PAHO-CDC Collaboration in CancerPAHO-CDC Collaboration in Cancer: Supporting PAHO's 7-Point Plan of Action for Cervical Cancer Prevention and Control, Including Strengthening Cancer Registries
Report of Meeting between PAHO, CDC, and Selected Latin American and Caribbean (LAC) Countries (Atlanta, GA, USA, 29-30 April 2009)

Representatives from country cervical cancer program managers and cancer registry personnel from four countries (Barbados, Bolivia, Guatemala, Trinidad & Tobago) met with staff from PAHO and staff from several divisions within CDC: Cancer, STDs, Immunization, HPV laboratory. The purpose was to discuss collaborative activities to support countries with their cervical cancer programs and cancer registries.

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This activity was programmed as part of the PAHO-CDC cooperative agreement on chronic disease and was a prelude to country missions to assess and evaluate programmatic needs.

The meeting objectives were to familiarize CDC staff with the PAHO and Member States' priorities, plans and needs for support with regards to cervical cancer and cancer registration and to brief participants on CDC's capacity to assist Member States to address these needs.

Cancer is the second leading cause of death in Latin America and the Caribbean (LAC) with an estimated 480,000 deaths from cancer in 2002 in this region (Ferlay J, Bray F, Pisani P, Parkin DM. GLOBOCAN 2002: Cancer incidence, mortality and prevalence worldwide. IARC CancerBase No. 5, Version 2.0. Lyon, France: IARCPress; 2004). Among women, cervical cancer is one of the most commonly occurring cancers and is a leading cause of cancer death in the majority of countries in the Region (Ferlay et al. 2004). Despite the availability of cancer services and cervical cancer screening programs, most countries lack capacity to effectively screen for and prevent cervical cancer. In a 2005 national capacity survey conducted by PAHO, only 50% of the responding Ministries of Health reported having a cancer program and budget line for cancer. All countries in the Americas reported having cervical cancer screening services, yet screening coverage is assessed to be less than 50% of the population in the majority of these programs (PAHO, 2005). Many countries have cancer registries, however most are hospital based and the quality and completeness of data is often poor.

In recognition of the country needs to improve cancer control, and cervical cancer prevention in particular, and cognizant of the wealth of expertise and resources available in the U.S. Centers for Disease Control and Prevention (CDC) and the Pan American Health Organization (PAHO), these two organizations have embarked on a collaborative effort to assist country cancer programs. This collaboration is in the context of a broader PAHO-CDC cooperative agreement for chronic diseases and health promotion.

A first meeting of PAHO-CDC and selected LAC countries was convened in Atlanta, Georgia, USA on 29—30 April 2009 to share information, discuss and plan the types of collaborative activities which could be undertaken to support cervical cancer prevention programs, including HPV vaccine introduction and cancer registries (see Appendix for meeting agenda). In addition to participants from PAHO, representatives from several divisions of CDC attended the meeting, including the Divisions of Cancer Prevention and Control, Sexually Transmitted Infections, Global Immunization, and the HPV Laboratory. From LAC countries, cervical cancer program managers and cancer registry managers from Barbados, Bolivia, Guatemala, and Trinidad & Tobago participated in the meeting. These countries were selected on the basis of expressed need and desire to engage in the PAHO-CDC collaboration in cancer and also to ensure a balance of representation from the Caribbean sub-region, Central America subregion and South America.

Regional Plan, Cervical CancerA brief background on PAHO's work in cancer, the Regional Strategy and Plan of Action for Cervical Cancer Prevention and Control, and the ProVAC initiative were presented. Member States at the meeting provided a situation briefing on their cervical cancer programs, including HPV vaccine introduction and cancer registries and identified key areas in which they require support. CDC staff presented their various initiatives and showcased an array of programs, research studies, laboratory capacity, cancer registry tools, HPV vaccine policy and program monitoring systems. This was a tremendous opportunity to identify how CDC can partner with PAHO to provide technical assistance and provision of advice and guidance to Member States in cervical cancer control activities, cancer registration and HPV vaccine introduction.

Country needs for technical assistance, according to the PAHO 7-point plan of action for cervical cancer were identified during the meeting. A workplan was developed for joint activities which would be feasible to implement in the next year within the context of the PAHO-CDC cooperative agreement (#5U58DP3248A3-04). All four countries identified the conduct of needs assessment/program evaluations, national workshops with key stakeholders for advocacy and awareness raising, and support to improve cancer registration as priority activities. All four countries expressed interest to participate in the ProVAC initiative and to receive policy advice and guidance with regards to HPV vaccine implementation. In addition, each country proposed specific requests for assistance in the areas of cancer registration, operational research, and training. We agreed that, by December 2009 visits to two countries would take place by a team from PAHO-CDC to participate in national advocacy meetings and to conduct rapid program assessments; and that visits for the same purpose would be organized in two more countries in 2010, the selection of which would be determined at a later date, and depend on resources available and other practical issues. The group will continue to communicate regularly, and hold virtual meetings, to plan out the country visits and define in more detail the purpose, agenda and timing of the country visits.