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Mosquera I, Barajas CB, Theriault H, Benitez Majano S, Zhang L, Maza M, Luciani S, Carvalho AL, Basu P. Assessment of barriers to cancer screening and interventions implemented to overcome these barriers in 27 Latin American and Caribbean countries. Int J Cancer 2024. [PMID: 38648380 DOI: 10.1002/ijc.34950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/19/2024] [Accepted: 02/28/2024] [Indexed: 04/25/2024]
Abstract
There is a gap in the understanding of the barriers to cancer screening participation and complying with downstream management in the Community of Latin American and Caribbean states (CELAC). Our study aimed to assess barriers across the cancer screening pathway from the health system perspective, and interventions in place to improve screening in CELAC. A standardized tool was used to collect information on the barriers across the screening pathway through engagement with the health authorities of 27 member states of CELAC. Barriers were organized in a framework adapted from the Tanahashi conceptual model and consisted of the following dimensions: availability of services, access (covering accessibility and affordability), acceptability, user-provider interaction, and effectiveness of services (which includes governance, protocols and guidelines, information system, and quality assurance). The tool also collected information of interventions in place, categorized in user-directed interventions to increase demand, user-directed interventions to increase access, provider-directed interventions, and policy and system-level interventions. All countries prioritized barriers related to the information systems, such as the population register not being accurate or complete (N = 19; 70.4%). All countries implemented some kind of intervention to improve cancer screening, group education being the most reported (N = 23; 85.2%). Training on screening delivery was the most referred provider-directed intervention (N = 19; 70.4%). The study has identified several barriers to the implementation of cancer screening in the region and interventions in place to overcome some of the barriers. Further analysis is required to evaluate the effectiveness of these interventions in achieving their objectives.
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Affiliation(s)
- Isabel Mosquera
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
| | | | - Hannah Theriault
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Sara Benitez Majano
- Pan American Health Organization, Washington, DC, USA
- Inequalities in Cancer Outcomes Network, London School of Hygiene and Tropical Medicine, London, UK
| | - Li Zhang
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Mauricio Maza
- Pan American Health Organization, Washington, DC, USA
| | | | - Andre L Carvalho
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Partha Basu
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
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Antini C, Caixeta R, Luciani S, Hennis AJM. Diabetes mortality: trends and multi-country analysis of the Americas from 2000 to 2019. Int J Epidemiol 2024; 53:dyad182. [PMID: 38205867 PMCID: PMC10859152 DOI: 10.1093/ije/dyad182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/12/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Diabetes has been increasing worldwide and is now among the 10 leading causes of death globally. Diabetic kidney disease (DKD), a complication of poorly managed diabetes, is related to high mortality risk. To better understand the situation in the Americas region, we evaluated diabetes and DKD mortality trends over the past 20 years. METHODS We analysed diabetes and DKD mortality for 33 countries in the Americas from 2000 to 2019. Data were extracted from the World Health Organization (WHO) Global Health Estimates and the World Population Prospects, 2019 Revision, estimating annual age-standardized mortality rates (ASMR) and gaps in the distribution of diabetes and DKD mortality by sex and country. Trend analyses were based on the annual average percentage of change (AAPC). RESULTS From 2000 to 2019, the overall mortality trend from diabetes in the Americas remained stable [AAPC: -0.2% (95% CI: -0.4%-0.0%]; however, it showed important differences by sex and by country over time. By contrast, DKD mortality increased 1.5% (1.3%-1.6%) per year, rising faster in men than women, with differences between countries. Central America, Mexico and the Latin Caribbean showed significant increases in mortality for both diseases, especially DKD. In contrast in North America, diabetes mortality decreased whereas DKD mortality increased. CONCLUSIONS The increase in DKD mortality is evidence of poorly controlled diabetes in the region. The lack of programmes on prevention of complications, self-care management and gaps in quality health care may explain this trend and highlight the urgent need to build more robust health systems based on primary care, prioritizing diabetes prevention and control.
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Affiliation(s)
- Carmen Antini
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC 20037, USA
| | - Roberta Caixeta
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC 20037, USA
| | - Silvana Luciani
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC 20037, USA
| | - Anselm J M Hennis
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC 20037, USA
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Fuentes-Alabí S, Carpenter K, Shea M, Vásquez L, Benitez Majano S, Maza M, Luciani S, Albanti I. Storytelling workshop to encourage stakeholder engagement with the Global Initiative for Childhood Cancer. Rev Panam Salud Publica 2023; 47:e148. [PMID: 37818485 PMCID: PMC10561658 DOI: 10.26633/rpsp.2023.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/21/2023] [Indexed: 10/12/2023] Open
Abstract
Storytelling can enhance stakeholder engagement and support the implementation of the World Health Organization and Pan American Health Organization's (PAHO) Global Initiative for Childhood Cancer, which aims to improve care globally for children with cancer. The Initiative aligns with the United Nations Sustainable Development Goals, addressing health, education, inequalities and international collaboration. This report describes the design and implementation of a workshop that used storytelling through film to encourage stakeholders in national cancer control plans to engage with the Initiative in its focal countries in Central America, the Dominican Republic and Haiti. A six-step process was used to develop the virtual workshop hosted by PAHO: (i) define the audience; (ii) define the goals of storytelling; (iii) build an appropriate storyline, including choosing a platform and content, and addressing group dynamics and the length of the film; (iv) guide the workshop's design and implementation with current theoretical frameworks, including the Socioecological Model of Health and the Theory of Change; (v) design interactive group exercises; and (vi) disseminate workshop results. The skills-building component of the day-long workshop included 80 representatives from eight countries in the Region of the Americas, with participants representing pediatric oncology, hospital administration, ministries of health, nonprofit foundations, the scientific community and public health organizations. Outputs from the workshop included (i) a summary report, (ii) an empathy word cloud with live reactions from participants, (iii) qualitative responses (i.e. quotes from participants), (iv) stakeholders' analyses and (v) a prioritization matrix for country-level strategic activities that could be undertaken to strengthen health systems when caring for children with cancer. The workshop used storytelling through film to try to reduce health inequalities and have a regional impact. Combining art, public health and medicine, the workshop created positive change by sharing real-life experiences. Commitment was fostered among stakeholders through their engagement with the workshop, which aimed to increase their awareness of the need and advocacy to improve health systems and enhance access to health care for this vulnerable population.
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Affiliation(s)
- Soad Fuentes-Alabí
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
| | - Kendall Carpenter
- Boston Children’s HospitalHarvard Medical SchoolBostonUnited States of AmericaBoston Children’s Hospital, Harvard Medical School, Boston, United States of America
| | - Meghan Shea
- Persistent ProductionsRockportUnited States of AmericaPersistent Productions, Rockport, United States of America
| | - Liliana Vásquez
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
| | - Sara Benitez Majano
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
| | - Mauricio Maza
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
| | - Silvana Luciani
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
| | - Irini Albanti
- Harvard Humanitarian InitiativeHarvard School of Public HealthBostonUnited States of AmericaHarvard Humanitarian Initiative, Harvard School of Public Health, Boston, United States of America
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Vásquez L, Fuentes-Alabi S, Benitez-Majano S, Ribeiro KB, Abraham M, Agulnik A, Baker JN, Blanco DB, Caniza MA, Cardenas-Aguirre A, Salaverria C, Sullivan CE, Damasco-Avila E, García-Quintero X, Loggetto P, McNeil MJ, Luna-Fineman S, Rossell N, Garcia de Lima RA, de Mendonca RH, Trigoso V, Segovia L, Vasquez R, Moreno F, Friedrich P, Luciani S, Lam C, Metzger ML, Rodríguez-Galindo C, Maza M. Collaboration for success: the Global Initiative for Childhood Cancer in Latin America. Rev Panam Salud Publica 2023; 47:e144. [PMID: 37799823 PMCID: PMC10548891 DOI: 10.26633/rpsp.2023.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/17/2023] [Indexed: 10/07/2023] Open
Abstract
The Global Initiative for Childhood Cancer (GICC) aims to increase the cure rate for children with cancer globally by improving healthcare access and quality. The Pan American Health Organization (PAHO), St. Jude Children's Research Hospital (St. Jude), and collaborators have joined efforts to improve outcomes of children with cancer in Latin America and the Caribbean (LAC) using the CureAll framework. In this article, we describe the process of developing regional resources aimed at accelerating the GICC implementation in LAC. In March 2021, PAHO formed regional working groups to develop core projects aligned with CureAll pillars and enablers. Seven working groups emerged from regional dialogues: early detection, nursing, psychosocial, nutrition, supportive care, treatment abandonment, and palliative care. PAHO arranged regular online meetings under the mentorship and support of St. Jude regional/transversal programs and international mentors. Between April and December 2021, 202 multidisciplinary experts attended 43 online meetings to promote the dialogue between stakeholders to improve childhood cancer outcomes. Fourteen technical outputs were produced: four regional snapshots, four technical documents, two virtual courses, one set of epidemiological country profiles, one educational content series for parents/caregivers, and two communication campaigns. The ongoing dialogue and commitment of PAHO, St. Jude, LAC working committees, and international collaborators are essential foundations to successfully accelerate GICC implementation. This is achievable through the development of materials of regional and global relevance. Further research and evaluation are needed to determine the impact of these strategies and resources on childhood cancer outcomes in LAC and other regions.
