Eliminating HPV-caused cancers in Europe: Achieving the possible.

The 690,000 cases of cancer caused worldwide each year by HPV (human papillomavirus) are among the easiest of all cancers to prevent. However, the actions so far taken in terms of both policy and practice by health systems in many European states have neither matched the scale of the problem nor seized the opportunities for disease prevention potentially offered by vaccination and screening. Treatments for HPV-caused cancers are also inequitably provided across the region and widespread misinformation about HPV undermines efforts to improve public health. The European Cancer Organisation's HPV Action Network has made the case for action for the elimination of all the cancers caused by HPV through gender-neutral vaccination, effective cervical cancer screening, better quality treatments, and public and professional education across Europe. The World Health Organisation's new global strategy for the elimination of cervical cancer (launched in November 2020), together with Europe's Beating Cancer Plan (February 2021), together provide a major opportunity to tackle decisively all the cancers caused by HPV. The Beating Cancer Plan, which was significantly influenced by evidence provided by the HPV Action Network, commits to supporting EU member states' efforts to extend routine vaccination of girls and boys and to creating a new EU-supported Cancer Screening Scheme to help Member States ensure that 90% of the EU population who qualify for cervical cancer screening are offered it by 2025. The goal of HPV cancer elimination is now both possible and achievable. The challenge is to ensure implementation and delivery by EU member states and more widely across the European region.

The European Code of Cancer Practice.

There are considerable disparities between the quality of cancer care and clinical outcomes for cancer patients in different European countries, regions, hospitals and communities. These have persisted despite the introduction of many European and National Cancer Plans, an extensive portfolio of clinical guidelines and the existence of evidence based guidelines for the good practice in planning cancer healthcare systems. We describe the European Code of Cancer Practice which is a citizen and patient-centred accessible widely disseminated statement of the core requirements for good clinical cancer practice. The Code sets out 10 key overarching Rights of what a patient should expect from their healthcare system each supported by a plain language explanation. The Rights highlight the importance of equal access to affordable and optimal cancer care, good quality information about an individual patient's disease and treatment and about the quality and outcomes of the cancer service they will use. Specialised multidisciplinary cancer care teams, shared decision-making, research and innovation, a focus on quality of life, the integration of supportive and palliative care within oncology are all emphasised. There is a need for a systematic approach to supporting cancer survivors with a survivorship care plan including their rehabilitation, reintegration into society and return to work where appropriate without discrimination. The Code has been co-produced by a team of cancer patients, patient advocates and cancer professionals to bridge the gap between clinical guidelines, healthcare policies and patients' everyday experience. It is robustly evidence-based and supported by a comprehensive review of the medical literature and evidence for good clinical practice. The Code is strongly endorsed by Europe's professional and patient cancer organisations and the European Commission.

Entanglement of New Zealand fur seals in man-made debris at Kaikoura, New Zealand.

New Zealand fur seals in the Kaikoura region breed near a town with expanding tourist and fishing industries and commonly come ashore entangled in nets and plastic debris. However, the rate at which entanglement occurs was previously unknown. A decade of Department of Conservation seal callout data was analysed to determine the level of entanglement in the region and the most common debris type. Monitoring of adult female fur seals released from entanglement provided information on the potential for serious wounds to heal and survivorship of released individuals. Entanglement rates of pinnipeds in Kaikoura are some of the highest reported world-wide (average range: 0.6-2.8%) with green trawl net (42%), and plastic strapping tape (31%) together contributing the most to debris types. Nearly half of the reported entangled seals are successfully released (43%) and post-release monitoring shows that with appropriate intervention the chance of an individual surviving even with a significant entanglement wound is high. Our study demonstrates that while entanglement in the region is high, a successful intervention protocol may help reduce the potential for entanglement-related mortality in the region.

Identification of cervical cancer markers by cDNA and tissue microarrays.

The Pap test has effectively reduced the incidence and mortality of cervical cancer. However, because of the morphological basis of this test, sensitivity and specificity are less than ideal, a situation that complicates the clinical management of women diagnosed with low-grade cervical abnormalities. In an attempt to understand the molecular basis of cervical tumorigenesis and to discover molecular markers for accurate cervical cancer screening, we used cDNA microarrays containing >30,000 Unigene clones to examine the gene expression patterns of 34 cervical tissues from different clinically defined stages. It was found that global gene expression patterns separated normal cervical tissues and low-grade squamous intraepithelial lesions from cervical cancers and most of the high-grade squamous intraepithelial lesions (HSILs). Among the top 62 genes/(expressed sequence tags) that were overexpressed in tumors and HSIL tissues, 35 were confirmed using in situ hybridization on cervical tissue micorarrays. Many of these genes were overexpressed in high-grade dysplastic and malignant cervical epithelium or in stroma adjacent to the diseased tissues, with cellular proliferation and extracellular matrix-associated genes being the most common. In general, the extent of gene overexpression increased as the lesions progressed from low-grade squamous intraepithelial lesions to HSILs and finally to cancer. It is hoped that with additional development, some of these markers will improve the interpretation of cervical screening tests and provide useful information for patient management decisions.