Call to Eliminate Cervical Cancer in the Next Decade with a Focus on Brazil

Primo, Walquíria Quida Salles Pereira; Speck, Neila Maria de Góis; Roteli-Martins, Cecília Maria; Fernandes, César Eduardo; Filho, Agnaldo Lopes da Silva

doi:10.1055/s-0041-1722939

Cited by 5 publications

(7 citation statements)

References 4 publications

(2 reference statements)

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“…Although HPV detection tests have not yet been incorporated into SUS, recommendations to guide professionals working in scenarios in which these tests are available have already been published, so they can be used based on scientific evidence and according to best practices (32). Additionally, studies investigating the molecular approach shift in CC screening in the Brazilian context have been conducted and published (33)(34)(35)(36)(37).…”

Section: Cervical Cancer Screeningmentioning

confidence: 99%

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Cervical cancer screening, treatment and prophylaxis in Brazil: Current and future perspectives for cervical cancer elimination

et al. 2022

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As a middle-income country, Brazil has one of the largest public health systems worldwide, which deals with free and universal access to health care. Regarding cervical cancer, the country possesses a large infrastructure for the screening of premalignant and malignant lesions, but yet based on old technology, having Papanicolaou as the major screening method, followed by colposcopy and treatment. Also, large disparities in access are present, which makes effectiveness of screening and treatment in different regions of the country highly unequal. In this review, we describe and evaluate the current screening, treatment and prophylactic (HPV vaccination) strategies to combat cervical cancer in Brazil, and discuss potential incorporation of more recent technologies in these areas in the country to pave its way toward cervical cancer elimination.

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Section: Cervical Cancer Screeningmentioning

confidence: 99%

“…In Brazil, there are some pilot experiences with new screening methods and better organization of screening ( 33 – 37 , 43 ). Since 2012 an organized CC screening has been established in the interior of the State of São Paulo (18 municipalities in Barreto's region) ( 43 ).…”

Section: Cervical Cancer Mitigation Through Vaccination Screening And...mentioning

confidence: 99%

Cervical cancer screening, treatment and prophylaxis in Brazil: Current and future perspectives for cervical cancer elimination

et al. 2022

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“…While high-grade results confer high precancer risks, the most common cytologic abnormalities are equivocal and low grade which, although usually associated with transient HPV infection or other benign cervical changes, are managed with repeated inefficient testing. Within Brazil, researchers have accumulated evidence demonstrating challenges organizing the current cytology-based screening program, indicating a need for change (3,(17)(18)(19)(20)(21). Over the next decades as vaccinated girls age into adulthood these programs will be less cost effective because abnormal cytology results will confer even lower risk of precancer [lower positive predictive value (PPV)] ( 22).…”

Section: Screeningmentioning

confidence: 99%

“…Numerous resources have been created to assist health planners worldwide with introducing and scaling up HPV testing for cervical cancer screening programs (48,52). Figure 4 outlines some of the key steps for Brazil at the 21,53,54). Unfortunately, due to the pandemic's enormous socioeconomic consequences, most steps to prevent cervical cancer have slowed down and goals have been delayed.…”

Section: Next Stepsmentioning

confidence: 99%

Rethinking Cervical Cancer Screening in Brazil Post COVID-19: A Global Opportunity to Adopt Higher Impact Strategies

Ribeiro

Corrêa

Migowski

et al. 2021

Cancer Prevention Research

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The World Health Organization global call to eliminate cervical cancer encourages countries to consider introducing or improving cervical cancer screening programs. Brazil's Unified Health System (SUS) is among the world's largest public health systems offering free cytology testing, follow-up colposcopy, and treatment. Yet, health care networks across the country have unequal infrastructure, human resources, equipment, and supplies resulting in uneven program performance and large disparities in cervical cancer incidence and mortality. An effective screening program needs multiple strategies feasible for each community's reality, facilitating coverage and follow-up adherence. Prioritizing those at highest risk with tests that better stratify risk will limit inefficiencies, improving program impact across different resource settings. Highly sensitive human papillomavirus (HPV)-DNA testing performs better than cytology and, with self-collection closer to homes and workplaces, improves access, even in remote regions. Molecular triage strategies like HPV genotyping can identify from the same self-collected sample, those at highest risk requiring follow-up. If proven acceptable, affordable, cost-effective, and efficient in the Brazilian context, these strategies would increase coverage while removing the need for speculum exams for routine screening and reducing follow-up visits. SUS could implement a nationwide organized program that accommodates heterogenous settings across Brazil, informing a variety of screening programs worldwide.

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“…70 women with high-grade cytology results showed challenges attending colposcopy, taking biopsies, and receiving treatment; resulting in fewer than half of the women treated. HPV vaccination coverage in the Amazonas has believed to be inadequate with declines after initial introduction in 2014 [17]. However, it is likely that calculations of annual coverage underestimate the overall vaccine protection because vaccinations over previous years were not aggregated [14].…”

Section: Plos Onementioning

confidence: 99%

Moving towards a strategy to accelerate cervical cancer elimination in a high-burden city—Lessons learned from the Amazon city of Manaus, Brazil

Torres

Rondon

Martins³

et al. 2021

PLoS ONE

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The World Health Organization Call to Eliminate Cervical Cancer resonates in cities like Manaus, Brazil, where the burden is among the world’s highest. Manaus has offered free cytology-based screening since 1990 and HPV immunization since 2013, but the public system is constrained by many challenges and performance is not well-defined. We obtained cervical cancer prevention activities within Manaus public health records for 2019 to evaluate immunization and screening coverage, screening by region and neighborhood, and the annual Pink October screening campaign. We estimated that among girls and boys age 14–18, 85.9% and 64.9% had 1+ doses of HPV vaccine, higher than rates for age 9–13 (73.4% and 43.3%, respectively). Of the 90,209 cytology tests performed, 24.9% were outside the target age and the remaining 72,230 corresponded to 40.1% of the target population (one-third of women age 25–64). The East zone had highest screening coverage (49.1%), highest high-grade cytology rate (2.5%) and lowest estimated cancers (38.1/100,000) compared with the South zone (32.9%, 1.8% and 48.5/100,000, respectively). Largest neighborhoods had fewer per capita screening locations, resulting in lower coverage. During October, some clinics successfully achieved higher screening volumes and high-grade cytology rates (up to 15.4%). Although we found evidence of some follow-up within 10 months post-screening for 51/70 women (72.9%) with high-grade or worse cytology, only 18 had complete work-up confirmed. Manaus has successfully initiated HPV vaccination, forecasting substantial cervical cancer reductions by 2050. With concerted efforts during campaigns, some clinics improved screening coverage and reached high-risk women. Screening campaigns in community locations in high-risk neighborhoods using self-collected HPV testing can achieve widespread coverage. Simplifying triage and treatment with fewer visits closer to communities would greatly improve follow-up and program effectiveness. Achieving WHO Cervical Cancer Elimination goals in high-burden cities will require major reforms for screening and simpler follow-up and treatment.

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Call to Eliminate Cervical Cancer in the Next Decade with a Focus on Brazil

Cited by 5 publications

References 4 publications

Cervical cancer screening, treatment and prophylaxis in Brazil: Current and future perspectives for cervical cancer elimination

Cervical cancer screening, treatment and prophylaxis in Brazil: Current and future perspectives for cervical cancer elimination

Rethinking Cervical Cancer Screening in Brazil Post COVID-19: A Global Opportunity to Adopt Higher Impact Strategies

Moving towards a strategy to accelerate cervical cancer elimination in a high-burden city—Lessons learned from the Amazon city of Manaus, Brazil

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