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Affiliation(s)
- Liliana Vásquez
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
| | - Soad Fuentes-Alabi
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
| | - Sara Benitez-Majano
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
| | - Karina Braga Ribeiro
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
| | - Monnie Abraham
- St. Jude Children’s Research HospitalMemphisUnited States of AmericaSt. Jude Children’s Research Hospital, Memphis, United States of America
| | - Asya Agulnik
- St. Jude Children’s Research HospitalMemphisUnited States of AmericaSt. Jude Children’s Research Hospital, Memphis, United States of America
| | - Justin N. Baker
- St. Jude Children’s Research HospitalMemphisUnited States of AmericaSt. Jude Children’s Research Hospital, Memphis, United States of America
| | - Daniel Bastardo Blanco
- St. Jude Children’s Research HospitalMemphisUnited States of AmericaSt. Jude Children’s Research Hospital, Memphis, United States of America
| | - Miguela A. Caniza
- St. Jude Children’s Research HospitalMemphisUnited States of AmericaSt. Jude Children’s Research Hospital, Memphis, United States of America
| | - Adolfo Cardenas-Aguirre
- St. Jude Children’s Research HospitalMemphisUnited States of AmericaSt. Jude Children’s Research Hospital, Memphis, United States of America
| | - Carmen Salaverria
- Ayúdame a Vivir FoundationSan SalvadorEl SalvadorAyúdame a Vivir Foundation, San Salvador, El Salvador
| | - Courtney E. Sullivan
- University of Alabama at BirminghamBirminghamUnited States of AmericaUniversity of Alabama at Birmingham, Birmingham, United States of America
| | - Erika Damasco-Avila
- Columbia University Irving Medical CenterNew YorkUnited States of AmericaColumbia University Irving Medical Center, New York, United States of America
| | - Ximena García-Quintero
- St. Jude Children’s Research HospitalMemphisUnited States of AmericaSt. Jude Children’s Research Hospital, Memphis, United States of America
| | - Patricia Loggetto
- St. Jude Children’s Research HospitalMemphisUnited States of AmericaSt. Jude Children’s Research Hospital, Memphis, United States of America
| | - Michael J. McNeil
- St. Jude Children’s Research HospitalMemphisUnited States of AmericaSt. Jude Children’s Research Hospital, Memphis, United States of America
| | - Sandra Luna-Fineman
- University of ColoradoAuroraUnited States of AmericaUniversity of Colorado, Aurora, United States of America
| | - Nuria Rossell
- University of AmsterdamAmsterdamNetherlandsUniversity of Amsterdam, Amsterdam, Netherlands
| | - Regina Aparecida Garcia de Lima
- University of São Paulo at Ribeirão Preto College of NursingRibeirão PretoBrazilUniversity of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil
| | | | - Viviana Trigoso
- Pontifical Catholic University of PeruLimaPeruPontifical Catholic University of Peru, Lima, Peru
| | - Lorena Segovia
- St. Jude Children’s Research HospitalMemphisUnited States of AmericaSt. Jude Children’s Research Hospital, Memphis, United States of America
| | - Roberto Vasquez
- Hospital Nacional de Niños Benjamin BloomSan SalvadorEl SalvadorHospital Nacional de Niños Benjamin Bloom, San Salvador, El Salvador
| | - Florencia Moreno
- Registro Onco-pediátrico Hospitalario ArgentinoBuenos AiresArgentinaRegistro Onco-pediátrico Hospitalario Argentino, Buenos Aires, Argentina
| | - Paola Friedrich
- St. Jude Children’s Research HospitalMemphisUnited States of AmericaSt. Jude Children’s Research Hospital, Memphis, United States of America
| | - Silvana Luciani
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
| | - Catherine Lam
- St. Jude Children’s Research HospitalMemphisUnited States of AmericaSt. Jude Children’s Research Hospital, Memphis, United States of America
| | - Monika L. Metzger
- St. Jude Children’s Research HospitalMemphisUnited States of AmericaSt. Jude Children’s Research Hospital, Memphis, United States of America
| | - Carlos Rodríguez-Galindo
- St. Jude Children’s Research HospitalMemphisUnited States of AmericaSt. Jude Children’s Research Hospital, Memphis, United States of America
| | - Mauricio Maza
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
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Ramírez AT, Valls J, Baena A, Rojas FD, Ramírez K, Álvarez R, Cristaldo C, Henríquez O, Moreno A, Reynaga DC, Palma HG, Robinson I, Hernández DC, Bardales R, Cardinal L, Salgado Y, Martínez S, González E, Guillén D, Fleider L, Tatti S, Villagra V, Venegas G, Cruz-Valdez A, Valencia M, Rodríguez G, Terán C, Picconi MA, Ferrera A, Kasamatsu E, Mendoza L, Calderon A, Luciani S, Broutet N, Darragh T, Almonte M, Herrero R. Performance of cervical cytology and HPV testing for primary cervical cancer screening in Latin America: an analysis within the ESTAMPA study. Lancet Reg Health Am 2023; 26:100593. [PMID: 37766799 PMCID: PMC10520426 DOI: 10.1016/j.lana.2023.100593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/28/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023]
Abstract
Background Cervical cytology remains widely used as the initial tool in cervical cancer screening worldwide. WHO guidelines recommend replacing cytology with primary HPV testing to reach cervical cancer elimination goals. We assessed the performance of cytology and high-risk HPV testing to detect cervical precancer, cervical intraepithelial neoplasia (CIN) grade 3 or worse (CIN3+) among women aged 30-64 years participating in the ESTAMPA study. Methods Women were screened with cytology and HPV across ESTAMPA study centres in Latin America. Screen-positives were referred to colposcopy with biopsy collection and treatment as needed. Those with no evident precancer were recalled at 18-months for a second HPV test to complete disease ascertainment. Performance indicators for cytology and HPV to detect CIN3+ were estimated. Findings 30,606 participants with available cytology and HPV results were included in the analysis. A total of 440 histologically confirmed CIN3s and 30 cancers were diagnosed. Cytology sensitivity for CIN3+ was 48.5% (95% CI: 44.0-53.0), whereas HPV testing had a sensitivity of 98.1% (95% CI: 96.3-96.7). Specificity was 96.5% (95% CI: 96.3-96.7) using cytology and 88.7% (95% CI: 88.3-89.0) with HPV. Performance estimates varied substantially by study centre for cytology (ranging from 32.1% to 87.5% for sensitivity and from 89.2% to 99.5% for specificity) while for HPV results were more consistent across sites (96.7%-100% and 83.6-90.8%, respectively). Interpretation The limited and highly variable sensitivity of cytology strongly supports transition to the more robust and reproducible HPV-based cervical screening to ensure progress towards global cervical cancer elimination targets in Latin America. Funding IARC/WHO, UNDP, HRP/WHO, NCI and local funders.
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Affiliation(s)
- Arianis Tatiana Ramírez
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Joan Valls
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Armando Baena
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Freddy David Rojas
- Caja Costarricense de Seguro Social (CCSS), Región Pacífico Central, San Jose, Costa Rica
| | - Katherine Ramírez
- Caja Costarricense de Seguro Social (CCSS), Región Pacífico Central, San Jose, Costa Rica
| | - Rodrigo Álvarez
- Caja Costarricense de Seguro Social (CCSS), Región Pacífico Central, San Jose, Costa Rica
| | - Carmen Cristaldo
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | | | - Adrián Moreno
- Hospital Nacional Alejandro Posadas, Buenos Aires, Argentina
| | - Daysi Colque Reynaga
- Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia
| | - Hans González Palma
- Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia
| | | | - Diana Carolina Hernández
- Laboratorio de citología, IPS Universitaria, Escuela de Microbiología, Universidad de Antioquia, Medellín, Colombia
| | - Rosa Bardales
- Departamento Laboratorio Clínico y Anatomía Patológica, Hospital Nacional Dos de Mayo, Lima, Perú
| | - Lucia Cardinal
- Hospital de Clínicas, Jose de San Martín, Buenos Aires, Argentina
| | - Yuly Salgado
- Instituto Nacional de Cancerología, Bogotá, Colombia
| | | | - Emmanuel González
- Caja Costarricense de Seguro Social, Departamento de Patología, Hospital Dr. Enrique Baltodano Briceño, Guanacaste, Costa Rica
- Agencia Costarricense de Investigaciones Biomédicas (ACIB), Fundación Inciensa, Guanacaste, Costa Rica
| | - Diego Guillén
- Agencia Costarricense de Investigaciones Biomédicas (ACIB), Fundación Inciensa, Guanacaste, Costa Rica
- Caja Costarricense de Seguro Social, Departamento de Patología, Hospital Max Peralta, Cartago, Costa Rica
| | - Laura Fleider
- Hospital de Clínicas, Jose de San Martín, Buenos Aires, Argentina
| | - Silvio Tatti
- Hospital de Clínicas, Jose de San Martín, Buenos Aires, Argentina
| | | | - Gino Venegas
- Clínica Angloamericana, Lima, Perú
- Escuela de Medicina Humana, Universidad de Piura, Lima, Perú
| | | | - Marleny Valencia
- Laboratorio de citología, IPS Universitaria, Escuela de Microbiología, Universidad de Antioquia, Medellín, Colombia
| | | | - Carolina Terán
- Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia
| | | | - Annabelle Ferrera
- Instituto de Infecciones en Microbiología, Universidad Nacional Autónoma de Honduras (UNAH), Tegucigalpa, Honduras
| | - Elena Kasamatsu
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Laura Mendoza
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Alejandro Calderon
- Caja Costarricense de Seguro Social (CCSS), Región Pacífico Central, San Jose, Costa Rica
| | - Silvana Luciani
- Pan American Health Organization (PAHO), Washington, DC, USA
| | - Nathalie Broutet
- Department of Sexual and Reproductive Health and Research (SRH), World Health Organization, Geneva, Switzerland
| | - Teresa Darragh
- Department of Pathology, University of California, San Francisco, CA, USA
| | - Maribel Almonte
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
- Department of Sexual and Reproductive Health and Research (SRH), World Health Organization, Geneva, Switzerland
| | - Rolando Herrero
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
- Agencia Costarricense de Investigaciones Biomédicas (ACIB), Fundación Inciensa, Guanacaste, Costa Rica
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Peiris S, Izcovich A, Ordunez P, Luciani S, Martinez C, Aldighieri S, Reveiz L. Challenges to delivering evidence-based management for long COVID. BMJ Evid Based Med 2023; 28:295-298. [PMID: 37491142 PMCID: PMC10579509 DOI: 10.1136/bmjebm-2023-112311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 07/27/2023]
Affiliation(s)
- Sasha Peiris
- Pan American Health Organization, Washington, District of Columbia, USA
| | - Ariel Izcovich
- Pan American Health Organization, Washington, District of Columbia, USA
| | - Pedro Ordunez
- Pan American Health Organization, Washington, District of Columbia, USA
| | - Silvana Luciani
- Pan American Health Organization, Washington, District of Columbia, USA
| | - Carmen Martinez
- Pan American Health Organization, Washington, District of Columbia, USA
| | | | - Ludovic Reveiz
- Pan American Health Organization, Washington, District of Columbia, USA
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Schüz J, Espina C, Carvalho A, Maza M, Luciani S, Cazap E, Hennis A, Weiderpass E. Latin America and the Caribbean Code Against Cancer 1st Edition: A landmark for cancer prevention in the region. Cancer Epidemiol 2023; 86 Suppl 1:102453. [PMID: 37852730 DOI: 10.1016/j.canep.2023.102453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Affiliation(s)
- Joachim Schüz
- International Agency for Research on Cancer (IARC/WHO), World Health Organisation, Lyon, France.
