Innovation in cervical cancer prevention and control in Mexico.
Disparities related to cervical cancer continue to exist in Mexico, including insufficient screening coverage, problems with quality control and a resulting greater risk of mortality among women from marginalized areas. A lack of opportunities and requirements for continuing education and accreditation of healthcare personnel involved in the screening program is also an issue. HPV DNA testing and HPV vaccines are recent technological innovations that offer a potential solution to the continued negative impact of cervical cancer among Mexican women. This essay attempts to answer questions such as: Why should HPV testing be integrated into the early detection program in Mexico? How can HPV testing best be integrated into the program in Mexico? How-from a public health perspective that seeks to reduce disparities-can HPV vaccination best be implemented in Mexico? HPV testing allows increased positive predictive value while also reducing costly and unnecessary overtreatment of low-grade abnormalities, and HPV vaccines offer the possibility of primary prevention of cervical cancer. The strategy proposed for Mexico includes primary prevention with HPV vaccination for girls aged between 12 and 16 years (before sexual initiation), Pap testing with excellent quality control for women 24-34 years of age and high-risk HPV DNA testing for women 35 years and older. HPV samples would be either clinically collected or self-collected and women with positive HPV test results would receive follow-up high-quality Pap testing. This approach is creative and focuses on reducing disparities and providing high-quality care that is also cost effective.
Center for Population Health Research, National Institute of Public Health, Mexico, D.F., Mexico.
Eduardo
E
Lazcano-Ponce
Betania
B
Allen-Leigh
D004279:DNA, Viral / Q000032:analysis; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods; D008800:Mexico; D009313:National Health Programs / Q000191:economics; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000517:prevention & control / Q000821:virology; D053918:Papillomavirus Vaccines / Q000191:economics; D011634:Public Health / Q000191:economics; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000517:prevention & control*; D014626:Vaginal Smears / Q000191:economics / Q000379:methods; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000517:prevention & control / Q000821:virology
D004279:DNA, Viral; D053918:Papillomavirus Vaccines