The path to elimination: FEBRASGO 2023's targeted strategies against cervical cancer in Brazil

Abstract

T he battle against cervical cancer in Brazil starkly mirrors the broader global health inequity, posing significant challenges to women's health worldwide. As the fourth most common cancer among women on a global scale, the prevalence of cervical cancer underscores the urgent need for enhanced prevention, detection, and treatment efforts. The World Health Organization (WHO) highlighted this imperative in 2018 when Director-General Dr. Tedros Adhanom Ghebreyesus issued a call to action for the elimination of cervical cancer as a public health concern-a call that was further amplified by a historic resolution by the WHO Member States in 2020, setting ambitious targets for 2030. (1,2) In Brazil, the urgency of this issue is underscored by an expected annual incidence of 17,010 new cases between 2023 and 2025, ranking it as the third most common cancer among Brazilian women. The significant health burden posed by cervical cancer is unevenly distributed across the country, necessitating tailored regional responses to effectively combat the disease. The established link between cervical cancer and infection with a high-risk oncogenic type of Human Papillomavirus (HPV) further highlights the critical importance of comprehensive vaccination and screening programs. (3)(4)(5) However, the challenges in the diagnosis and management of cervical cancer in Brazil are manifold. The average age of diagnosis is 48.7 years, with the majority of cases being advanced at presentation. Notably, the Southeast region reports fewer advanced cases compared to other regions, but more than half of the patients nationwide face treatment delays, contributing to a concerning early mortality rate. Despite a marginal decline in mortality rates from 2000 to 2015, the rates have since plateaued, indicating persistent obstacles in the prevention and management of the disease. (4) The situation is further complicated by the shortfall in HPV vaccination coverage in Brazil, which currently falls below the WHO's elimination goals for 2030. Although the HPV vaccine has been available for girls since 2014 and boys since 2017, vaccination coverage in Brazil has not reached the target of 90%. In 2023, coverage for girls in accumulated doses was 57.7% and for boys 27.4% considering the recommendation of a two-dose schedule in the age group 9 to 14 years. (6)