Abstract PL05-01: Cervical cancer as an example of gender-associated health inequality.
Authors: Herrero Rolando 
Published: August 2014

Abstract
Latin America has experienced important improvements in socio-economic and health indicators in the last few decades. Between 1960 and 2000, per capita income doubled, life expectancy increased from 57 to 70 years and infant mortality decreased from 97 to 27/1000 children born alive (1). However, the region, together with sub Saharan Africa, is the most unequal in the world (2) and the benefits of the improved indicators are only reaching a subset of the population. In this context, it is no surprise that cervical cancer, that characteristically affects poor women without access to medical care, continues to be one of the leading public health problems in the region as it is in most developing areas. Almost 90% of cervical cancer occurs in developing regions, and remarkable geographical differences are present even in low-incidence countries, where the most disadvantaged segments of the population are still at high risk of this disease. Efforts to control cervical cancer have been largely unsuccessful in developing regions, in part because the preventive interventions of the past were very limited and complex. Programs based on cytology screening, despite their success in cervical cancer control in high income countries, have been very difficult to implement, in part because of the limitations of the technique (low sensitivity, need for quality control) and in part because of the multiple visits required when the test is positive (screening, colposcopy, treatment), which involve ample coordination between multiple instances within the health system, with the corresponding high cost. The new options available for primary and secondary prevention offer an excellent opportunity to intervene more effectively. Vaccination of adolescent women promises significant reduction in the burden of disease within several decades, and the new screening methodologies available represent an improvement in multiple aspects of the process, but require active and decisive efforts of scientists, activists and the health system for their implementation in organized national programs. The production of new knowledge about cervical cancer and the development of new preventive methods have had the unprecedented participation of multiple research centers in Latin America, as well as many thousands of study participants from the region who have generously contributed. The more than 25 years collaboration between the US National Cancer Institute and Costa Rican researchers to investigate multiple aspects of the natural history of HPV and associated neoplasia (3-8) including the evaluation of an HPV vaccine in a large randomized clinical trial, is an example of the potential of multinational collaboration. The extensive technology transfer associated with this effort has likely contributed to an important decline in cervical cancer mortality in Costa Rica HPV vaccination of young women is advancing rapidly in the region, and organized screening programs based on HPV testing and incorporating innovative strategies, are starting with the leadership of Mexico, Argentina and Colombia. Many questions remain unanswered, including how to manage HPV positive women and its associated psychosocial issues, but we are at the threshold of a new era where the terrible suffering imposed by cervical cancer on Latin American families will be a thing of the past.
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Citation Format: Rolando Herrero. Cervical cancer as an example of gender-associated health inequality. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr PL05-01.