Cervical Cancer Prevention and Cancer Control in Latin America—Letter
Authors: Tatiana Vidaurre
Journal: Clinical Cancer Research (2015)

Cervical cancer is the most common cancer affecting several Latin American countries, causing high mortality for women living in poor economic conditions. It represents a major public health problem in Latin America and is of major economic impact on society. Cancer treatments are expensive and not affordable for many patients, and the cost must be borne by public health systems. Lou and colleagues reported in Clinical Cancer Research the first study focusing on molecular analyses of cervical cancer in Latin America (1). Their study characterized the exome sequence of 24 tumors from Guatemala and targeted sequencing of seven of the most frequently mutated genes in 675 tumors from Guatemala, Venezuela, and Mexico. They demonstrated frequent activation of the PIK3CA pathway, almost exclusively mutations in the helical domain of PIK3CA. Lou and colleagues also provide preliminary data on the possibility that cooking with wood may be a cancer risk factor, along with the known effects of tobacco. The article is an excellent example of the need for studies of high prevalence cancers in the countries affected and international cooperation in important global health issues. In Peru, we have generated a public health strategy to diagnose and treat cervical cancer.For highly vulnerable Latin American women, especially Peruvian women, the Government of Peru enacted a Supreme Decree that states “Turning on the light of hope for prevention and control of cancer in Peru, because with cancer it is also possible to live well” (2). Plan Esperanza is a response to this, and a health strategy of historic importance in Peru. Plan Esperanza has a transcendent meaning for Peruvian Public Health, because it represents the possibility for patients with cancer to be diagnosed and treated without financial cost, including patients with cancer and populations at risk. In addition, Plan Esperanza: (i) promotes healthy lifestyles and early detection of cancer, comprehensive oncology healthcare, (ii) strengthens capacities of health professionals in prevention and control of cancer, (iii) benefits Peruvian populations nationwide, (iv) develops oncology education and research, and (v) mobilizes the society for prevention and cancer control in Peru (3, 4).Plan Esperanza has already made an unprecedented change in access and availability of comprehensive oncology healthcare, offering full coverage for prevention and cancer care. Between 2011 and 2013, Instituto Nacional de Enfermedades Neoplásicas (INEN) implemented preventive health facilities around the country. From 2011 to 2014, 16 million people in Peru received health interventions, including educational sessions and counseling for a healthy lifestyle, and prevention for cervical, breast, gastric, lung, colon, and prostate cancers. In the same period, over 2 million women were screened for cervical cancer. In addition, 1,389 health professionals were trained in the Center of Excellence for Prevention and Control of Cervical Cancer for Latin American at the INEN. A collaboration between INEN and the Peruvian National Institute of Health is promoting best practices in cervical cytology (4). Plan Esperanza functionally integrates the health sector for prevention and cancer control actions, at the national, regional, and local levels. It is an example of a successful cancer control plan implemented in Latin America where the Peruvian Government and civil society in a multidisciplinary team have joined efforts to obtain and develop cancer control policies for the benefit of the Peruvian population. As result of this change between 2009 and 2014, the affiliation to INEN increased from 17% to 65%, and out-of pocket expenses decreased from 58% to 7%; in 2 years, more than 106,000 people with cancer living in poverty in Peru were served without cost (4, 5).In Peru, the human papilloma virus (HPV) vaccine is included in Plan Esperanza and it is free of charge as of November 2014. Tetravalent HPV vaccination was included in the National Vaccination Program approved in 2013 by the Ministry of Health, and three doses are given to girls from 5th and 6th grades of elementary school or girls 10 years old not in school, effectively protecting women before exposure to HPV (6–8). The plan includes free coverage for screening for cancer of the cervix in targeted populations (women ages 30 to 49), including cytology (PAP smear or liquid-based cytology), cervical visual inspection with acetic acid (VIA), and/or cryotherapy (see and treat), colposcopy, and molecular HPV tests (hybrid capture and/or PCR; refs. 5, 9). In this context, INEN promotes prevention and basic VIA methodology and/or cryotherapy (see and treat) in rural or remote areas. Within Plan Esperanza, these tests are completely funded by the Government beginning in 2013 (4).However, INEN is not working alone. Training through the INEN's Excellence School has connected the whole country with prestigious oncology scientific networks and global public health organizations, including NCI-US collaborative groups and networks, MDACC Sister Institution Program, IARC (International Agency for Research on Cancer), UICC (Union for International Cancer Control), SWOG, EORTC (European Organisation for Research and Treatment of Cancer), RINC (Red de Institutos Nacionales de Cáncer)-UNASUR, ICCA, IRD, among others. Plan Esperanza is meant to affect not only prevention and oncology standards of care, but also to promote scientific interchange for research and education. In Plan Esperanza, there is funding support for prevention and for cancer control, to accomplish a world, continent, region, and country free of advanced cancer, with universal coverage and comprehensive cancer healthcare.No potential conflicts of interest were disclosed.