Cervical Cancer Control in Latin America

GCI collaborators recently published an extensive review article “Cervical Cancer Control in Latin America: A Call to Action,” led by Dr. Brittany Bychkovsky. The paper outlined the current state of HPV vaccination and cervical cancer screening in Latin America, and noted the challenges of a successful campaign against cervical cancer throughout the region.

Here are some key facts from the paper:

• Human papillomavirus (HPV) is the most common sexually transmitted infection worldwide
• HPV is associated with the majority of cervical cancers
• 88% of cervical cancer deaths occur in low- and middle-income countries (LMICs)
• Cervical cancer is the second most common cause of cancer-related deaths among women in Latin America
• Deaths from cervical cancer are 100% preventable by vaccination and screening
• <55% of eligible women in Latin America received a recent Pap test
• Although 80% of young girls in Latin America live in countries with an HPV immunization program, the majority of girls lack access to receive and complete the vaccine series

The paper concluded with a call to action to improve cervical cancer control throughout Latin America.‍

Dr. Bychkovsky and her team put forth some possible strategies for controlling cervical cancer in Latin America moving forward:

1. Primary prevention (HPV vaccination):‍

The Pan American Health Organization (PAHO) recommends that HPV vaccination be introduced only if the immunization program is public, targets the whole country, and gradually increases its rates to achieve high coverage. The most important factors to consider include:

• ‍Coverage: The incidence of cervical cancer will be reduced if vaccination coverage is high (>70%).
• Cost: The HPV vaccine should be procured at reduced rates so the program may be cost-effective for the LMICs of Latin America.
• Target population: All vaccination plans in Latin America recommend vaccinating preadolescent girls between 9 and 12 years of age.
• Dose: PAHO and WHO recommend introducing the vaccine on a 3-dose or 2-dose schedule (studies have shown that the 2-dose will likely become the new standard in Latin America.)
• Administration: Vaccination programs will be most successful if integrated into schools.
• Monitoring: Programs must be monitored to ensure efficacy, efficiency, and cost-effectiveness.

2. Secondary prevention (screening): In addition to HPV vaccination, screening will remain essential because it can take decades for HPV vaccination to have substantial effects on cervical cancer incidence. The team put forth some strategies for optimal screening practices:

• ‍Novel approaches: Mobile HPV screening programs, like one implemented in Panama, are effective in reducing cervical cancer incidence and are able to reach the most underserved  communities.
• HPV-DNA testing: This has proven to be effective as a stand-alone test for screening, and allows self-sampling, which increases participation rates among women in Latin America.
• Visual inspection with acetic acid (VIA): This has been proven to be an effective screening tool in low-resource areas and can reduce cervical cancer mortality by over 30%.

3. Further management:

• ‍Patient education: Educational initiatives are essential for increasing awareness, especially among disenfranchised and rural populations. This can be done through media campaigns, or through the use of patient navigation programs (PNPs).
• Patient navigators: PNPs not only help increase awareness and education on cervical cancer prevention, but they also help assist positively screened women with accessing timely follow-up care and health resources.