Cervical Cancer Screening Programs in Latin America and the Caribbean

Worldwide, cervical cancer is the third most common cancer in women, and the first or second most common in developing countries. Cervical cancer remains in Colombia the first cause of cancer mortality and the se­cond cause of cancer incidence among women, despite the existence of screening programs during the last 3 decades. Bucaramanga, Manizales and Cali reported rates around 20 per 100,000 and Pasto 27 per 100,000. The Cali cancer registry has reported a progressive decrease in the age standardized incidence and mortality rates of cervical cancer over the past 40 years. Reasons for the decline in incidence and mortality of cervical cancer are multiple and probably include: improvement in socio-economic conditions, decrease in parity rates and some effect of screening programs. Human papilloma Virus is the main cause of cervical cancer, HPV natural history studies have now revealed that HPVs are the commonest of the sexually transmitted infections in most populations. Most HPV expo­sures result in spontaneous clearance without clinical manifestations and only a small fraction of the infected persons, known as chronic or persistent carriers, will retain the virus and progress to precancerous and cancer. HPV 16 and 18 account for 70% of cervical cancer and the 8 most common types. (HPV 16, 18, 45, 33, 31, 52, 58 and 35) account for about 90% of cervical cancer. Case-control studies also allowed the identification of the following cofactors that acting together with HPV increase the risk of progression from HPV persistent infection to cervical cancer: tobacco, high parity, long term use of oral contraceptives and past infections with herpes simplex type 2 and Chlamydia trachomatis . The demonstration that infection with certain types of human papillomavirus (HPV) is not only the main cause but also a necessary cause of cervical cancer has led to great advances in the prevention of this disease on two fronts: (i) Primary prevention by the use of prophylactic HPV vaccines; and (ii) secondary prevention by increasing the accuracy of cervical cancer screening.

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Epidemiology of cervical cancer in Colombia

Background
Cervical cancer is one of the top causes of cancer morbidity and mortality in Colombia despite the existence of a national preventive program. Screening coverage with cervical cytology does not explain the lack of success of the program in reducing incidence and mortality rates by cervical cancer. To address this problem an ecological analysis, at department level, was carried out in Colombia to assess the relationship between cervical screening characteristics and cervical cancer mortality rates.

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How protective is cervical cancer screening against cervical cancer mortality in developing countries? The Colombian case

Fil: Arrossi, Silvina. Centro de Estudios de Estado y Sociedad; Argentina. Consejo Nacional de Investigaciones Cientificas y Tecnicas; Argentina

https://onlinelibrary.wiley.com/doi/pdf/10.1002/ijc.29530

Implementation of HPV-testing for cervical cancer screening in programmatic contexts: The Jujuy demonstration project in Argentina.

Objetivos. Describir la tendencia temporal de la incidencia, mortalidad y los factores pronosticos del cancer de cuello uterino en Cali, Colombia, y revisar la evidencia epidemiologica molecular que muestra que el VPH es la causa principal y necesaria del cancer cervical y las implicaciones de este descubrimiento para la prevencion primaria y secundaria. Material y metodos. Se estimaron las tasas de incidencia de cancer de cuello uterino durante un periodo de 45 anos (1962-2007) con la informacion del registro poblacional de cancer de Cali y las de mortalidad con las estadisticas de la Secretaria de Salud Municipal de Cali. Los factores pronosticos se estimaron sobre la base de la supervivencia relativa. La revision de la evidencia epidemiologica molecular que une el VPH con el cancer cervical se centro en los estudios llevados a cabo en Cali y en otros paises. Resultados. Las tasas de incidencia de carcinoma de celulas escamosas (SCC) por 100000 se redujeron desde 120.4 en 1962-66 a 25.7 en 2003-07, mientras que las de adenocarcinoma aumentaron desde 4.2 hasta 5.8. Las tasas de mortalidad por cancer de cuello uterino por 100000 se redujeron desde 18.5 en 1984-88 a 7.0 en 2009-11. La supervivencia fue menor en las mujeres de mas de 65 anos de edad y en los estadios clinicos 3-4. La revision de la evidencia epidemiologica molecular mostro que ciertos tipos de VPH son la causa central y necesaria del cancer cervical. Conclusiones. Se documento la disminucion de la incidencia y la mortalidad por SCC y un aumento en la incidencia de adenocarcinoma durante un periodo de 45 anos en Cali, Colombia

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Objective: To assess cost-effectiveness of conventional cytology and HPV DNA testing for cervical-cancer screening in Colombia. Material and Methods: The National Cancer Institute of Colombia (NCIC) in 2007 developed a Markov model on the natural history of cervical cancer; no screening, conventional cytology, and HPV DNA testing were compared. Only direct costs were used. Outcomes comprise cervical cancer mortality, years of life saved, and lifetime costs. Dis counted incremental cost-effectiveness ratios were estimated and sensitivity analyses were conducted for key parameters. Results: Depending on the screening strategy a 69-81% mortality reduction might be expected. The HPV DNA tes ting every five years is a cost-effective strategy (Incremental Cost-Effectiveness Ratio (ICER): USD$44/YLS) if the cost per test is under USD$31. The effectiveness was sensitive to coverage and primarily to follow-up. Conclusions: HPV DNA testing is a cost-effective alternative for screening in Colombia. Not only high coverage but high follow-up rates are critical for successful screening programs.

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Liliana Chicaíza

Papers

Cost-effectiveness of conventional cytology and HPV DNA testing for cervical cancer screening in Colombia