| | - Carolina Espina
- International Agency for Research on Cancer (IARC/WHO), World Health Organisation, Lyon, France
| | - Andre Carvalho
- International Agency for Research on Cancer (IARC/WHO), World Health Organisation, Lyon, France
| | | | | | - Eduardo Cazap
- Sociedad Latinoamericana y del Caribe de Oncología Médica (SLACOM), Buenos Aires, Argentina
| | | | - Elisabete Weiderpass
- International Agency for Research on Cancer (IARC/WHO), World Health Organisation, Lyon, France
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Mosquera I, Barajas CB, Zhang L, Lucas E, Benitez Majano S, Maza M, Luciani S, Basu P, Carvalho AL. Assessment of organization of cervical and breast cancer screening programmes in the Latin American and the Caribbean states: The CanScreen5 framework. Cancer Med 2023; 12:19935-19948. [PMID: 37768035 PMCID: PMC10587918 DOI: 10.1002/cam4.6492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 07/21/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND In the Community of Latin American and Caribbean States (CELAC), breast cancer and cervical cancer are the first and third causes of cancer death among females. The objectives are to assess the characteristics of the cervical and breast cancer screening programmes in CELAC, their level of organization, and the association of screening organization and coverage of essential health services. METHODS Representatives of the Ministries of Health of 33 countries were invited to the CanScreen5 project. Twenty-seven countries participated in a "Train The Trainers" programme on cancer screening, and 26 submitted data using standardized questionnaires. Data were discussed and validated. The level of organization of the screening programmes was examined adapting the list of essential elements of organized screening programmes identified in a recently published IARC study. RESULTS Twenty-one countries reported a screening programme for cervical cancer and 15 for breast cancer. For cervical cancer, 14 countries dedicated budget for screening (66.7%), and women had to pay in 3 countries for screening (14.3%), 9 for diagnosis (42.9%) and 8 for treatment (38.1%). Only 4 countries had a system to invite women individually (19.0%). For breast cancer, 8 countries dedicated budget for screening (53.3%), and women had to pay for screening in 3 countries (20.0%), diagnosis in 7 (46.7%) and treatment in 6 (40.0%). One country (6.7%) invited women individually. There was variability in the level of organization of both cancer screening programmes. The level of organization of cervical cancer screening and coverage of essential health services were correlated. CONCLUSION Large gaps were identified in the organization of cervical and breast cancer screening services. CELAC governments need pragmatic public health policies and strengthened health systems. They should guarantee sustainable funding, and universal access to cancer diagnosis and treatment. Moreover, countries should enhance their health information system and ensure adequate monitoring and evaluation.
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Affiliation(s)
- Isabel Mosquera
- Early Detection, Prevention & Infections BranchInternational Agency for Research on CancerLyonFrance
| | | | - Li Zhang
- Early Detection, Prevention & Infections BranchInternational Agency for Research on CancerLyonFrance
| | - Eric Lucas
- Early Detection, Prevention & Infections BranchInternational Agency for Research on CancerLyonFrance
| | - Sara Benitez Majano
- Pan American Health OrganizationWashingtonDCUSA
- Inequalities in Cancer Outcomes NetworkLondon School of Hygiene and Tropical MedicineLondonUK
| | | | | | - Partha Basu
- Early Detection, Prevention & Infections BranchInternational Agency for Research on CancerLyonFrance
| | - Andre L. Carvalho
- Early Detection, Prevention & Infections BranchInternational Agency for Research on CancerLyonFrance
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Espina C, Feliu A, Maza M, Almonte M, Ferreccio C, Finck C, Herrero R, Dommarco JR, de Almeida LM, Arrossi S, García PJ, Garmendia ML, Mohar A, Murillo R, Santamaría J, Tortolero-Luna G, Cazap E, Gabriel OO, Paonessa D, Zoss JW, Luciani S, Carvalho A, Schüz J. Latin America and the Caribbean Code Against Cancer 1st Edition: 17 cancer prevention recommendations to the public and to policy-makers (World Code Against Cancer Framework). Cancer Epidemiol 2023; 86 Suppl 1:102402. [PMID: 37852725 DOI: 10.1016/j.canep.2023.102402] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/02/2023] [Accepted: 06/15/2023] [Indexed: 10/20/2023]
Abstract
Preventable risk factors are responsible of at least 40% of cases and almost 45% of all cancer deaths worldwide. Cancer is already the leading cause of death in almost half of the Latin American and the Caribbean countries constituting a public health problem. Cost-effective measures to reduce exposures through primary prevention and screening of certain types of cancers are critical in the fight against cancer but need to be tailored to the local needs and scenarios. The Latin America and the Caribbean (LAC) Code Against Cancer, 1st edition, consists of 17 evidence-based recommendations for the general public, based on the most recent solid evidence on lifestyle, environmental, occupational, and infectious risk factors, and medical interventions. Each recommendation is accompanied by recommendations for policymakers to guide governments establishing the infrastructure needed to enable the public adopting the recommendations. The LAC Code Against Cancer has been developed in a collaborative effort by a large number of experts from the region, under the umbrella strategy and authoritative methodology of the World Code Against Cancer Framework. The Code is a structured instrument ideal for cancer prevention and control that aims to raise awareness and educate the public, while building capacity and competencies to policymakers, health professionals, stakeholders, to contribute to reduce the burden of cancer in LAC.
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Affiliation(s)
- Carolina Espina
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, 25 avenue Tony Garnier CS 90627, 69366 CEDEX 07 Lyon, France.
| | - Ariadna Feliu
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, 25 avenue Tony Garnier CS 90627, 69366 CEDEX 07 Lyon, France
| | - Mauricio Maza
- Pan American Health Organization (PAHO), Cancer Prevention and Control, Washington, DC 20037, United States
| | - Maribel Almonte
- World Health Organization (WHO), Department of Sexual and Reproductive Health and Research, Geneva, Switzerland
| | - Catterina Ferreccio
- Departamento de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Advanced Center for Chronic Diseases ACCDIS, Santiago, Chile
| | - Carolyn Finck
- Departamento de Psicología, Universidad de los Andes, Bogotá, Colombia
| | - Rolando Herrero
- Agencia Costarricense de Investigaciones Biomédicas, Fundación INCIENSA, Costa Rica
| | | | - Liz Maria de Almeida
- National Cancer Institute of Brazil (INCA), Prevention and Surveillance, Rio de Janeiro, Brazil
| | - Silvina Arrossi
- Centro de Estudios de Estado y Sociedad (CEDES), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | | | | | - Alejandro Mohar
- Instituto Nacional de Cancerología, Instituto de Investigaciones Biomédicas (UNAM), Tlalpan, Mexico
| | - Raúl Murillo
- Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá, Colombia
| | | | | | - Eduardo Cazap
- Sociedad Latinoamercia y del Caribe de Oncología Médica (SLACOM), Red de Institutos e Instituciones Nacionales de Cáncer (RINC-SLACOM), Buenos Aires, Argentina
| | - Owen O Gabriel
- Owen King EU Hospital, Department of Oncology, Saint Lucia
| | - Diego Paonessa
- Asociación Latina e Ibérica Contra el Cáncer (ALICC), Buenos Aires, Argentina
| | - J Walter Zoss
- Red de Institutos e Instituciones Nacionales de Cáncer (RINC-SLACOM), Rio de Janeiro, Brazil
| | - Silvana Luciani
- Pan American Health Organization (PAHO), Cancer Prevention and Control, Washington, DC 20037, United States
| | - Andre Carvalho
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, 25 avenue Tony Garnier CS 90627, 69366 CEDEX 07 Lyon, France
| | - Joachim Schüz
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, 25 avenue Tony Garnier CS 90627, 69366 CEDEX 07 Lyon, France
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Vásquez L, Fuentes-Alabí S, Loggetto P, Benitez-Majano S, Metzger ML, Jarquin-Pardo M, Echeandia-Abud N, Gupta S, Denburg A, Friedrich P, Ortiz R, Lam C, Luciani S, Ilbawi A, Rodríguez-Galindo C, Maza M. Advances in the Global Initiative for Childhood Cancer: implementation in Latin America and the Caribbean. Rev Panam Salud Publica 2023; 47:e128. [PMID: 37750056 PMCID: PMC10516329 DOI: 10.26633/rpsp.2023.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/30/2023] [Indexed: 09/27/2023] Open
Abstract
This report describes the status of childhood cancer control initiatives in Latin America and the Caribbean (LAC). Progress between 2017 and 2023 is measured using the outcome indicators from the Pan American Health Organization (PAHO) childhood cancer logic model aligned with the World Health Organization Global Initiative for Childhood Cancer (GICC). This report also describes the advances, barriers, and facilitators for the implementation of the GICC at the Regional level. Methods used in this report encompassed a comprehensive approach, incorporating a literature review, interviews, surveys, and a Delphi study developed by the technical team of the PAHO Non-Communicable Diseases and Mental Health Department and by the GICC LAC working group. Since 2017, there has been a substantial increase in the number of countries that have included childhood cancer in their national regulations. Currently, 21 LAC countries are involved in the GICC implementation, activities, and dialogues. However, the objectives for 2030 will only be achieved if Member States overcome the barriers to accelerating the pace of initiative implementation. There is an urgent need to increase the efforts in childhood cancer control in LAC, especially regarding the prioritization of timely detection, essential diagnostics, access to cancer treatment, palliative care, and close follow-up of children and adolescents with cancer.
