Cervical Cancer in Women with HIV in Latin America and the Caribbean: Update and Steps Towards Elimination
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Cervical Cancer in Women with HIV in Latin America and the Caribbean: Update and Steps Towards Elimination. (2022). [Fact sheets]. PAHO. https://iris.paho.org/handle/10665.2/55706
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English; 11 pages
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2022
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PAHO/CDE/HT/21-0018
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This fact sheet is based on a systematic review of the literature on HPV and cervical cancer epidemiology, and a survey on policies and practices related to the prevention and control of cervical cancer among women living with HIV (WLHIV) to PAHO Member States. It details scorecards on the advances of countries against WHO recommendations and international commitments for cervical cancer prevention and control among WLHIV.
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Item Investigating under-reported human papillomavirus genotypes in Grenadian women through self-sampling for cervical cancer screening(2024)[ABSTRACT]. Objective. To compare the adequacy, agreement, and acceptability of Papanicolaou testing (cytology) for cervical cancer screening using self-collected samples compared to physician-collected samples in Grenada in the Caribbean. Furthermore, the study identifies the human papillomavirus (HPV) genotypes present among asymptomatic women testing positive for HPV, the etiologic cause of cervical cancer. Methods. Participants were divided into two groups and two cervical samples were collected from the women in each group: a self-collected sample and a physician-collected sample. Cervical specimens were tested for cytology and HPV. HPV genotyping was performed on positive specimens. Results. Self-collected samples were adequate and in agreement with physician-collected samples, showing no difference between the two sampling methods. Oncogenic high-risk HPV genotypes were identified in cervical samples which were positive for atypical squamous cells and low-grade squamous intraepithelial lesions. The high-risk HPV genotypes found, notably HPV 45 and 53, differed from those most commonly reported. Although the commonly reported high-risk genotypes HPV 16 and 18 were found, so were 31, 33, 35, 52, 66, 68, and 82. Conclusions. Using self-collection facilitated the discovery of unexpected HPV genotypes among asymptomatic women in Grenada. These findings add new information to the literature regarding cervical cancer and neoplasia screening and HPV genotypes in the Caribbean. This genotype information may impact surveillance of women with low-grade lesions, HPV vaccine selection, and possibly further vaccine research. Research regarding HPV in Caribbean pathology samples of cervical neoplasia and cancer is needed.Item Síntesis de evidencia y recomendaciones: directriz para el tamizaje, la detección y el tratamiento del cáncer de cuello uterino(2023)[RESUMEN]. Objetivos. Sintetizar las recomendaciones desarrolladas por la Organización Mundial de la Salud (OMS) con el fin de mejorar la calidad del cuidado y los desenlaces en salud sobre el tamizaje y tratamiento de las muje- res con lesiones precancerosas para la prevención del cáncer de cuello uterino. Métodos. Las directrices elaboradas por la OMS siguen los métodos de elaboración de la directriz GRADE (Grading of Recommendations Assessment Development and Evaluation) del Manual para el desarrollo de directrices de la OMS. Se llevó a cabo una síntesis de las recomendaciones de dos directrices de OMS. Adicionalmente, se realizó una búsqueda sistemática en PubMed, Lilacs, Health Systems Evidence, Epistemo- nikos y literatura gris de estudios desarrollados en las Américas con el fin de identificar barreras, facilitadores, estrategias de implementación e indicadores. Resultados. Se formularon 19 recomendaciones y 10 puntos de buena práctica para el tamizaje de lesiones precancerosas del cuello del útero y el tratamiento del cáncer de cuello uterino. Se identificaron barreras y facilitadores para la implementación y se crearon indicadores de adherencia y resultado. Conclusiones. Las recomendaciones formuladas proveen orientación para mejorar la calidad del cuidado y los desenlaces en salud sobre el tamizaje y tratamiento de las mujeres con lesiones precancerosas para la prevención del cáncer de cuello uterino, con consideraciones para su implementación en América Latina y el Caribe.Item High frequency of HPV high-risk preventable genotypes in Ecuadorian women with invasive cervical cancer(2024-12-04)[ABSTRACT]. Objective. To determine the distribution of human papillomavirus (HPV) genotypes in invasive cervical cancer samples from Ecuadorian women who attended the Cancer Institute (Sociedad de Lucha Contra el Cáncer – SOLCA). Methods. Archived formalin-fixed paraffin-embedded (FFPE) cervical cancer tissue samples collected during 2017–2021 were deparaffinized, and nucleic acid extraction and purification was performed using silica columns. The obtained nucleic acids were analyzed using INNO-LiPA® HPV Genotyping Extra II per the manufacturer’s specifications. Data were retrieved from records, and HPV