Challenges

Eleven per cent of deaths from cervical cancer worldwide occur in Latin America (over 28,000 deaths per year), where it is the second most commonly diagnosed tumour among women. Seventy per cent of deaths in Latin America occur in South America, a region where the countries with the highest mortality are concentrated (20,000 deaths/year; Source: IARC’s Globocan 2012).

Cervical cancer is an eradicable disease. This is why health authorities in Latin America should be committed to decreasing the incidence and preventing unnecessary deaths from the disease in the region and support the achievement of SDG Target 3.4.

A survey conducted by the network of Latin American National Cancer Institutes and Institutions (RINC) in several countries of the region showed considerable heterogeneity in terms of organized programmes, technologies used and target populations. However, these programmes are also characterized by precarious coverage, low quality and limited provision of the services involved. In general, countries face problems related to access to screening, with long waiting lists, low target population coverage, limited screening of low-risk young women and lack of diagnosis and treatment of cases that test positive.

Toward a Solution

In recent decades, as a result of scientific and technological advances, the human papillomavirus (HPV) vaccine has emerged as a primary prevention strategy, HPV testing as a secondary prevention strategy and the emergence of other low-cost technologies, particularly visual inspection with acetic acid or Lugol’s iodine. These technologies are particularly suitable for areas and populations with very limited access to health services.

The availability of this technology offers Latin America an opportunity to eliminate cervical cancer in the region. In this regard, the South American Health Council (SAHC) of the Union of South American Nations (UNASUR) worked with RINC to develop a five-year technical assistance plan for countries in the region with support from the South American Institute of Government in Health (ISAGS), to curb growth in new cases and prevent avoidable deaths from cervical cancer in the region. The Plan was developed under a mandate from UNASUR’s Board of Ministers of Health, with funds from the UNASUR Common Initiatives Fund. The Plan was designed in 2016 and 2017 by experts from the region, in collaboration with the International Agency for Research on Cancer (IARC), PAHO/WHO, the Union for International Cancer Control (UICC) and other leading regional and international institutions.

It focuses on the cross-country transfer of good practices regarding nine components that form the priority work areas developed to achieve the objectives of screening, diagnosis and treatment of precancerous lesions and cancer and vaccination of girls against HPV. A web-based technological platform for technical assistance (PlaTeAT) is being created to support and strengthen the activities proposed under each of the nine components. This tool seeks to improve professional practices, quality of data and access to information, encouraging constant exchange between all individuals involved in the health system including policymakers, doctors, coordinators and health workers.

The Plan has led to bilateral agreements, such as the one between two RINC member states, Argentina and the Plurinational State of Bolivia. It has also been recognized by PAHO as an important and strategic tool in the context of its own Plan of Action for Cervical Cancer Prevention and Control 2018-2030, launched in May 2018.

Additional achievements of the RINC include: establishing 16 biobanks with samples of tumour tissue for research purposes in 19 Latin American countries; inaugurating the Latin American Hub for Cancer Registries in collaboration with IARC/WHO; and creating the Cervical Cancer Control Working Group, with representatives from screening programmes across the region. This Group has been responsible for developing the basis for the RINC Regional Plan and, since its inception, has been committed to sharing knowledge and strategies. As a result of the Plan and the Working Group, quality control standards for cytology laboratories were created in 2017.

RINC maintained a close relationship with the UNASUR entities, thereby ensuring political and financial support, and with a network of specialists from Latin American countries, including groups organized by specialty, which allowed regular consultations during the participatory working process. Their contributions were essential in terms of achieving consensus at all stages of preparing the document, from analysing the current status of cervical cancer and the programmes and services in each country, to approving the actions proposed in the Plan. These aspects will also ensure the Plan’s long-term sustainability and increase the opportunity to expand its scope by collaborating with international organizations, aiming to achieve a Latin American region that is truly free from cervical cancer.

Implementing the Regional Technical Assistance Plan on Cervical Cancer Control is a complex challenge, given its multi-programmatic approach and, consequently, the need exists to involve and cooperate with Member States from the region with different health systems and levels of development. The first step involved the development, by IBM in partnership with Brazil’s Cancer Foundation (Fundação do Câncer), of a technological platform for technical assistance – the core of the initiative is to monitor, articulate and strengthen the activities proposed under each of the nine components related to screening programmes.