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Affiliation(s)
- Liliana Vásquez
- Unit of Noncommunicable DiseasesDepartment of Noncommunicable Diseases and Mental HealthPan American Health Organization/World Health OrganizationWashington, DCUnited States of AmericaUnit of Noncommunicable Diseases, Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization/World Health Organization, Washington, DC, United States of America.
| | - Soad Fuentes-Alabí
- Unit of Noncommunicable DiseasesDepartment of Noncommunicable Diseases and Mental HealthPan American Health Organization/World Health OrganizationWashington, DCUnited States of AmericaUnit of Noncommunicable Diseases, Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization/World Health Organization, Washington, DC, United States of America.
| | - Patricia Loggetto
- Department of Global Pediatric MedicineWorld Health Organization–Collaborating Center for Childhood CancerSt. Jude Children’s Research HospitalMemphisUnited States of AmericaDepartment of Global Pediatric Medicine, World Health Organization–Collaborating Center for Childhood Cancer, St. Jude Children’s Research Hospital, Memphis, United States of America.
| | - Sara Benitez-Majano
- Unit of Noncommunicable DiseasesDepartment of Noncommunicable Diseases and Mental HealthPan American Health Organization/World Health OrganizationWashington, DCUnited States of AmericaUnit of Noncommunicable Diseases, Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization/World Health Organization, Washington, DC, United States of America.
| | - Monika L. Metzger
- Department of Global Pediatric MedicineWorld Health Organization–Collaborating Center for Childhood CancerSt. Jude Children’s Research HospitalMemphisUnited States of AmericaDepartment of Global Pediatric Medicine, World Health Organization–Collaborating Center for Childhood Cancer, St. Jude Children’s Research Hospital, Memphis, United States of America.
| | - Marta Jarquin-Pardo
- Department of Global Pediatric MedicineWorld Health Organization–Collaborating Center for Childhood CancerSt. Jude Children’s Research HospitalMemphisUnited States of AmericaDepartment of Global Pediatric Medicine, World Health Organization–Collaborating Center for Childhood Cancer, St. Jude Children’s Research Hospital, Memphis, United States of America.
| | - Naomi Echeandia-Abud
- Department of Global Pediatric MedicineWorld Health Organization–Collaborating Center for Childhood CancerSt. Jude Children’s Research HospitalMemphisUnited States of AmericaDepartment of Global Pediatric Medicine, World Health Organization–Collaborating Center for Childhood Cancer, St. Jude Children’s Research Hospital, Memphis, United States of America.
| | - Sumit Gupta
- Division of Hematology–OncologyThe Hospital for Sick ChildrenTorontoCanadaDivision of Hematology–Oncology, The Hospital for Sick Children, Toronto, Canada.
| | - Avram Denburg
- Division of Hematology–OncologyThe Hospital for Sick ChildrenTorontoCanadaDivision of Hematology–Oncology, The Hospital for Sick Children, Toronto, Canada.
| | - Paola Friedrich
- Department of Global Pediatric MedicineWorld Health Organization–Collaborating Center for Childhood CancerSt. Jude Children’s Research HospitalMemphisUnited States of AmericaDepartment of Global Pediatric Medicine, World Health Organization–Collaborating Center for Childhood Cancer, St. Jude Children’s Research Hospital, Memphis, United States of America.
| | - Roberta Ortiz
- Department for the Management of Noncommunicable Diseases, Disability, Violence and Injury PreventionWorld Health OrganizationGenevaSwitzerlandDepartment for the Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, World Health Organization, Geneva, Switzerland.
| | - Catherine Lam
- Department of Global Pediatric MedicineWorld Health Organization–Collaborating Center for Childhood CancerSt. Jude Children’s Research HospitalMemphisUnited States of AmericaDepartment of Global Pediatric Medicine, World Health Organization–Collaborating Center for Childhood Cancer, St. Jude Children’s Research Hospital, Memphis, United States of America.
| | - Silvana Luciani
- Unit of Noncommunicable DiseasesDepartment of Noncommunicable Diseases and Mental HealthPan American Health Organization/World Health OrganizationWashington, DCUnited States of AmericaUnit of Noncommunicable Diseases, Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization/World Health Organization, Washington, DC, United States of America.
| | - Andre Ilbawi
- Department for the Management of Noncommunicable Diseases, Disability, Violence and Injury PreventionWorld Health OrganizationGenevaSwitzerlandDepartment for the Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, World Health Organization, Geneva, Switzerland.
| | - Carlos Rodríguez-Galindo
- Department of Global Pediatric MedicineWorld Health Organization–Collaborating Center for Childhood CancerSt. Jude Children’s Research HospitalMemphisUnited States of AmericaDepartment of Global Pediatric Medicine, World Health Organization–Collaborating Center for Childhood Cancer, St. Jude Children’s Research Hospital, Memphis, United States of America.
| | - Mauricio Maza
- Unit of Noncommunicable DiseasesDepartment of Noncommunicable Diseases and Mental HealthPan American Health Organization/World Health OrganizationWashington, DCUnited States of AmericaUnit of Noncommunicable Diseases, Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization/World Health Organization, Washington, DC, United States of America.
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11
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Loggetto P, Jarquin-Pardo M, Fuentes-Alabi S, Vasquez L, Benitez Majano S, Gonzalez Ruiz A, Maza M, Metzger ML, Friedrich P, Luciani S, Lam CG. Regional collaboration for the development of national childhood cancer plans in Latin America and the Caribbean. Rev Panam Salud Publica 2023; 47:e125. [PMID: 37750054 PMCID: PMC10516325 DOI: 10.26633/rpsp.2023.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/21/2023] [Indexed: 09/27/2023] Open
Abstract
This article aims to describe the activities conducted by the National Childhood Cancer Plan Working Group to support the development of national childhood cancer plans in Latin America and the Caribbean in the period 2019-2022, and to present the stage of plan development. The Working Group activities were supported by the Pan American Health Organization and St. Jude Children's Research Hospital, which is the World Health Organization (WHO) Collaborating Centre for Childhood Cancer. Year after year, the workshops and activities developed with the Working Group mobilized key stakeholders: pediatric oncologists, representatives of the Ministry of Health, foundations supporting childhood cancer initiatives, and hospital administrators. As of February 2023, one regional framework is in place, approved by the Council of Ministries of Health of Central America and the Dominican Republic, nine countries are currently implementing national plans or laws that include childhood cancer, and ten countries are writing new plans. The WHO three-step framework helped to guide the Working Group activities. All plans were supported by a situational analysis, which highlighted the importance of having systematized data for evidence-based policies. To increase implementation success, an accompanying budget and timeline help to ensure the adequate implementation of the interventions. More than anything, committed stakeholders remain the most fundamental element to successfully write and approve a national childhood cancer plan. This is an opportunity to share these countries' experience so the strategy can be adapted to support other countries developing a childhood cancer plan and extended to other public health areas.
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Affiliation(s)
- Patrícia Loggetto
- St. Jude Children’s Research HospitalWHO Collaborating Centre for Childhood CancerMemphisUnited States of AmericaSt. Jude Children’s Research Hospital, WHO Collaborating Centre for Childhood Cancer, Memphis, United States of America
| | - Marta Jarquin-Pardo
- St. Jude Children’s Research HospitalWHO Collaborating Centre for Childhood CancerMemphisUnited States of AmericaSt. Jude Children’s Research Hospital, WHO Collaborating Centre for Childhood Cancer, Memphis, United States of America
| | - Soad Fuentes-Alabi
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
| | - Liliana Vasquez
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
| | - Sara Benitez Majano
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
| | - Alejandra Gonzalez Ruiz
- St. Jude Children’s Research HospitalWHO Collaborating Centre for Childhood CancerMemphisUnited States of AmericaSt. Jude Children’s Research Hospital, WHO Collaborating Centre for Childhood Cancer, Memphis, United States of America
| | - Mauricio Maza
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
| | - Monika L. Metzger
- Médecins Sans FrontièresGenevaSwitzerlandMédecins Sans Frontières, Geneva, Switzerland
| | - Paola Friedrich
- St. Jude Children’s Research HospitalWHO Collaborating Centre for Childhood CancerMemphisUnited States of AmericaSt. Jude Children’s Research Hospital, WHO Collaborating Centre for Childhood Cancer, Memphis, United States of America
| | - Silvana Luciani
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
| | - Catherine G. Lam
- St. Jude Children’s Research HospitalWHO Collaborating Centre for Childhood CancerMemphisUnited States of AmericaSt. Jude Children’s Research Hospital, WHO Collaborating Centre for Childhood Cancer, Memphis, United States of America
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12
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Batman S, Varon ML, San Miguel-Majors SL, Benitez Majano S, Pontremoli Salcedo M, Montealegre J, Arrossi S, Oliveira MTDC, Oliveira LHD, Luciani S, Milan J, Trimble EL, Schmeler KM, Maza M. Elimination of cervical cancer in Latin America (Project ECHO-ELA): lessons from phase one of implementation. Rev Panam Salud Publica 2023; 47:e113. [PMID: 37489237 PMCID: PMC10361421 DOI: 10.26633/rpsp.2023.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 05/02/2023] [Indexed: 07/26/2023] Open
Abstract
We describe the outcomes of The Extension for Community Healthcare Outcomes-Elimination of Cervical Cancer in The Americas (ECHO-ELA) program, which was developed as a tri-lateral cooperation between Pan American Health Organization (PAHO), the U.S. National Cancer Institute (NCI) and The University of Texas MD Anderson Cancer Center (MD Anderson). The program's purpose is to disseminate strategies for cervical cancer prevention and is structured around the three pillars of the World Health Organization's (WHO) Cervical Cancer Elimination Strategy and the associated 90-70-90 target goals. The target audience includes health authorities from Latin American and Caribbean countries, as well as PAHO's non-communicable disease Focal Points in country offices as well as clinical and public health collaborators. The virtual sessions are held in Spanish for 1.5 hours every month using the ECHO® format. From May 2020 to June 2021, 14 ECHO sessions were held with an average of 74 participants per session (range: 46 - 142). We conducted two anonymous surveys (baseline and follow up) and two focus groups. Respondents stated that the topics they learned the most about included the state of HPV vaccination in the region and strategies for implementing HPV vaccination. Identified needs included support between ECHO sessions and country-specific technical assistance. The ECHO-ELA program provides a forum for increased collaboration between countries in Latin America/Caribbean and the dissemination of best-practice strategies to reach the WHO Cervical Cancer Elimination target goals.
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Affiliation(s)
- Samantha Batman
- The University of Texas MD Anderson Cancer CenterHoustonUnited States of AmericaThe University of Texas MD Anderson Cancer Center, Houston, United States of America.
| | - Melissa Lopez Varon
- The University of Texas MD Anderson Cancer CenterHoustonUnited States of AmericaThe University of Texas MD Anderson Cancer Center, Houston, United States of America.
| | - Sandra L. San Miguel-Majors
- US National Cancer InstituteBethesdaUnited States of AmericaUS National Cancer Institute, Bethesda, United States of America.
| | - Sara Benitez Majano
- Pan American Health Organization (PAHO)Washington, DCUnited States of AmericaPan American Health Organization (PAHO), Washington, DC, United States of America.
| | - Mila Pontremoli Salcedo
- The University of Texas MD Anderson Cancer CenterHoustonUnited States of AmericaThe University of Texas MD Anderson Cancer Center, Houston, United States of America.
| | - Jane Montealegre
- Baylor College of MedicineHoustonUnited States of AmericaBaylor College of Medicine, Houston, United States of America.
| | - Silvina Arrossi
- Consejo Nacional de Investigaciones Científicas y TécnicasCentro de Estudios de Estado y SociedadBuenos AiresArgentinaConsejo Nacional de Investigaciones Científicas y Técnicas, Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina.
| | - Maria Tereza da Costa Oliveira
- Pan American Health Organization (PAHO)Washington, DCUnited States of AmericaPan American Health Organization (PAHO), Washington, DC, United States of America.
| | - Lucia H. De Oliveira
- Pan American Health Organization (PAHO)Washington, DCUnited States of AmericaPan American Health Organization (PAHO), Washington, DC, United States of America.
| | - Silvana Luciani
- Pan American Health Organization (PAHO)Washington, DCUnited States of AmericaPan American Health Organization (PAHO), Washington, DC, United States of America.
| | - Jessica Milan
- The University of Texas MD Anderson Cancer CenterHoustonUnited States of AmericaThe University of Texas MD Anderson Cancer Center, Houston, United States of America.
| | - Edward L. Trimble
- US National Cancer InstituteBethesdaUnited States of AmericaUS National Cancer Institute, Bethesda, United States of America.
| | - Kathleen M. Schmeler
- The University of Texas MD Anderson Cancer CenterHoustonUnited States of AmericaThe University of Texas MD Anderson Cancer Center, Houston, United States of America.
| | - Mauricio Maza
- Pan American Health Organization (PAHO)Washington, DCUnited States of AmericaPan American Health Organization (PAHO), Washington, DC, United States of America.
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Mossadeghi B, Caixeta R, Ondarsuhu D, Luciani S, Hambleton IR, Hennis AJM. Multimorbidity and social determinants of health in the US prior to the COVID-19 pandemic and implications for health outcomes: a cross-sectional analysis based on NHANES 2017-2018. BMC Public Health 2023; 23:887. [PMID: 37189096 DOI: 10.1186/s12889-023-15768-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 04/26/2023] [Indexed: 05/17/2023] Open
Abstract
Multimorbidity increases the risk of all-cause mortality, and along with age, is an independent risk factor for severe disease and mortality from COVID-19. Inequities in the social determinants of health contributed to increased mortality from COVID-19 among disadvantaged populations. This study aimed to evaluate the prevalence of multimorbid conditions and associations with the social determinants of health in the US prior to the pandemic.Methods Data from the 2017-18 cycle of NHANES were used to determine the prevalence of 13 chronic conditions, and the prevalence of having 0, 1, or 2 or more of those conditions, among the US adult population aged ≥ 20 years. Multimorbidity was defined as having 2 or more of these conditions. Data were stratified according to demographic, socioeconomic and indicators of health access, and analyses including logistic regression, performed to determine the factors associated with multimorbidity.Results The prevalence of multimorbidity was 58.4% (95% CI 55.2 to 61.7). Multimorbidity was strongly associated with age and was highly prevalent among those aged 20-29 years at 22.2% (95% CI 16.9 to 27.6) and continued to increase with older age. The prevalence of multimorbidity was highest in those defined as Other or multiple races (66.9%), followed in decreasing frequency by rates among non-Hispanic Whites (61.2%), non-Hispanic Blacks (57.4%), Hispanic (52.0%) and Asian (41.3%) groups.Logistic regression showed a statistically significant relationship between multimorbidity and age, as expected. Asian race was associated with a reduced likelihood of 2 or more chronic conditions (OR 0.4; 95% CI 0.35 to 0.57; P < 0.0001). Socioeconomic factors were related to multimorbidity. Being above the poverty level (OR 0.64; 95% CI 0.46 to 0.91, p = 0.013); and a lack of regular access to health care (OR 0.61 (95% CI 0.42 to 0.88, p = 0.008) were both associated with a reduced likelihood of multimorbidity. Furthermore, there was a borderline association between not having health insurance and reduced likelihood of multimorbidity (OR 0.63; 95% CI 0.40 to 1.0; p = 0.053).Conclusions There are high levels of multimorbidity in the US adult population, evident from young adulthood and increasing with age. Cardiometabolic causes of multimorbidity were highly prevalent, especially obesity, hyperlipidemia, hypertension, and diabetes; conditions subsequently found to be associated with severe disease and death from COVID-19. A lack of access to care was paradoxically associated with reduced likelihood of comorbidity, likely linked to underdiagnosis of chronic conditions. Obesity, poverty, and lack of access to healthcare are factors related to multimorbidity and were also relevant to the health impact of the COVID-19 pandemic, that must be addressed through comprehensive social and public policy measures. More research is needed on the etiology and determinants of multimorbidity, on those affected, patterns of co-morbidity, and implications for individual health and impact on health systems and society to promote optimal outcomes. Comprehensive public health policies are needed to tackle multimorbidity and reduce disparities in the social determinants of health, as well as to provide universal access to healthcare.
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Affiliation(s)
- Bijan Mossadeghi
- Stony Brook University Medical Center, 101 Nicolls Road Health Sciences Center, Stony Brook, NY, 11794-843, USA
- , New York, United States
| | - Roberta Caixeta
- Pan American Health Organization, Washington, DC, USA
- , Washington D.C., United States
| | - Dolores Ondarsuhu
- Pan American Health Organization, Washington, DC, USA
- , Washington D.C., United States
| | - Silvana Luciani
- Pan American Health Organization, Washington, DC, USA
- , Washington D.C., United States
| | - Ian R Hambleton
- George Alleyne Chronic Disease Research Centre, The University of the West Indies, Bridgetown, Barbados
- , Bridgetown, Barbados
| | - Anselm J M Hennis
- Pan American Health Organization, Washington, DC, USA.
- , Washington D.C., United States.
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Hambleton IR, Caixeta R, Jeyaseelan SM, Luciani S, Hennis AJ. The rising burden of non-communicable diseases in the Americas and the impact of population aging: a secondary analysis of available data. The Lancet Regional Health - Americas 2023; 21:100483. [PMID: 37065858 PMCID: PMC10090658 DOI: 10.1016/j.lana.2023.100483] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 01/22/2023] [Accepted: 03/15/2023] [Indexed: 04/03/2023]
Abstract
Background Public health progress in the Americas has reduced the burden of many infectious diseases, helping more people live longer lives. At the same time, the burden of non-communicable diseases (NCDs) is increasing. NCD prevention rightly focuses on lifestyle risk factors, social, and economic determinants of health. There is less published information on the importance of population growth and aging to the regional NCD burden. Methods For 33 countries in the Americas, we used United Nations population data to describe rates of population growth and aging over two generations (1980-2060). We used World Health Organization estimates of mortality and disability (disability-adjusted life years, DALYs) to describe changes in the NCD burden between 2000 and 2019. After combining these data resources, we decomposed the change in the number of deaths and DALYs to estimate the percentage change due to population growth, due to population aging, and due to epidemiological advances, measured by changing mortality and DALY rates. In a supplement, we provide a summary briefing for each country. Findings In 1980, the proportion of the regional population aged 70 and older was 4.6%. It rose to 7.8% by 2020 and is predicted to rise to 17.4% by 2060. Across the Americas, DALY rate reductions would have decreased the number of DALYs by 18% between 2000 and 2019 but was offset by a 28% increase due to population aging and a 22% increase due to population growth. Although the region enjoyed widespread reductions in rates of disability, these improvements have not been sufficiently large to offset the pressures of population growth and population aging. Interpretation The region of the Americas is aging and the pace of this aging is predicted to increase. The demographic realities of population growth and population aging should be factored into healthcare planning, to understand their implications for the future NCD burden, the health system needs, and the readiness of governments and communities to respond to those needs. Funding This work was funded in part by the Pan American Health Organization, Department of Noncommunicable Diseases and Mental Health.
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15
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Baena A, Mesher D, Salgado Y, Martínez S, Villalba GR, Amarilla ML, Salgado B, Flores B, Bellido‐Fuentes Y, Álvarez‐Larraondo M, Valls J, Lora O, Virreira‐Prout G, Figueroa J, Turcios E, Soilán AM, Ortega M, Celis M, González M, Venegas G, Terán C, Ferrera A, Mendoza L, Kasamatsu E, Murillo R, Wiesner C, Broutet N, Luciani S, Herrero R, Almonte M. Performance of visual inspection of the cervix with acetic acid (VIA) for triage of HPV screen-positive women: results from the ESTAMPA study. Int J Cancer 2023; 152:1581-1592. [PMID: 36451311 PMCID: PMC10107773 DOI: 10.1002/ijc.34384] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/29/2022] [Accepted: 11/09/2022] [Indexed: 12/03/2022]
Abstract
VIA is recommended for triage of HPV-positive women attending cervical screening. In the multicentric ESTAMPA study, VIA performance for detection of cervical intraepithelial neoplasia grade 3 or worse (CIN3+) among HPV-positive women was evaluated. Women aged 30-64 years were screened with HPV testing and cytology and referred to colposcopy if either test was positive. At colposcopy visit, study-trained midwives/nurses/GPs performed VIA ahead of colposcopy. VIA was considered positive if acetowhite lesions were observed in or close to the transformation zone. Ablative treatment eligibility was assessed for VIA positives. Performance indicators were estimated. Three thousand one hundred and forty-two HPV-positive women were included. Sensitivity for CIN3+ was 85.9% (95% CI 81.2-89.5) among women <50 years and, although not significant, slightly lower in women 50+ (78.0%, 95% CI 65.9-86.6). Overall specificity was 58.6% (95% CI 56.7-60.5) and was significantly higher among women 50+ (70.3%, 95% CI 66.8-73.5) compared to women <50 (54.3%, 95% CI 52.1-56.5). VIA positivity was lower among women 50+ (35.2%, 95% CI 31.9-38.6) compared to women <50 (53.2, 95% CI 51.1-55.2). Overall eligibility for ablative treatment was 74.5% and did not differ by age. VIA sensitivity, specificity, and positivity, and ablative treatment eligibility varied highly by provider (ranges: 25%-95.4%, 44.9%-94.4%, 8.2%-65.3%, 0%-98.7%, respectively). VIA sensitivity for cervical precancer detection among HPV-positive women performed by trained providers was high with an important reduction in referral rates. However, scaling-up HPV screening triaged by VIA will be challenging due to the high variability of VIA performance and providers' need for training and supervision.
