Primary screening with HPV test could save lives, prevent cervical cancer

High-level experts and public health advocates are meeting at the Pan American Health Organization/World Health Organization (PAHO/WHO) this week to identify ways of making testing for human papillomavirus (HPV) infection more widely available as a primary screening method for cervical cancer in Latin America and the Caribbean.

High-level meeting at PAHO/WHO will assess the possibility of making HPV testing widely available in screening and treatment programs in Latin America and the Caribbean

Washington, D.C., 13 May 2013 (PAHO/WHO) — High-level experts and public health advocates are meeting at the Pan American Health Organization/World Health Organization (PAHO/WHO) this week to identify ways of making testing for human papillomavirus (HPV) infection more widely available as a primary screening method for cervical cancer in Latin America and the Caribbean.

The meeting follows WHO's publication of new guidelines that recommend HPV testing in women ages 30-49 years, coupled with treatment of pre-cancerous lesions, as the preferred method for primary screening for cervical cancer. Experts say that better and more widely accessible screening and treatment for women in this at-risk age group could prevent many cervical cancer deaths in Latin America and the Caribbean, where the disease is often diagnosed at late stages and where more women have difficulty accessing treatment. Around 80% of the 36,000 women who died from cervical cancer in the Americas in 2012 were in Latin America or the Caribbean.

Of the more than 100 types of HPV, at least 14 are known to cause cancer. HPV tests detect HPV infection and are much more sensitive to the presence of abnormal cells than other screening tests.

"The evidence shows that this newer technology is better at detecting precancerous lesions and, when coupled with treatment, could save many women's lives," said Silvana Luciani, PAHO/WHO regional advisor on cancer prevention and control. "It also has the advantage that women can take their own samples at home without having to go to a health center, which helps overcome geographic and cultural barriers."

HPV tests also allow a longer interval between screening tests for women with negative results: women ages 30-49 with a negative HPV test can be re-screened every 5 to 10 years. "If it were possible to implement this test in screening and treatment programs, we could prevent many women from losing their lives, especially the poorest and those who have difficulty accessing health services," said Luciani.

To date, Argentina and Mexico are the only Latin American countries that have introduced HPV testing in their national public programs for cervical cancer control. Other countries, including Colombia, El Salvador, and St. Vincent and the Grenadines, are implementing the test on a pilot basis.

In the United States, an HPV test that had previously been approved for use in conjunction with the Pap smear received approval from the Food and Drug Administration (FDA) in late April for use alone in primary screening. The test can distinguish HPV 16 and 18 (which cause about 70% of cervical cancer cases) along with 12 other types of high-risk HPVs.

Until now, the limited availability and the high cost of HPV tests have been barriers to their wider use in Latin America and the Caribbean. In addition, some cervical cancer screening tests that are currently available can be difficult to carry out in low-income settings due to infrastructure limitations. At this week's meeting, organized by PAHO/WHO and the National Cancer Institute of the United States, participants will evaluate these and other barriers to effective cervical cancer screening and try to identify solutions for expanding access.

New WHO guidelines

The WHO guidelines for screening and treatment of precancerous lesions for cervical cancer prevention propose a comprehensive approach to prevention and control throughout the life course, starting with vaccination against HPV for girls ages 9-13, combined with screening for precancerous lesions in women over 30, followed with proper treatment.

The currently available screening tests are the (DNA-based) HPV test, visual inspection with acetic acid (VIAA) and the Pap smear (cytology).

The WHO group of experts who reviewed scientific evidence on available screening tests and the effectiveness of different treatment methods for precancerous lesions recommended four screening and treatment strategies. The preferred strategy, however, is HPV testing, followed by appropriate treatment.

The guidelines note that decisions about what strategy to use should be based on factors including cost, infrastructure requirements, available human and financial resources, benefits and harms for patients, availability and accessibility of health services, and effectiveness in reducing the number of patients lost to follow-up.

The guidelines recommend that all women ages 30-49 be screened for cervical cancer at least once. Screening can be appropriate for younger or older women depending on their risk of presenting precancerous lesions.

The new guidelines were published in English in late 2013 and in Spanish (translated by PAHO) in February of this year.

Facts about cervical cancer

• With an estimated 528,000 new cases each year worldwide, cervical cancer is the third most common cancer in women and the third-leading cause of cancer deaths in women.
• Some 266,000 women worldwide die of cervical cancer annually, more than 85% of them in low- and middle-income countries.
• In the Americas, more than 83,000 women were diagnosed with cervical cancer in 2012, and nearly 36,000 died, 80% of them in Latin America and the Caribbean.
• Death rates from cervical cancer are three times higher in Latin America and the Caribbean than in North America.
• Screening followed by treatment of precancerous lesions is a cost-effective prevention strategy.
• In most cases, and especially in younger women, HPV infections are transitory and resolve without any medical intervention. A small proportion of infections with certain types of HPV can persist and progress toward cancer.
• Early treatment can prevent over 80% of cervical cancer in developing countries.

PAHO, founded in 1902, is the oldest international public health organization in the world. It works with its member countries to improve the health and the quality of life of the people of the Americas. It serves as the Regional Office for the Americas of WHO and is part of the Inter-American system.

Links:

• PAHO information on cervical cancer
• WHO guidelines for screening and treatment of precancerous lesions for cervical cancer prevention
• Meeting: HPV Testing's Role in Reducing the Global Cervical Cancer Burden
• https://www.facebook.com/PAHONCDs
• https://twitter.com/pahowho #cancer #NCDs #women
  https://twitter.com/ncds_paho #cancer #NDCs #women

Media Contacts: