Scant Progress on Cervical Cancer

A new Pan American Health Organization (PAHO) report, A Situational Analysis of Cervical Cancer in Latin America and the Caribbean, finds that cervical cancer screening programs in the region have generally failed to reduce cases and mortality rates largely because of inadequacies in treatment and follow-up.

According to the report, incidence and mortality rates from cervical cancer have declined steeply in North America, to below 10 per 100,000 females in both Canada and the United States. Yet rates in most Latin American and Caribbean countries are higher than 20 cases per 100,000 (in many cases, much higher) and are surpassed only by rates found in East Africa and Melanesia.

In addition, cervical cancer accounts for a higher percentage of cancer deaths in the region—as high as 49.2 percent in Haiti, compared with 2.5 percent in North America.

These higher rates persist even though screening programs are found in countries throughout the region. In Mexico, where screening has been used for more than 20 years, less than 13 percent of preventable cases have been averted. In Costa Rica, none of the screening programs in place since the 1960s has had an impact on incidence or mortality. In Cuba, where screening has been available since 1968, incidence and mortality have increased, especially among younger women.

According to the report, these high rates are the result of problems in access and quality of services. In Mexico, for example, cervical cancer rates correlate with poverty levels. In Costa Rica, higher rates of invasive cervical cancer were found in coastal areas, which have less access to health services.

The report highlights other problems:

• Women may be afraid to get screened because they fear cancer and lack knowledge about treatment options. In a study of rural Mexico, only 40 percent of women knew what a Pap test was.
• Women often have to wait so long for Pap smear results that they lose interest in the process and fail to return for follow-up.
• Health centers may fail to automatically schedule diagnosis and treatment, preventing timely follow-up.
• Many programs lack sufficient quality control in smear sampling, collection, preparation and interpretation of results. A 1996 study in Mexico found that false negatives ranged from 10 percent to 54 percent in 16 reading centers.
• Younger women are screened more often than older women, despite their lower risk of developing the disease.
• Screening coverage of target populations remains low in many countries.

To improve the situation, the PAHO report advocates the following:

• The formation of technical advisory groups to help countries and subregions develop strategic policies and plans;
• Advocacy at the political, technical, donor and community levels to ensure the inclusion of cervical cancer prevention on countries' political agendas;
• More research on the human papillomavirus and on the cost-effectiveness of screening, diagnostic and treatment models;
• Better coordination and information sharing between countries and regions;
• Incorporation of the latest knowledge about cervical cancer into education and training of health professionals.