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Affiliation(s)
- Armando Baena
- International Agency for Research on CancerLyonFrance
| | - David Mesher
- International Agency for Research on CancerLyonFrance
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV ServiceUK Health Security AgencyLondonUK
| | - Yuli Salgado
- Instituto Nacional de CancerologíaBogotáColombia
| | | | - Griselda Raquel Villalba
- Hospital Materno Infantil de San LorenzoMinisterio de Salud Pública y Bienestar SocialSan LorenzoParaguay
| | | | - Brenda Salgado
- Instituto de Investigaciones en Microbiología, Escuela de MicrobiologíaUniversidad Nacional Autónoma de HondurasTegucigalpaHonduras
| | - Bettsy Flores
- Facultad de MedicinaUniversidad Mayor, Real y Pontificia de San Francisco Xavier de ChuquisacaSucreBolivia
| | | | | | - Joan Valls
- International Agency for Research on CancerLyonFrance
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC)MadridSpain
| | - Oscar Lora
- Facultad de MedicinaUniversidad Mayor, Real y Pontificia de San Francisco Xavier de ChuquisacaSucreBolivia
- Hospital Gineco‐Obstétrico y Neonatal “Dr Jaime Sánchez Porcel”SucreBolivia
| | - Gonzalo Virreira‐Prout
- Hospital Gineco‐Obstétrico y Neonatal “Dr Jaime Sánchez Porcel”SucreBolivia
- Seguro Social Universitario (SSU)SucreBolivia
| | | | - Elmer Turcios
- Programa Nacional contra el CáncerTegucigalpaHonduras
| | - Ana María Soilán
- Instituto de Investigaciones en Ciencias de la SaludUniversidad Nacional de AsunciónSan LorenzoParaguay
| | - Marina Ortega
- Instituto de Investigaciones en Ciencias de la SaludUniversidad Nacional de AsunciónSan LorenzoParaguay
| | | | | | - Gino Venegas
- Clínica AngloamericanaLimaPeru
- Escuela de Medicina HumanaUniversidad de PiuraLimaPeru
| | - Carolina Terán
- Facultad de MedicinaUniversidad Mayor, Real y Pontificia de San Francisco Xavier de ChuquisacaSucreBolivia
| | - Annabelle Ferrera
- Instituto de Investigaciones en Microbiología, Escuela de MicrobiologíaUniversidad Nacional Autónoma de HondurasTegucigalpaHonduras
| | - Laura Mendoza
- Instituto de Investigaciones en Ciencias de la SaludUniversidad Nacional de AsunciónSan LorenzoParaguay
| | - Elena Kasamatsu
- Instituto de Investigaciones en Ciencias de la SaludUniversidad Nacional de AsunciónSan LorenzoParaguay
| | - Raúl Murillo
- International Agency for Research on CancerLyonFrance
- Centro Javeriano de OncologíaHospital Universitario San IgnacioBogotáColombia
| | | | - Nathalie Broutet
- Department of Sexual and Reproductive Health and ResearchWorld Health OrganizationGenevaSwitzerland
| | - Silvana Luciani
- Pan American Health Organization (PAHO)WashingtonDistrict of ColumbiaUSA
| | - Rolando Herrero
- International Agency for Research on CancerLyonFrance
- Agencia Costarricense de Investigaciones Biomédicas (ACIB)Fundación InciensaGuanacasteCosta Rica
| | - Maribel Almonte
- International Agency for Research on CancerLyonFrance
- Department of Sexual and Reproductive Health and ResearchWorld Health OrganizationGenevaSwitzerland
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Luciani S, Caixeta R, Chavez C, Ondarsuhu D, Hennis A. What is the NCD service capacity and disruptions due to COVID-19? Results from the WHO non-communicable disease country capacity survey in the Americas region. BMJ Open 2023; 13:e070085. [PMID: 36863746 PMCID: PMC9990165 DOI: 10.1136/bmjopen-2022-070085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
OBJECTIVE This article presents the Americas regional results of the WHO non-communicable diseases (NCDs) Country Capacity Survey from 2019 to 2021, on NCD service capacity and disruptions from the COVID-19 pandemic. SETTING Information on public sector primary care services for NCDs, and related technical inputs from 35 countries in the Americas region are provided. PARTICIPANTS All Ministry of Health officials managing a national NCD programme, from a WHO Member State in the Americas region, were included throughout this study. Government health officials from countries that are not WHO Member States were excluded. OUTCOME MEASURES The availability of evidence-based NCD guidelines, essential NCD medicines and basic technologies in primary care, cardiovascular disease risk stratification, cancer screening and palliative care services were measured in 2019, 2020 and 2021. NCD service interruptions, reassignments of NCD staff during the COVID-19 pandemic and mitigation strategies to reduce disruptions for NCD services were measured in 2020 and 2021. RESULTS More than 50% of countries reported a lack of comprehensive package of NCD guidelines, essential medicines and related service inputs. Extensive disruptions in NCD services resulted from the pandemic, with only 12/35 countries (34%), reporting that outpatient NCD services were functioning normally. Ministry of Health staff were largely redirected to work on the COVID-19 response, either full time or partially, reducing the human resources available for NCD services. Six of 24 countries (25%) reported stock out of essential NCD medicines and/or diagnostics at health facilities which affected service continuity. Mitigation strategies to ensure continuity of care for people with NCDs were deployed in many countries and included triaging patients, telemedicine and teleconsultations, and electronic prescriptions and other novel prescribing practices. CONCLUSIONS The findings from this regional survey suggest significant and sustained disruptions, affecting all countries regardless of the country's level of investments in healthcare or NCD burden.
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Affiliation(s)
- Silvana Luciani
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, District of Columbia, USA
| | - Roberta Caixeta
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, District of Columbia, USA
| | - Carolina Chavez
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, District of Columbia, USA
| | - Dolores Ondarsuhu
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, District of Columbia, USA
| | - Anselm Hennis
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, District of Columbia, USA
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Valls J, Baena A, Venegas G, Celis M, González M, Sosa C, Santin JL, Ortega M, Soilán A, Turcios E, Figueroa J, Rodríguez de la Peña M, Figueredo A, Beracochea AV, Pérez N, Martínez-Better J, Lora O, Jiménez JY, Giménez D, Fleider L, Salgado Y, Martínez S, Bellido-Fuentes Y, Flores B, Tatti S, Villagra V, Cruz-Valdez A, Terán C, Sánchez GI, Rodríguez G, Picconi MA, Ferrera A, Mendoza L, Calderón A, Murillo R, Wiesner C, Broutet N, Luciani S, Pérez C, Darragh TM, Jerónimo J, Herrero R, Almonte M. Performance of standardised colposcopy to detect cervical precancer and cancer for triage of women testing positive for human papillomavirus: results from the ESTAMPA multicentric screening study. Lancet Glob Health 2023; 11:e350-e360. [PMID: 36796982 PMCID: PMC10020136 DOI: 10.1016/s2214-109x(22)00545-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 12/01/2022] [Accepted: 12/05/2022] [Indexed: 02/16/2023]
Abstract
BACKGROUND Colposcopy, currently included in WHO recommendations as an option to triage human papillomavirus (HPV)-positive women, remains as the reference standard to guide both biopsy for confirmation of cervical precancer and cancer and treatment approaches. We aim to evaluate the performance of colposcopy to detect cervical precancer and cancer for triage in HPV-positive women. METHODS This cross-sectional, multicentric screening study was conducted at 12 centres (including primary and secondary care centres, hospitals, laboratories, and universities) in Latin America (Argentina, Bolivia, Colombia, Costa Rica, Honduras, Mexico, Paraguay, Peru, and Uruguay). Eligible women were aged 30-64 years, sexually active, did not have a history of cervical cancer or treatment for cervical precancer or a hysterectomy, and were not planning to move outside of the study area. Women were screened with HPV DNA testing and cytology. HPV-positive women were referred to colposcopy using a standardised protocol, including biopsy collection of observed lesions, endocervical sampling for transformation zone (TZ) type 3, and treatment as needed. Women with initial normal colposcopy or no high-grade cervical lesions on histology (less than cervical intraepithelial neoplasia [CIN] grade 2) were recalled after 18 months for another HPV test to complete disease ascertainment; HPV-positive women were referred for a second colposcopy with biopsy and treatment as needed. Diagnostic accuracy of colposcopy was assessed by considering a positive test result when the colposcopic impression at the initial colposcopy was positive minor, positive major, or suspected cancer, and was considered negative otherwise. The main study outcome was histologically confirmed CIN3+ (defined as grade 3 or worse) detected at the initial visit or 18-month visit. FINDINGS Between Dec 12, 2012, and Dec 3, 2021, 42 502 women were recruited, and 5985 (14·1%) tested positive for HPV. 4499 participants with complete disease ascertainment and follow-up were included in the analysis, with a median age of 40·6 years (IQR 34·7-49·9). CIN3+ was detected in 669 (14·9%) of 4499 women at the initial visit or 18-month visit (3530 [78·5%] negative or CIN1, 300 [6·7%] CIN2, 616 [13·7%] CIN3, and 53 [1·2%] cancers). Sensitivity was 91·2% (95% CI 88·9-93·2) for CIN3+, whereas specificity was 50·1% (48·5-51·8) for less than CIN2 and 47·1% (45·5-48·7) for less than CIN3. Sensitivity for CIN3+ significantly decreased in older women (93·5% [95% CI 91·3-95·3] in those aged 30-49 years vs 77·6% [68·6-85·0] in those aged 50-65 years; p<0·0001), whereas specificity for less than CIN2 significantly increased (45·7% [43·8-47·6] vs 61·8% [58·7-64·8]; p<0·0001). Sensitivity for CIN3+ was also significantly lower in women with negative cytology than in those with abnormal cytology (p<0·0001). INTERPRETATION Colposcopy is accurate for CIN3+ detection in HPV-positive women. These results reflect ESTAMPA efforts in an 18-month follow-up strategy to maximise disease detection with an internationally validated clinical management protocol and regular training, including quality improvement practices. We showed that colposcopy can be optimised with proper standardisation to be used as triage in HPV-positive women. FUNDING WHO; Pan American Health Organization; Union for International Cancer Control; National Cancer Institute (NCI); NCI Center for Global Health; National Agency for the Promotion of Research, Technological Development, and Innovation; NCI of Argentina and Colombia; Caja Costarricense de Seguro Social; National Council for Science and Technology of Paraguay; International Agency for Research on Cancer; and all local collaborative institutions.
