The high burden of cervical cancer in the Americas represents a major public health problem that needs to be addressed using a comprehensive approach (adolescent health, sexual and reproductive health, immunization and cervical cancer control). The long natural history of the disease yields many opportunities for intervention throughout the lifecycle of women by effective primary and secondary prevention strategies in conjunction with appropriate diagnostic and therapeutic case management including access to palliative care.
Comprehensive approach to cervical cancer prevention and control
NEW TOOLS FOR CERVICAL CANCER PREVENTION
Cervical cytology (the Pap test) has been used to screen women for early signs of cervical cancer and has led to a reduction in cervical cancer deaths. In many developing countries, and in many Latin American and Caribbean (LAC) countries, the use of the Pap test as a screening method has not led to reductions in cervical cancer as compared to developed countries. The failure of the screening programs in LAC is due not only to the limitations of cytology as a screening technique but also to the organization of the health system, as well as cultural and community factors. There are now new tools available, including new screening technologies and HPV vaccines, which offer unprecedented new opportunities to prevent and control cervical cancer.
- Safe and efficacious prophylactic HPV vaccines against oncogenic types 16 and 18 are available, allowing primary prevention of about 70% of cervical cancer cases caused by these HPV types.
- New approaches to screen for cervical cancer include visual inspection with acetic acid (VIA test) and HPV DNA testing.
- Screening with the VIA test is effective and feasible in low-resource settings, especially when paired with cryotherapy for treatment of pre-cancerous cervical lesions (“screen and treat” approach).
- A comprehensive public health strategy is needed for cervical cancer prevention, which includes vaccination of adolescents (when affordable and sustainable); screening women in the age group at risk for developing cervical cancer (women aged 35 years and older); and treatment of all women with pre-cancerous cervical lesions and invasive cervical cancer.
There is clear and well-established scientific evidence and enough quality research in LAC countries to support the introduction of these new technologies for preventing cervical cancer that will have a positive impact on the burden of disease.
PAHO’S STRATEGY FOR CERVICAL CANCER PREVENTION AND CONTROL
The Regional Strategy and Plan of Action for Cervical Cancer Prevention and Control was developed by the Pan American Health Organization (PAHO) in 2008 in response to the high burden of disease and the limited impact of current screening programs in LAC. The Strategy was endorsed by the PAHO Directing Council, composed of the Ministers of Health of the Americas, and a resolution was passed to urge Member States to strengthen their cervical cancer programs. The aim is to improve the capacity of countries to implement sustainable and effective programs for the prevention of cervical cancer and generate an integrated approach across existing programs on adolescent health, sexual and reproductive health, immunization and cervical cancer control. A plan of action was proposed for the Regional Strategy consisting of the following seven points:
- Conduct a situation analysis
- Intensify information, education and counseling
- Fortify screening and pre-cancer treatment programs
- Establish or strengthen information systems and cancer registries
- Improve access and quality of cancer treatment and of palliative care
- Generate evidence to facilitate decision making regarding HPV vaccine introduction
- Advocate for equitable access and affordable comprehensive cervical cancer prevention
PAHO´s partnerships and projects in Cervical Cancer
PAHO has been working in partnership with the Alliance for Cervical cancer Prevention (ACCP) since 1999 and with the global coalition Cervical Cancer Action since 2007 to advocate for and strengthen cervical cancer prevention and control in low resource settings. Demonstration projects have been established using alternative screening approaches in several countries in LAC. Technical assistance is also provided to countries in the Region to strengthen their cervical cancer programs. HPV vaccines are included in PAHO´s Revolving Fund, enabling bulk purchase at one unique price for all countries in the Americas who have introduced the HPV vaccine into their national public health programs. With respect to treatment, PAHO has a longstanding history of working with Ministries of Health in the Americas to improve quality and access to radiotherapy services and strengthen capacity for cancer treatment, working together with the International Atomic Energy Agency.