title: Control of cervical cancer in Peru: Current barriers and challenges for the future.
abstract: Cervical cancer is the leading malignant neoplasm in Peruvian women. This malignancy is a public health problem and several efforts were previously performed to develop cancer control plans. Geographical, cultural, structural, infrastructural and procedural barriers can limit the implementation of such strategies. Several previous studies have characterized human papilloma virus (HPV) epidemiology, where prevalence of high-risk HPV in adult females is ~12% and the prevalence in cervical cancer is 90-95%. The predominant barriers for the control of cervical cancer are lack of specialists in remote villages, education/cultural issues, loss of patients in follow-up, lack of access to HPV testing and lack of compliance for HPV vaccination. A good strategy for the prevention and early detection of high-risk HPV, pre-malignant neoplasms and cervical cancer, identified by interventional studies, is the self-sampling test, which assists with overcoming the cultural and geographic barriers. The current cancer control plan, termed 'Plan Esperanza', is performed with massive training of health professionals and social sensitization campaigns leading to filling the gaps regarding education and, in addition, it provides cancer care coverage for poorer individuals. In our experience at Oncosalud-AUNA, with a cohort of ~750,000 affiliates using a pre-paid system with annual screenings for cervical cancer for women, offered free-of-charge, a lower incidence of this malignancy (5.8/100,000) is now observed compared with the national incidence (32.7/100,000). As in other countries, the HPV vaccination can be a cost-utility strategy to reduce the high burdens of cervical cancer in Peru, a rapid and cheap HPV molecular sub-typification is rapidly required.
authors.affiliation: Department of Medical Oncology, Oncosalud-AUNA, San Borja, Lima 41, Peru.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Aguilar
authors.affiliation: Unit of Basic and Translational Research, Oncosalud-AUNA, San Borja, Lima 41, Peru.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Pinto
authors.affiliation: Unit of Basic and Translational Research, Oncosalud-AUNA, San Borja, Lima 41, Peru.
authors.forename: Jhajaira
authors.initials: J
authors.lastname: Araujo
authors.affiliation: School of Human Medicine, St. John's Private University, Chorrillos, Lima 09, Peru.
authors.forename: Williams
authors.initials: W
authors.lastname: Fajardo
authors.affiliation: School of Human Medicine, St. John's Private University, Chorrillos, Lima 09, Peru.
authors.forename: Leny
authors.initials: L
authors.lastname: Bravo
authors.affiliation: Department of Radiotherapy, Oncosalud-AUNA, San Borja, Lima 41, Peru.
authors.forename: Luis
authors.initials: L
authors.lastname: Pinillos
authors.affiliation: Department of Medical Oncology, Oncosalud-AUNA, San Borja, Lima 41, Peru.
authors.forename: Carlos
authors.initials: C
authors.lastname: Vallejos
keywords: cancer control program; cervical cancer; human papilloma virus