genotypes were determined from the FFPE samples. Results. The study included samples from 190 women diagnosed with invasive cervical cancer, with a median age of 52.78 years. Squamous cell carcinoma accounted for 78.94% of the cases, while 21.05% had adenocarcinoma. Among the 190 samples, 80.53% tested positive for HPV DNA, while 19.47% were negative. The most common genotypes detected were HPV 16 (64.05%), 18 (16.99%), and 58 (6.54%). HPV infection frequency was higher in samples from patients with elementary level education (p < 0.05). Conclusions. This study provides valuable insights into the distribution of HPV genotypes in invasive cervical cancer samples from Ecuadorian women. The results indicate an elevated presence of HPV 16, HPV 18, and HPV 58, which are vaccine-preventable genotypes.Item Controle do câncer do colo do útero na atenção primária à saúde em países sul-americanos: revisão sistemática(2022)[RESUMO]. Objetivo. Descrever as estratégias para prevenção e controle do câncer do colo do útero (CCU) na atenção primária à saúde (APS) na América do Sul. Métodos. Revisão de literatura em duas etapas: revisão documental em sites governamentais de Argentina, Bolívia, Brasil, Chile, Colômbia, Equador, Paraguai, Peru, Uruguai e Venezuela; e revisão sistemática da literatura nas bases LILACS, MEDLINE, Scopus, SciELO e Science Direct. Resultados. Foram incluídos 21 documentos institucionais (planos, guias de prática e diretrizes nacionais) e 25 artigos. Todos os países tinham taxas elevadas de morbimortalidade por CCU. Predominou o rastreamento oportunístico na APS, embora os documentos disponíveis sinalizassem intenções e estratégias para diagnóstico precoce e acompanhamento longitudinal dos casos suspeitos e confirmados, preferencialmente na rede pública. Todos os países adotavam uma concepção abrangente de APS, embora o processo de implementação estivesse em estágios heterogêneos e predominassem a focalização e a seletividade. Destaca- se pior acesso ao rastreamento para mulheres de regiões rurais ou remotas e para povos originários. A indisponibilidade de serviços de APS próximos às residências/comunidade foi uma importante barreira para o rastreamento do CCU. Conclusões. A fragmentação dos sistemas de saúde e a segmentação na oferta de serviços são obstáculos para a prevenção e o controle do CCU na América do Sul. São necessários programas organizados de rastreamento do CCU e a incorporação de busca ativa para realização do Papanicolaou via APS. A interculturalidade nas práticas e a formulação de políticas numa perspectiva interseccional são fundamentais para superar as iniquidades no controle do CCU nos países sul-americanos.Item Global Cervical Cancer Elimination Forum: Advancing the call to action. Cartagena de Indias, Colombia, 5–7 March 2024. Executive summary(PAHO, 2024-12-11)The Global Cervical Cancer Elimination Forum, held in Cartagena de Indias, Colombia, 5–7 March 2024, marked a significant milestone in global collaboration for women’s health to advocate for greater commitments for cervical cancer elimination. The Forum was co-hosted by the governments of Colombia and Spain, the Spanish Agency for International Development Cooperation (AECID), Bill & Melinda Gates Foundation, Gavi, Global Financing Facility, UNICEF, Unitaid, United States Agency for International Development (USAID), World Bank, and Pan American Health Organization/World Health Organization (PAHO/WHO). It gathered approximately 302 representatives from governments, civil society, and international organizations from around 54 countries, showcasing the collective commitment toward eliminating cervical cancer as a public health concern. The Forum reinforced the Global Strategy to Accelerate the Elimination of Cervical Cancer as a Public Health Problem, which entails 90% of girls fully vaccinated with human papillomavirus (HPV) vaccine by age 15 years, 70% of women screened with a high-performance test by 35 years of age and again by 45 years of age, and 90% of women identified with cervical disease received treatment (known as the 90–70–90 targets). The Forum concluded with a strong call to action to intensify global and national efforts in the fight against cervical cancer. It is imperative that these commitments lead to concrete and sustainable actions that ensure universal access to vaccination, early detection, and effective treatment. The importance of continuing to build strategic alliances and ensuring sustained commitment from all stakeholders to achieve the goals set for 2030 was underscored. The need to focus on equity, innovation, access, and quality of healthcare services was emphasized as essential to overcoming this public health challenge. The international collaboration and renewed commitment from participants underline the genuine possibility of eliminating cervical cancer as a public health issue. This Forum served not only to highlight existing challenges but also to mobilize global actors toward joint action, emphasizing that effective prevention and treatment are fundamental rights of all women. The call for action to all countries and organizations to continue working together, sharing resources, knowledge, and successful experiences was emphasized as essential to overcome pending challenges and achieve the goals set for 2030.