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Affiliation(s)
- Joan Valls
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France; Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain.
| | - Armando Baena
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Gino Venegas
- Clínica Angloamericana, Lima, Peru; Escuela de Medicina Humana, Universidad de Piura, Lima, Peru
| | - Marcela Celis
- Instituto Nacional de Cancerología, Bogotá, Colombia
| | | | - Carlos Sosa
- Hospital Monseñor Victor Manuel Sanabria Martínez, Puntarenas, Costa Rica
| | - Jorge Luis Santin
- Hospital Monseñor Victor Manuel Sanabria Martínez, Puntarenas, Costa Rica
| | - Marina Ortega
- Hospital Nacional, Ministerio de Salud Pública y Bienestar Social, Itauguá, Paraguay; Instituto Nacional del Cáncer, Ministerio de Salud Pública y Bienestar Social, Capiatá, Paraguay
| | - Ana Soilán
- Hospital Nacional, Ministerio de Salud Pública y Bienestar Social, Itauguá, Paraguay; Hospital Materno Infantil de San Lorenzo, Ministerio de Salud Pública y Bienestar Social, San Lorenzo, Paraguay
| | - Elmer Turcios
- Programa Nacional contra el Cáncer, Tegucigalpa, Honduras
| | | | | | - Alicia Figueredo
- Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | | | - Natalia Pérez
- Hospital de Clínicas, Facultad de Medicina, Montevideo, Uruguay
| | | | - Oscar Lora
- Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia; Hospital Gineco-Obstétrico y Neonatal Dr Jaime Sánchez Porcel, Sucre, Bolivia
| | | | - Diana Giménez
- Hospital Materno Infantil de Trinidad, Ministerio de Salud Pública y Bienestar Social, Asunción, Paraguay
| | - Laura Fleider
- Hospital de Clínicas, José de San Martín, Buenos Aires, Argentina
| | - Yuly Salgado
- Instituto Nacional de Cancerología, Bogotá, Colombia
| | | | | | - Bettsy Flores
- Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia
| | - Silvio Tatti
- Hospital de Clínicas, José de San Martín, Buenos Aires, Argentina
| | | | | | - Carolina Terán
- Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia
| | | | | | | | - Annabelle Ferrera
- Instituto de Infecciones en Microbiología, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Laura Mendoza
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Alejandro Calderón
- Caja Costarricense de Seguro Social, Región Pacífico Central, San José, Costa Rica
| | - Raul Murillo
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France; Instituto Nacional de Cancerología, Bogotá, Colombia
| | | | - Nathalie Broutet
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | | | - Carlos Pérez
- Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Teresa M Darragh
- Department of Pathology, University of California, San Francisco, CA, USA
| | - José Jerónimo
- Liga contra el Cáncer-Peru, Lima, Peru; US National Cancer Institute, Bethesda, MD, USA
| | - Rolando Herrero
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France; Agencia Costarricense de Investigaciones Biomédicas, Fundación Inciensa, Guanacaste, Costa Rica
| | - Maribel Almonte
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France; Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
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Fernández Deaza GP, Zuluaga M, Maza M, Luciani S, Murillo R. Follow-up on Women with Abnormal Findings of Cervical Cancer Screening in “The Americas” Region:. Univ Med 2023. [DOI: 10.11144/javeriana.umed63-4.foll] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The Americas region ranks third in the world in incidence and mortality from cervical cancer among World Health Organization (WHO) regions. Several studies analyze screening coverage and accuracy of screening tests as the main reasons for lack of effectiveness; however, reports on follow-up of positive-screened women are scarce. Aim: To synthesize the existing knowledge about compliance with follow-up recommendations after an abnormal result of cervical cancer screening. Methods: We will search the PubMed via Medline and LILACS databases, with additional searches of grey literature. Inclusion criteria comprise studies on adult women from the Pan American Health Organization (PAHO) affiliated countries, with full text available and with specified data on follow-up outcomes. There are no language or publication date restrictions. Studies on special populations or including only women under age 25 will be excluded. Two reviewers will screen titles and abstracts independently, and two researchers will assess the methodological quality and risk of bias by using validated tools according to type of study. Disagreements will be solved by consensus. Discussion: This systematic review will provide information on differences and determinants of effective follow-up of positive-screened women in cervical cancer screening. The use of a Latin American database, the review of grey literature, and the inclusion of studies in all languages will allow us to identify more reports that might be relevant for low and middle income countries (LMIC) accounting with a high burden of disease.
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Vahos J, Rojas-Cortés R, Daza D, Osorio-Florez LC, Macías Saint-Gerons D, Pastrana T, Muñoz S, Fitzgerald J, Porrás A, Luciani S, Castro JL. Barriers of Access to Opioid Medicines within the Context of Palliative Care in Latin America: The Perception of Health Professionals. J Palliat Med 2023; 26:199-209. [PMID: 36040320 PMCID: PMC9894602 DOI: 10.1089/jpm.2022.0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: Different sets of barriers have been identified to explain the difficulties in the access and availability of opioid analgesics in palliative care, particularly in low- and middle-income countries, including Latin America. Objective: To validate a structured questionnaire for the access to opioid medicines and to investigate the perception of health professionals regarding access barriers to opioid analgesics in 17 countries of the Latin American Region. Design: Survey to identify the domains and barriers of access to opioid medicines according to health professionals, including physicians, nurses, and pharmacists affiliated to institutions that provide palliative care in Latin America between August 2019 and October 2020. Results: We analyzed responses from 426 health professionals. The median age was 44 years old (ranging from 23 to 73 years) with an average experience in palliative care of 10 years (range: 1-35), 71.8% were women, and 49.8% were affiliated to specialized health care facilities of urban areas (94.6%). The main barriers perceived to be extremely relevant by the respondents were "belief that patients can develop addiction" and "financial limitations of patients" for the patient's domain and the "appropriate education, instruction, and training of professionals" for health professional's domain. Conclusions: It is necessary to develop strategies to strengthen less-developed health systems of the region to review legal frameworks, ensure integrated palliative care systems, and deploy multidisciplinary strategies for sensitizing, training, and raising the awareness of patients, caregivers and, particularly, health professionals regarding appropriate prescription and rational use of opioid analgesics.
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Affiliation(s)
- Juanita Vahos
- Department of Pharmacy, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Robin Rojas-Cortés
- Pan American Health Organization, Washington, DC, USA.,Address correspondence to: Robin Rojas-Cortés, MS, Pan American Health Organization, 525 23rd Street NW, Washington, DC 20037, USA
| | - Daniela Daza
- Pharmaceutical Chemist, MSc Epidemiology, Bogota, Colombia
| | | | - Diego Macías Saint-Gerons
- Pan American Health Organization, Washington, DC, USA.,Department of Medicine, University of Valencia, INCLIVA Health Research Institute and CIBERSAM, Valencia, Spain
| | - Tania Pastrana
- Department of Palliative Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Sergio Muñoz
- Department of Public Health-CIGES, Faculty of Medicine, Universidad de la Frontera, Temuco, Chile
| | | | - Analía Porrás
- Pan American Health Organization, Washington, DC, USA
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20
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Lam CG, Vasquez L, Loggetto P, Fuentes-Alabi S, Gonzalez Ruiz A, Benitez Majano S, Jarquin-Pardo M, Maza M, Spencer J, Metzger ML, Luciani S. Partnering to implement the Global Initiative for Childhood Cancer in the Americas: prioritizing systems strengthening. Rev Panam Salud Publica 2023; 47:e41. [PMID: 36909810 PMCID: PMC9996541 DOI: 10.26633/rpsp.2023.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 11/08/2022] [Indexed: 03/11/2023] Open
Abstract
Working with PAHO/WHO to prioritize childhood cancer in the context of systems strengthening is central to St. Jude Children's Research Hospital (SJCRH)'s role as WHO Collaborating Centre for Childhood Cancer. This manuscript focuses on how SJCRH and PAHO/WHO have partnered to apply C5 (Country Collaboration for Childhood Cancer Control) to define and implement priority actions regionally, strengthening Ministry programs for childhood cancer, while implementing the Global Initiative for Childhood Cancer since 2018. Using C5, a tool developed by SJCRH, PAHO/WHO and SJCRH co-hosted regional/national workshops engaging authorities, clinicians and other stakeholders across 10 countries to map health systems needs and prioritize strategic activities (spanning Central America, Dominican Republic, Haiti, Brazil and Uruguay). SJCRH provided English/Spanish/Portuguese C5 versions/templates for analysis/prioritization exercises, and worked with PAHO/WHO and country teams to implement C5, analyze findings, and develop outputs. In an eight-country regional workshop, countries defined priorities within national/regional initiatives and ranked their value and political will, incorporating country-specific surveys and stakeholder dialogues. Each country prioritized one strategic activity for 2022-2023, exchanged insights via storytelling, and disseminated and applied results to inform country-specific and regional action plans. National workshops analyses have been incorporated into cancer control planning activities and collaborative work regionally. Implementation success factors include engaging actors beyond the clinic, enabling flexibility, and focusing on co-design with stakeholders. Joint implementation of C5 catalyzed prioritization and accelerated strategic activities to improve policies, capacity, and quality of care for children in the Americas, supporting Ministries to integrate childhood cancer interventions as part of systems strengthening.
