Control and prevention in cervical cancer

Abstract

Cervical cancer (CC) remains one of the most frequent types of neoplasia and in developing countries is the second most common cause of reported cases, after breast cancer. In Mexico, improvements have been made in defining and perfecting public policies related to this disease and, more importantly, innovative strategies aimed at increasing primary and secondary prevention have been implemented. Beginning in 1974, annual cervical cytology with referral to colposcopy was used for diagnosis and control of CC. In 1994 a histopathological registry was created, in 1996 a cancer information system set up and in 1998 the program transitioned to triennial cytology testing in women with two previous consecutive negative results. In 2007 HPV vaccination began for girls 9-12 years, and the high-risk HPV test (hrHPV) was incorporated as the primary screening test for women 35-64 years. Since 2008, regional molecular biology laboratories for hrHPV test analysis were set up, and 23 out of the 32 states currently have such a laboratory. Extending vaccination programs to include women up to 30 years old (and in some cases up to 45-50 years old) and performing at least one hrHPV test on women =30 years old has been proposed. Introduction of an alternative 2-dose HPV vaccination scheme with a periodicity of 6-12 months between doses is recommended for women younger than 15 years old. To improve the results of CC detection programs, it is necessary to: employ appropriate and timely triage alternatives for hrHPV-positive patients, professionalize healthcare personnel and guarantee the quality of program processes, increase screening coverage of the hrHPV test, improve information systems and use a combination of vaccination and screening to accelerate the reduction in the burden of disease associated with CC.