BREAST AND CERVICAL CANCER IN THE AMERICAS: Situation Analysis and Way Forward
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1 BREAST AND CERVICAL CANCER IN THE AMERICAS: Situation Analysis and Way Forward Silvana Luciani Area of Health Surveillance, Disease Prevention and Control Pan American Health Organization/World Health Organization
2 Source: PAHO, mortality database Epidemiological Transition in LAC Non communicable diseases Communicable diseases
3 Breast cancer is the most common cancer in LAC. Cervical cancer is also a significant problem.
4 Breast and Cervical Cancer in the Americas Breast Cancer NAm LAC No. new cases (ASIR) 205,500 (76.7) 114,900 (39.7) No. deaths (ASMR) 45,600 (14.8) 36,950 (12.4) Cervical Cancer NAm LAC 12,490 ( 5.7) 68,220 (23.5) 4,400 ( 1.7) 31,700 (10.8) TOTAL 400, ,600
5 Within Country Disparities: The case of Colombia cervical cancer mortality breast cancer mortality Source: Pedraza AM et al. Breast Cancer Res Treat 2012 & Source: Parkin et al. Vaccine 2008 National Cancer Institute of Colombia, 2012
6 CERVICAL CANCER MORTALITY TRENDS SELECTED LATIN AMERICAN COUNTRIES Source: PAHO, mortality database. 2012
7 BREAST CANCER MORTALITY TRENDS SELECTED LATIN AMERICAN COUNTRIES Source: PAHO, mortality database. 2012
8 Breast and Cervical Cancer Mortality: 3 Scenarios 30 BRAZIL 30 MEXICO CERVIX MAMA 15 CERVIX MAMA Source: PAHO Mortality Database, 2012
9 111,000 68, , ,900
10 COMPREHENSIVE CANCER PROGRAM COMMUNITY PRIMARY HEALTH CARE SECONDARY HEALTH CARE TERTIARY HEALTH CARE PRIMARY PREVENTION awareness health education counselling HPV vaccination SCREENING & EARLY DETECTION cxca screening: cytology, HPV test, VIA breast cancer: clinical breast exam, mamography DIAGNOSIS, TREATMENT & PALLIATIVE CARE pathology labs surgery, radiotherapy, chemotherapy supportive care, survivorship, palliative care ORGANIZED PROGRAM [training, quality control, cancer registry for monitoring and evaluation]
11 Capacity for Cancer Control In LAC No. Countries (%) National Cancer Plan 19/31 (61%) Budget for the cancer program 12/19 (63%) Monitoring and evaluation 12/19 (63%) cervical cytology 24/25 (96%) free service 21/24 (87.5%) Screening services clinical breast exam 24/32 (84%) free service 21/24 (87.5%) mammography 21/25 (59%) free service 8/21 (38%) Chemotherapy available 23/25 (92%) Radiotherapy available 17/25 (68%) Oral morphine available 18/25 (72%) Source: PAHO Survey of National NCD Program Managers, 2012
12 HPV VACCINE INTRODUCTION, 2012 Source: Cervical Cancer Action. Progress in Cervical Cancer Prev The CCA Report Card
13 RESEARCH ON SCREENING TEST PERFORMANCE IN LAC
14 NEW STRATEGIES FOR CERVICAL CANCER SCREENING IN LAC Cytology testing Visual inspection screening + cytology HPV DNA testing Visual inspection screening only
15 CHALLENGES TO SCALE UP NEW STRATEGIES IN LAC competing public health priorities limited awareness and demand resistance to change cost of new technologies
16 PAHO S RESPONSE Mobilize political commitment Assess and plan cancer programs Technical cooperation & building capacity Access to vaccines, medicines, radiotherapy Multi-sector partnerships
17 PAHO REGIONAL STRATEGY FOR CERVICAL CANCER 1. Conduct a situation assessment 2. Intensify information, education and counseling 3. Fortify screening and pre-cancer treatment 4. Establish or strengthen information systems and cancer registries 5. Improve access and quality of cancer treatment and of palliative care 6. Generate evidence for decision making on HPV vaccine introduction 7. Advocate for equitable access and affordable comprehensive cervical cancer prevention
18 PAHO s Support for Cervical Cancer Policies and guidelines Needs assessment/program evaluation Demonstration projects Training of providers PROVAC Initiative for HPV vaccines and cervical cancer screening HPV vaccine monitoring and evaluation Knowledge exchange
19 PAHO s Support for Breast Cancer Review of breast cancer care in Latin America Training in mammography and breast ultrasound BHGI Guidelines stratified to resource levels early detection diagnosis treatment supportive and palliative care health system
20 PAHO s Radiation Health Program Radiological Services diagnostic imaging radiation therapy Radiation Protection
21 PAHO s REVOLVING FUND & STRATEGIC FUND REVOLVING FUND HPV Vaccines STRATEGIC FUND Currently available asparaginase doxorubicin bleomycin etoposide calcium folinate mercaptopurine chlorambucil mesna cisplatin morphine cyclophosphamide methotrexate cytarabine tamoxifen dacarbazine procarbazine dactinomycin vinblastine daunorubicin vincristine Forthcoming additions trastuzumab carboplatin docetaxel fluorouracil ifosfamide paclitaxel
22 PAHO s support to Palliative Care Clinical practice guide Guidelines for opioid availability Palliative care program development Workshops with regulators and health professionals
23
24 WOMEN S CANCER INITIATIVE A public-private partnership of the PAFNCD
25
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