Cervical cancer screening programs in Latin America: current recommendations for facing elimination challenges

Abstract

Objective. To describe current cervical cancer screening program guidelines in Latin America. Materials and methods. We searched official recommendations for the general population and women living with HIV (WLHIV) by reviewing official sources from 19 countries; these data were supplemented with a consultation carried out by the WHO with the Ministries of Health. Results. Screening policies vary significantly in regard to target populations, primary tests, and screening intervals. Sixteen countries have recently updated their recommendations; however, cytology remains the primary screening test for most countries. Eleven countries have introduced HPV tests, and eight countries have implemented screen-and-treat algorithms; only three countries have developed evidence-based guidelines. All countries but Costa Rica have specific recommendations for WLHIV. Conclusions. Although most countries have updated their screening policies, only a few are properly alig­ned with the WHO elimination strategy. Recommendations for WLHIV require better integration with cervical cancer screening programs.

Is it feasible to enhance quality assurance of cervical cancer screening in Latin America? A regional expert consensus

“…Furthermore, Latin American countries have updated national recommendations to introduce new screening tests and algorithms following international recommendations (HPV tests, visual inspection, screen-and-treat, etc.) 5,23 ; in consequence, greater variability is expected in terms of coverage data and for that reason the expert panel considers the most reliable but feasible information could be the history of screening during the previous year to the surveys, regardless of the type of test used (Table 2).…”

“…The latter is a traditional indicator of screening programs in the region; thus, we think the panel took into consideration the fact that, despite updated recommendations, cytology remains the predominant screening test all over Latin America. 5 The lack of consensus is mainly related to concerns around feasibility of data collection; however, given its relevance and the absence of indicators for tests other than conventional cytology, it is highly desirable to include some of the proposed indicators from international guidelines in the future. 3).…”

“…We included an additional category for screen-and-treat approaches as proposed by the WHO guidelines given the characteristics of screening programs in the region (Supplemental Table 1). 5,12 During the second phase an expert consensus using the Delphi method was implemented with the aim of identifying a set of indicators (basic and extended) for monitoring cervical cancer screening programs suitable to the regional context. The expert panel members were selected by the research team, and included gynaecologists, pathologists, public health specialists and cytology lab experts (Table 1).…”

“…Accordingly, most Latin American countries lack organized screening and QA programs, as indicated by the absence of publicly available comprehensive reports on program performance. 5 Latin American countries have been focused on screening coverage and information about other program components is scarce, whereas most high-income countries in Europe, North America and Oceania have actually developed comprehensive QA guidelines for cervical cancer screening. 6,7 Furthermore, the reports on coverage are mostly based on demographic and health surveys aimed at reproductive health rather than program management data, thus resulting in non-harmonized and non-standardized information.…”

Implementation of an mHealth intervention to increase adherence to triage among HPV-positive women with HPV - self-collection (ATICA study): post-implementation evaluation - women's perspective

“…Low adherence to triage after positive screening is a widespread and long-standing problem for cervical cancer screening programs in Low-and Middle-income Countries (LMICs). 7 Adherence to triage requires the patient to receive and understand the meaning of positive results and take action on that information to continue along the screening process. Adhering to triage can be challenging, especially among women with self-collected tests.…”