Please use this identifier to cite or link to this item: https://www.arca.fiocruz.br/handle/icict/54462
Title: Moving towards a strategy to accelerate cervical cancer elimination in a high-burden city: lessons learned from the Amazon city of Manaus, Brazil
Authors: Torres, Kátia Luz
Rondon, Heidy Halanna de Melo Farah
Martins, Toni Ricardo
Martins, Sandro
Saturnino, Ana Conceição Ribeiro Dantas
Raiol, Tainá
Marques, Carla Pintas
Corrêa, Flavia
Migowski, Arn
Minuzzi-Souza, Thais Tâmara Castro e
Schiffman, Mark
Rodriguez, Ana Cecilia
Gage, Julia C.
Affilliation: Amazon State Oncology Control Foundation. Manaus, AM, Brazil / The Federal University of Amazonas. Post Graduation Program in Health Sciences and Basic and Applied Immunology. Manaus, AM, Brazil / Fundação Oswaldo Cruz. Fiocruz Brasília. Núcleo de Epidemiologia e Vigilância em Saúde. Brasília, DF, Brasil.
The Federal University of Amazonas. Post Graduation Program in Health Sciences and Basic and Applied Immunology. Manaus, AM, Brazil / Fundação Oswaldo Cruz. Fiocruz Brasília. Núcleo de Epidemiologia e Vigilância em Saúde. Brasília, DF, Brasil.
São Paulo University. Tropical Medicine Institute. Virology Laboratory. São Paulo, SP, Brazil.
Fundação Oswaldo Cruz. Fiocruz Brasília. Núcleo de Epidemiologia e Vigilância em Saúde. Brasília, DF, Brazil.
Fundação Oswaldo Cruz. Fiocruz Brasília. Núcleo de Epidemiologia e Vigilância em Saúde. Brasília, DF, Brasil / University of Brasília. Faculty of Health Sciences. Department of Pharmacy. Brasília, DF, Brazil.
Fundação Oswaldo Cruz. Fiocruz Brasília. Núcleo de Epidemiologia e Vigilância em Saúde. Brasília, DF, Brasil.
Fundação Oswaldo Cruz. Fiocruz Brasília. Núcleo de Epidemiologia e Vigilância em Saúde. Brasília, DF, Brasil / University of Brasília. Collective Health. Brasília, DF, Brazil.
Brazilian National Cancer Institute. Cancer Early Detection Division. Rio de Janeiro, RJ, Brazil.
Brazilian National Cancer Institute. Cancer Early Detection Division. Rio de Janeiro, RJ, Brazil.
Fundação Oswaldo Cruz. Fiocruz Brasília. Núcleo de Epidemiologia e Vigilância em Saúde. Brasília, DF, Brasil / Ministry of Health. Health Surveillance Secretariat. National Immunization Program. Brasília, DF, Brazil.
National Cancer Institute. Division of Cancer Epidemiology and Genetics. Bethesda, MD, United States of America.
Abstract: The World Health Organization Call to Eliminate Cervical Cancer resonates in cities like Manaus, Brazil, where the burden is among the world’s highest. Manaus has offered free cytology-based screening since 1990 and HPV immunization since 2013, but the public system is constrained by many challenges and performance is not well-defined. We obtained cervical cancer prevention activities within Manaus public health records for 2019 to evaluate immunization and screening coverage, screening by region and neighborhood, and the annual Pink October screening campaign. We estimated that among girls and boys age 14–18, 85.9% and 64.9% had 1+ doses of HPV vaccine, higher than rates for age 9–13 (73.4% and 43.3%, respectively). Of the 90,209 cytology tests performed, 24.9% were outside the target age and the remaining 72,230 corresponded to 40.1% of the target population (one-third of women age 25–64). The East zone had highest screening coverage (49.1%), highest high-grade cytology rate (2.5%) and lowest estimated cancers (38.1/100,000) compared with the South zone (32.9%, 1.8% and 48.5/100,000, respectively). Largest neighborhoods had fewer per capita screening locations, resulting in lower coverage. During October, some clinics successfully achieved higher screening volumes and high-grade cytology rates (up to 15.4%). Although we found evidence of some follow-up within 10 months post-screening for 51/70 women (72.9%) with high-grade or worse cytology, only 18 had complete work-up confirmed. Manaus has successfully initiated HPV vaccination, forecasting substantial cervical cancer reductions by 2050. With concerted efforts during campaigns, some clinics improved screening coverage and reached high-risk women. Screening campaigns in community locations in high-risk neighborhoods using self-collected HPV testing can achieve widespread coverage. Simplifying triage and treatment with fewer visits closer to communities would greatly improve follow-up and program effectiveness. Achieving WHO Cervical Cancer Elimination goals in high-burden cities will require major reforms for screening and simpler follow-up and treatment.
Keywords: Cervical cancer
HPV vaccine
Manaus, Brazil
DeCS: Neoplasias do Colo do Útero
Vacinas contra Papillomavirus
Issue Date: 2021
Publisher: Public Library of Science
Citation: TORRES, Katia Luz et al. Moving towards a strategy to accelerate cervical cancer elimination in a high-burden city: lessons learned from the Amazon city of Manaus, Brazil. Plos One, [San Francisco], v. 16, n. 10, e0258539, p. 1-15, 2021.
DOI: 10.1371/journal.pone.0258539
ISSN: 1932-6203
Copyright: open access
Appears in Collections:BSB - Artigos de Periódicos
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