On 31 July and 1 August 2018, cervical cancer experts and representatives of the Ministries of Health from Latin America met to discuss and share experiences on introducing the human papillomavirus (HPV) test in cervical cancer screening programs. The meeting was held at the headquarters of the Pan American Health Organization/World Health Organization (PAHO/WHO) in Washington, D.C., and was cosponsored by PAHO, PATH, and the International Agency for Research on Cancer (IARC).At the meeting, experiences in countries of the Region in which the HPV test has already been incorporated in screening programs were shared. Based on the lessons learned from these countries, the participants identified a set of strategies for using the HPV test, to increase coverage and treatment rates, and to improve the effectiveness of cervical cancer screening programs. Finally, participants worked on a joint agenda for promoting the implementation of HPV testing-based screening programs in Latin America.
The World Health Organization recommends HPV testing for cervical cancer screening, as it is more sensitive and detects HPV infection before precancerous lesions appear, thus providing more opportunities for early treatment. It also allows for the women to collect their own sample (self-sampling), a strategy that has been proven effective in increasing women's acceptance of cervical cancer screening, thereby reducing barriers to access.
Despite the majority of countries in the Americas continue to rely on cytology as the preferred cervical cancer screening method, the meeting served to support the idea that incorporating the HPV test in Latin American cervical cancer screening programs is feasible. However, the test must be introduced as part of an organized program that provides adequate coverage and monitoring, along with high quality services. This requires communication efforts to ensure that patients are properly informed. Evidence-based guidelines that consider the characteristics of this test are also needed, and qualified health workers must adhere to these guidelines. Lastly, there need to be referral mechanisms to ensure access to treatment, whether by adopting a screen-and-treat strategy or by adding a diagnostic step between screening and treatment.
In 11 countries of the Region of the Americas, cervical cancer remains the leading cause of cancer deaths among women. Strengthening screening programs and providing appropriate treatment for precancerous lesions are key to reducing mortality from this disease. The HPV screening test offers an excellent opportunity to improve the effectiveness of cervical cancer screening programs. The results of this meeting will support the introduction of HPV testing in Latin America.
- Integrating HPV Testing in Cervical Cancer Screening Programs: a manual for program managers (PAHO)
- Comprehensive cervical cancer control: A guide to essential practice (WHO)
- Cervical cancer treatment planning tool that I presented during the meeting is available here, along with some supporting materials (PATH)
- Guidelines for Organizing a Quality Assurance Program for Introduction and Routine Use of careHPV in Low-Resource Settings (PATH)
- Statistical Modeling for Quality Assurance of Human Papillomavirus DNA Batch Testing
The presentations are available only in Spanish http://bit.ly/2MtRjyW
More photos available at