Academic journal article Bulletin of the World Health Organization

Cervical and Female Breast Cancers in the Americas: Current Situation and Opportunities for action/Cancer Du Col De L'uterus et Cancer Du Sein Sur le Continent Americain: Situation Actuelle et Actions envisagees/Cancer De Cuello Uterino Y De Mama En Las Americas: Situation En Actual Y Posibilidades De Actuacion

Academic journal article Bulletin of the World Health Organization

Cervical and Female Breast Cancers in the Americas: Current Situation and Opportunities for action/Cancer Du Col De L'uterus et Cancer Du Sein Sur le Continent Americain: Situation Actuelle et Actions envisagees/Cancer De Cuello Uterino Y De Mama En Las Americas: Situation En Actual Y Posibilidades De Actuacion

Article excerpt

Introduction

Cancer represents 30% of the burden posed by noncommunicable diseases in the Region of the Americas of the World Health Organization (WHO), where the leading causes of death have shifted from infectious diseases to noncommunicable diseases. (1) Changes in demographic, social, economic and environmental factors, as well as life course changes--for example, changes in reproductive patterns--have contributed greatly to this epidemiological shift. (2)

Breast and cervical cancers are generally considered to be the most important cancers among women in the Americas, as they are among women worldwide. (3) Globally, breast cancer incidence and mortality have increased over the past 30 years, at estimated annual rates of 3.1% and 1.8%, respectively. Over the same period, cervical cancer incidence and mortality have also increased, at estimated annual rates of 0.6% and 0.46%, respectively. (4) The corresponding trends in the Americas have generally matched these global trends. (5)

These increases have occurred even though effective, population-based interventions are available for the control of breast and cervical cancers and the prevention of unnecessary deaths from these cancers. For cervical cancer, these interventions include vaccination against human papillomavirus (HPV) infection, screening based on cervical cytology, visual inspection of the cervix after applying acetic acid and testing for HPV DNA, and effective treatment for precancerous lesions and invasive cancer. (6) WHO currently recommends the routine administration of HPV vaccine to girls--as part of a country's national immunization programme--if cervical cancer is a public health priority in the country and if such HPV vaccination is programmatically feasible and sustainable and appears to be cost-effective in the country. (7) If it is systematically applied with high coverage and quality assurance, cytological screening can reduce cervical cancer mortality by more than 50%. (8) For breast cancer, the disease can be detected in its early stages through breast self-examination, clinical breast examination and mammography screening. The effectiveness of these strategies has been found to vary according to the resources available and the needs of the population involved. (9) In general, however, mammography screening has led to a substantial reduction--estimated to be about 15%--in breast cancer mortality. (10)

The implementation of technologies that could reduce mortality from breast and cervical cancers continues to be a challenge in resource-constrained settings such as those often seen in the Caribbean and Latin America. This is especially true where several public health priorities compete for attention.

To assess the burden posed by breast and cervical cancers in the Americas and to understand the associated public health response, we reviewed the information on these cancers provided to the Pan American Health Organization (PAHO) by the relevant National Institutes of Vital Statistics and health ministry officials. We reviewed the temporal trends in mortality from breast and cervical cancers since 2000 and the results of a recent survey on the capacity of national programmes to prevent, screen for and treat noncommunicable diseases.

Methods

We extracted data--on mortality from breast and cervical cancers--from the PAHO Regional Mortality Database, which includes deaths that have been registered in national vital registration systems and reported annually to PAHO. (11) The quality of the data from each country was evaluated by verifying the integrity and consistency of the data and validating selected variables (i.e. sex, age and underlying cause of death). An algorithm to correct for under-registration and ill-defined causes was applied to the data from countries that show more than 10% under-registration, more than 10% of deaths with an ill-defined cause, or both. (12) For each of the 33 countries in WHO's Region of the Americas with complete data, we included data from 2000 to the last year with reported data. …

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