Control of cervical cancer in Peru: Current barriers and challenges for the future

Abstract

Cervical cancer is the leading malignant neoplasm in Peruvian women. This malignancy is a public health problem and several efforts were previously performed to develop cancer control plans. Geographical, cultural, structural, infrastructural and procedural barriers can limit the implementation of such strategies. Several previous studies have characterized human papilloma virus (HPV) epidemiology, where prevalence of high-risk HPV in adult females is ~12% and the prevalence in cervical cancer is 90–95%. The predominant barriers for the control of cervical cancer are lack of specialists in remote villages, education/cultural issues, loss of patients in follow-up, lack of access to HPV testing and lack of compliance for HPV vaccination. A good strategy for the prevention and early detection of high-risk HPV, pre-malignant neoplasms and cervical cancer, identified by interventional studies, is the self-sampling test, which assists with overcoming the cultural and geographic barriers. The current cancer control plan, termed ‘Plan Esperanza’, is performed with massive training of health professionals and social sensitization campaigns leading to filling the gaps regarding education and, in addition, it provides cancer care coverage for poorer individuals. In our experience at Oncosalud-AUNA, with a cohort of ~750,000 affiliates using a pre-paid system with annual screenings for cervical cancer for women, offered free-of-charge, a lower incidence of this malignancy (5.8/100,000) is now observed compared with the national incidence (32.7/100,000). As in other countries, the HPV vaccination can be a cost-utility strategy to reduce the high burdens of cervical cancer in Peru, a rapid and cheap HPV molecular sub-typification is rapidly required.

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“…The incidence of cervical cancer in Peru is double that seen in other South American countries and approximately 10 times the incidence rate in the United States. The prevalence of high‐risk human papillomavirus (HPV) in adult Peruvian women is equally high and ranges between 12% and 35% . The morbidity and mortality of impoverished women who develop invasive squamous cell carcinoma of the cervix in this resource‐poor setting are dismaying.…”

“…The morbidity and mortality of impoverished women who develop invasive squamous cell carcinoma of the cervix in this resource‐poor setting are dismaying. Unfortunately, there are several challenges for adequately controlling cervical cancer in Peru, including cultural and geographic barriers, a lack of education, a limited number of specialists in rural areas, the loss of women with abnormal Papanicolaou (Pap) tests to follow‐up, inadequate HPV vaccination, and no widespread HPV testing …”

“…Unfortunately, there are several challenges for adequately controlling cervical cancer in Peru, including cultural and geographic barriers, a lack of education, a limited number of specialists in rural areas, the loss of women with abnormal Papanicolaou (Pap) tests to follow-up, inadequate HPV vaccination, and no widespread HPV testing. 2,4,5…”