Worldwide, more than half a million women are diagnosed with cervical cancer annually and more than 300,000 die from the disease. At least 85% of the deaths occur in low-middle income countries (LMICs)and almost 10% of them in Latin America (LATAM) and the Caribbean, where mortality rates are almost five times higher than in high-income areas.
Infection with high-risk subtypes of the Human Papillomavirus (HPV) is a necessary, but not sufficient cause of cervical cancer. The natural history of the disease involves persistent high-risk HPV infections, followed by the development of precancerous cervical lesions, and progression to invasive cervical cancer, in a process that usually occurs throughout many years. The long natural history of the disease provides a window of opportunity for secondary prevention with screening tests, which identify women infected with HPV or with cytologic abnormalities indicative of precancerous lesions. These lesions can be successfully treated when diagnosed early. Besides, the existence of a primary infectious etiologic agent allows for primary prevention with prophylactic HPV vaccines capable of reducing the incidence of causative infections. Thus, cervical cancer is considered a preventable and treatable disease, but, despite that, it continues to be the third cause of cancer in women in the region.
In May 2018, the World Health Organization (WHO) made a call to action for the global elimination of the disease as a public health problem. Elimination would occur when incidence rates scale down to less than four cases per 100,000 women and would be possible through a strategy comprising three goals to be achieved by 2030: 90% HPV vaccination coverage of girls by 15 years of age, 70% screening coverage with high-performance tests of women by ages 35 and 45, and adequate management and treatment of 90% of precancerous lesions and invasive cancers.
According to WHO's predictions, in LMICs and in most countries of Latin America, cervical cancer elimination is possible in the long term but will depend heavily on achieving the target for vaccination coverage.
In 2017, an article published on the status of HPV vaccination programs in LATAM and the Caribbean showed that, as of 2016, 22 countries offered the HPV vaccine in their public health systems. However, there was scarce information about the outcomes of these programs. In most countries for which data was available, vaccine uptake was below the expected. The article reported the main barriers to widespread HPV vaccination in the regions, such as limited general knowledge regarding cervical cancer prevention, concerns about safety, financial constraints, and cultural barriers. Finally, it highlighted the need for continued vigilance of the existing programs, making an alert that they may have the same fate as Pap screening programs, being underutilized by the population.
The main objective of this article collection is to update most recent HPV vaccination and screening strategies coverage statistics in the twenty sovereign states of LATAM (comprised of all of the Portuguese and Spanish speaking nations located to the south of the United States), to present local obstacles for cervical cancer control in the region and to discuss ideas to overcome them.
Manuscripts consisting solely of bioinformatics, computational analysis, or predictions of public databases which are not accompanied by validation (independent cohort or biological validation in vitro or in vivo) will not be accepted in any of the sections of Frontiers in Oncology.
Worldwide, more than half a million women are diagnosed with cervical cancer annually and more than 300,000 die from the disease. At least 85% of the deaths occur in low-middle income countries (LMICs)and almost 10% of them in Latin America (LATAM) and the Caribbean, where mortality rates are almost five times higher than in high-income areas.
Infection with high-risk subtypes of the Human Papillomavirus (HPV) is a necessary, but not sufficient cause of cervical cancer. The natural history of the disease involves persistent high-risk HPV infections, followed by the development of precancerous cervical lesions, and progression to invasive cervical cancer, in a process that usually occurs throughout many years. The long natural history of the disease provides a window of opportunity for secondary prevention with screening tests, which identify women infected with HPV or with cytologic abnormalities indicative of precancerous lesions. These lesions can be successfully treated when diagnosed early. Besides, the existence of a primary infectious etiologic agent allows for primary prevention with prophylactic HPV vaccines capable of reducing the incidence of causative infections. Thus, cervical cancer is considered a preventable and treatable disease, but, despite that, it continues to be the third cause of cancer in women in the region.
In May 2018, the World Health Organization (WHO) made a call to action for the global elimination of the disease as a public health problem. Elimination would occur when incidence rates scale down to less than four cases per 100,000 women and would be possible through a strategy comprising three goals to be achieved by 2030: 90% HPV vaccination coverage of girls by 15 years of age, 70% screening coverage with high-performance tests of women by ages 35 and 45, and adequate management and treatment of 90% of precancerous lesions and invasive cancers.
According to WHO's predictions, in LMICs and in most countries of Latin America, cervical cancer elimination is possible in the long term but will depend heavily on achieving the target for vaccination coverage.
In 2017, an article published on the status of HPV vaccination programs in LATAM and the Caribbean showed that, as of 2016, 22 countries offered the HPV vaccine in their public health systems. However, there was scarce information about the outcomes of these programs. In most countries for which data was available, vaccine uptake was below the expected. The article reported the main barriers to widespread HPV vaccination in the regions, such as limited general knowledge regarding cervical cancer prevention, concerns about safety, financial constraints, and cultural barriers. Finally, it highlighted the need for continued vigilance of the existing programs, making an alert that they may have the same fate as Pap screening programs, being underutilized by the population.
The main objective of this article collection is to update most recent HPV vaccination and screening strategies coverage statistics in the twenty sovereign states of LATAM (comprised of all of the Portuguese and Spanish speaking nations located to the south of the United States), to present local obstacles for cervical cancer control in the region and to discuss ideas to overcome them.
Manuscripts consisting solely of bioinformatics, computational analysis, or predictions of public databases which are not accompanied by validation (independent cohort or biological validation in vitro or in vivo) will not be accepted in any of the sections of Frontiers in Oncology.
