
Revamped in 1988 as the NHS cervical screening programme, mortality rates from cervical cancer soon began to fall, and by 1999 had decreased by more than 40%. But with the new knowledge regarding HPV, researchers began to wonder whether simply testing for the presence of different viral strains – known as primary HPV testing – could act as a more effective initial warning system of potential cervical malignancies.
In 2017, Sasieni published research showing that incorporating primary HPV testing in the cervical screening programme could prevent around 24% of cervical cancer cases in women invited for screening in England. Two years later, an NHS pilot study supported by Cancer Research UK, revealed that a switch to HPV primary testing would be effective, and primary HPV testing became available in England at the end of 2019.
NHS England has recently announced the goal of eliminating cervical cancer by 2040, with Australia aiming to achieve a similar target five years earlier. Elimination, as defined by the World Health Organization, involves cutting incidence rates to just four cases per every 100,000 women. The current incidence rate of cervical cancer in England is 9.7 per 100,000 women and one of the key goals will be to increase HPV vaccination rates in girls from 86% to more than 90%.
Sasieni also points to wider goals for reducing rates of cervical cancer around the world. Strategies include ideas for self-collected samples as a means of broadening cervical screening coverage and offering one-dose, rather than two-dose, HPV vaccines to cut costs in low-income nations. These are being studied through projects funded by Cancer Research UK, and wouldn’t be possible without generous support from the public. A third of Cancer Research UK’s funding comes from legacy gifts left by people in their wills. These have already helped double cancer survival and support research, such as the HPV vaccine, which opens up the possibility of a better future for cancer prevention and treatment.
“Between vaccination and screening, we really do have the tools to tackle cervical cancer globally. And I think it’s imperative that we do,” says Sasieni.
Pledging a gift in your will helps Cancer Research UK invest in life-saving studies that increase understanding of cancer to save more lives, now and in the future. Find out more cruk.org/giftsinwills
