EARLY DETECTION OF CERVICAL CANCER IN CHILE: TIME FOR CHANGE

Detección precoz del cáncer cervicouterino en Chile: tiempo para el cambio

Author
Léniz Martelli, Javiera; Facultad de Medicina. Pontificia Universidad Católica de Chile

Van De Wyngard, Vanessa; Facultad de Medicina. Pontificia Universidad Católica de Chile

Lagos, Marcela; Facultad de Medicina. Pontificia Universidad Católica de Chile

Barriga, María Isabel; Facultad de Medicina. Pontificia Universidad Católica de Chile

Puschel Illanes, Klaus; Facultad de Medicina. Pontificia Universidad Católica de Chile

Ferreccio Readi, Catterina; Facultad de Medicina. Pontificia Universidad Católica de Chile

Full text
http://www.revistamedicadechile.cl/ojs/index.php/rmedica/article/view/3064
Abstract
Mortality rates for cervical cancer (CC) in Chile are higher than those of developed countries and it has an unequal socioeconomic distribution. The recognition of human papilloma virus (HPV) as the causal agent of cervical cancer in the early 80's changed the prevention paradigms. Current goals are to prevent HPV infection by vaccination before the onset of sexual activity and to detect HPV infection in women older than 30 years. This article reviews CC prevention and early detection methods, discusses relevant evidence to support a change in Chile and presents an innovation proposal. A strategy of primary screening based on HPV detection followed by triage of HPV-positive women by colposcopy in primary care or by cytological or molecular reflex testing is proposed. Due to the existence in Chile of a well-organized nationwide CC prevention program, the replacement of a low-sensitivity screening test such as the Papanicolau test with a highly sensitive one such as HPV detection, could quickly improve the effectiveness of the program. The program also has a network of personnel qualified to conduct naked-eye inspections of the cervix, who could easily be trained to perform triage colposcopy. The incorporation of new prevention strategies could reduce the deaths of Chilean women and correct inequities.
 
Mortality rates for cervical cancer (CC) in Chile are higher than those of developed countries and it has an unequal socioeconomic distribution. The recognition of human papilloma virus (HPV) as the causal agent of cervical cancer in the early 80's changed the prevention paradigms. Current goals are to prevent HPV infection by vaccination before the onset of sexual activity and to detect HPV infection in women older than 30 years. This article reviews CC prevention and early detection methods, discusses relevant evidence to support a change in Chile and presents an innovation proposal. A strategy of primary screening based on HPV detection followed by triage of HPV-positive women by colposcopy in primary care or by cytological or molecular reflex testing is proposed. Due to the existence in Chile of a well-organized nationwide CC prevention program, the replacement of a low-sensitivity screening test such as the Papanicolau test with a highly sensitive one such as HPV detection, could quickly improve the effectiveness of the program. The program also has a network of personnel qualified to conduct naked-eye inspections of the cervix, who could easily be trained to perform triage colposcopy. The incorporation of new prevention strategies could reduce the deaths of Chilean women and correct inequities.
 
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