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Affiliation(s)
- Catherine G Lam
- Department of Global Pediatric Medicine WHO Collaborating Centre for Childhood Cancer St. Jude Children's Research Hospital Memphis United States of America Department of Global Pediatric Medicine, WHO Collaborating Centre for Childhood Cancer, St. Jude Children's Research Hospital, Memphis, United States of America
| | - Liliana Vasquez
- Pan American Health Organization Washington, DC United States of America Pan American Health Organization, Washington, DC, United States of America
| | - Patrícia Loggetto
- Department of Global Pediatric Medicine WHO Collaborating Centre for Childhood Cancer St. Jude Children's Research Hospital Memphis United States of America Department of Global Pediatric Medicine, WHO Collaborating Centre for Childhood Cancer, St. Jude Children's Research Hospital, Memphis, United States of America
| | - Soad Fuentes-Alabi
- Pan American Health Organization Washington, DC United States of America Pan American Health Organization, Washington, DC, United States of America
| | - Alejandra Gonzalez Ruiz
- Local Health Systems Sustainability Project Latin America and the Caribbean Abt Associates Rockville United States of America Local Health Systems Sustainability Project Latin America and the Caribbean, Abt Associates. Rockville, United States of America
| | - Sara Benitez Majano
- Pan American Health Organization Washington, DC United States of America Pan American Health Organization, Washington, DC, United States of America
| | - Marta Jarquin-Pardo
- Department of Global Pediatric Medicine WHO Collaborating Centre for Childhood Cancer St. Jude Children's Research Hospital Memphis United States of America Department of Global Pediatric Medicine, WHO Collaborating Centre for Childhood Cancer, St. Jude Children's Research Hospital, Memphis, United States of America
| | - Mauricio Maza
- Pan American Health Organization Washington, DC United States of America Pan American Health Organization, Washington, DC, United States of America
| | - John Spencer
- Department of Global Pediatric Medicine WHO Collaborating Centre for Childhood Cancer St. Jude Children's Research Hospital Memphis United States of America Department of Global Pediatric Medicine, WHO Collaborating Centre for Childhood Cancer, St. Jude Children's Research Hospital, Memphis, United States of America
| | - Monika L Metzger
- Médecins Sans Frontières Geneva Switzerland Médecins Sans Frontières, Geneva, Switzerland
| | - Silvana Luciani
- Pan American Health Organization Washington, DC United States of America Pan American Health Organization, Washington, DC, United States of America
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Luciani S, Nederveen L, Martinez R, Caixeta R, Chavez C, Sandoval RC, Severini L, Cerón D, Gomes AB, Malik S, Gomez F, Ordunez P, Maza M, Monteiro M, Hennis A. Noncommunicable diseases in the Americas: a review of the Pan American Health Organization's 25-year program of work. Rev Panam Salud Publica 2023; 47:e13. [PMID: 37114168 PMCID: PMC10128884 DOI: 10.26633/rpsp.2023.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 10/30/2022] [Indexed: 04/29/2023] Open
Abstract
This article describes progress in tackling noncommunicable diseases (NCDs) in the Americas since the Pan American Health Organization (PAHO) started its NCD program 25 years ago. Changes in the epidemiology of NCDs, NCD policies, health service capacity, and surveillance are discussed. PAHO's NCD program is guided by regional plans of action on specific NCDs and risk factors, as well as a comprehensive NCD plan. Its work involves implementing evidence-based World Health Organization technical packages on NCDs and their risk factors with the aim of achieving the Sustainable Development Goal target of a one third reduction in premature mortality caused by NCDs by 2030. Important advances have been made in the past 25 years in implementation of: policies on NCD risk factors; interventions to improve NCD diagnosis and treatment; and NCD surveillance. Premature mortality from NCDs decreased by 1.7% a year between 2000 and 2011 and 0.77% a year between 2011 and 2019. However, policies on risk factor prevention and health promotion need to be strengthened to ensure more countries are on track to achieving the NCD-related health goals of the Sustainable Development Goals by 2030. Actions are recommended for governments to raise the priority of NCDs by: making NCDs a core pillar of primary care services, using revenues from health taxes to invest more in NCD prevention and control; and implementing policies, laws, and regulations to reduce the demand for and availability of tobacco, alcohol, and ultra-processed food products.
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Affiliation(s)
- Silvana Luciani
- Department of Noncommunicable Diseases and Mental HealthPan American Health OrganizationWashington, DCUnited States of AmericaDepartment of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States of America.
- Silvana Luciani,
| | - Leendert Nederveen
- Department of Noncommunicable Diseases and Mental HealthPan American Health OrganizationWashington, DCUnited States of AmericaDepartment of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States of America.
| | - Ramon Martinez
- Department of Noncommunicable Diseases and Mental HealthPan American Health OrganizationWashington, DCUnited States of AmericaDepartment of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States of America.
| | - Roberta Caixeta
- Department of Noncommunicable Diseases and Mental HealthPan American Health OrganizationWashington, DCUnited States of AmericaDepartment of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States of America.
| | - Carolina Chavez
- Department of Noncommunicable Diseases and Mental HealthPan American Health OrganizationWashington, DCUnited States of AmericaDepartment of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States of America.
| | - Rosa C. Sandoval
- Department of Noncommunicable Diseases and Mental HealthPan American Health OrganizationWashington, DCUnited States of AmericaDepartment of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States of America.
| | - Luciana Severini
- Department of Noncommunicable Diseases and Mental HealthPan American Health OrganizationWashington, DCUnited States of AmericaDepartment of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States of America.
| | - Diana Cerón
- Department of Noncommunicable Diseases and Mental HealthPan American Health OrganizationWashington, DCUnited States of AmericaDepartment of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States of America.
| | - Adriana B. Gomes
- Department of Noncommunicable Diseases and Mental HealthPan American Health OrganizationWashington, DCUnited States of AmericaDepartment of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States of America.
| | - Sehr Malik
- Department of Noncommunicable Diseases and Mental HealthPan American Health OrganizationWashington, DCUnited States of AmericaDepartment of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States of America.
| | - Fabio Gomez
- Department of Noncommunicable Diseases and Mental HealthPan American Health OrganizationWashington, DCUnited States of AmericaDepartment of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States of America.
| | - Pedro Ordunez
- Department of Noncommunicable Diseases and Mental HealthPan American Health OrganizationWashington, DCUnited States of AmericaDepartment of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States of America.
| | - Mauricio Maza
- Department of Noncommunicable Diseases and Mental HealthPan American Health OrganizationWashington, DCUnited States of AmericaDepartment of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States of America.
| | - Maristela Monteiro
- Department of Noncommunicable Diseases and Mental HealthPan American Health OrganizationWashington, DCUnited States of AmericaDepartment of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States of America.
| | - Anselm Hennis
- Department of Noncommunicable Diseases and Mental HealthPan American Health OrganizationWashington, DCUnited States of AmericaDepartment of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States of America.
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22
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Rol ML, Picconi MA, Ferrera A, Sánchez GI, Hernández MDLL, Lineros J, Peraza A, Brizuela M, Mendoza L, Mongelós P, Cabrera Y, Rodríguez de la Peña M, Correa RM, Terán C, Colque Reynaga D, García L, Ramírez AT, Hernández-Nevarez P, Doimi F, Ramón M, Arias-Stella J, Zúñiga M, Villagra V, Bobadilla ML, Cardinal L, Valls J, Lucas E, Baena A, Fleider L, Venegas G, Cruz-Valdez A, Rodríguez G, Calderón A, Wiesner C, Luciani S, Broutet N, Herrero R, Almonte M. Implementing HPV testing in 9 Latin American countries: The laboratory perspective as observed in the ESTAMPA study. Front Med (Lausanne) 2022; 9:1006038. [PMID: 36465901 PMCID: PMC9714610 DOI: 10.3389/fmed.2022.1006038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/24/2022] [Indexed: 11/18/2022] Open
Abstract
Background Replacement of cytology screening with HPV testing is recommended and essential for cervical cancer elimination. HPV testing for primary screening was implemented in 12 laboratories within 9 Latin American countries, as part of the ESTAMPA cervical cancer screening study. Our observations provide information on critical operational aspects for HPV testing implementation in diverse resource settings. Methods We describe the implementation process of HPV testing in ESTAMPA, focusing on laboratory aspects. We assess the readiness of 12 laboratories to start HPV testing and their continuity capacity to maintain good quality HPV testing until end of recruitment or up to December 2021. Readiness was based on a checklist. Information from the study database; regular meetings and monitoring visits; and a questionnaire on laboratory operational aspects sent in May 2020 were used to assess continuity capacity. Compliance with seven basic requirements (readiness) and eight continuity requirements (continuity capacity) was scored (1 = compliant, 0 = not compliant) and totaled to classify readiness and continuity capacity as very limited, limited, moderate or high. Experiences, challenges, and enablers of the implementation process are also described. Results Seven of 12 laboratories had high readiness, three moderate readiness, and of two laboratories new to HPV testing, one had limited readiness and the other very limited readiness. Two of seven laboratories with high readiness also showed high continuity capacity, one moderate continuity capacity, and the other four showed limited continuity capacity since they could not maintain good quality HPV testing over time. Among three laboratories with moderate readiness, one kept moderate continuity capacity and two reached high continuity capacity. The two laboratories new to HPV testing achieved high continuity capacity. Based on gained expertise, five laboratories have become part of national screening programs. Conclusion High readiness of laboratories is an essential part of effective implementation of HPV testing. However, high readiness is insufficient to guarantee HPV testing high continuity capacity, for which a "culture of quality" should be established with regular training, robust monitoring and quality assurance systems tailored to local context. All efforts to strengthen HPV laboratories are valuable and crucial to guarantee effective implementation of HPV-based cervical screening.
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Affiliation(s)
- Mary Luz Rol
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | | | - Annabelle Ferrera
- Instituto de Investigaciones en Microbiología, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | | | - María de la Luz Hernández
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
- SMS-Oncology, Amsterdam, Netherlands
| | - Joana Lineros
- Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Ana Peraza
- Caja Costarricense de Seguro Social (CCSS), Región Pacífico Central, San José, Costa Rica
| | - Marisol Brizuela
- Caja Costarricense de Seguro Social (CCSS), Región Pacífico Central, San José, Costa Rica
| | - Laura Mendoza
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Pamela Mongelós
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Yessy Cabrera
- Grupo de Infección y Cáncer, Universidad de Antioquia, Medellín, Colombia
| | | | - Rita Mariel Correa
- Instituto de Investigaciones en Microbiología, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Carolina Terán
- Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia
| | - Deisy Colque Reynaga
- Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia
| | - Laura García
- Laboratorio de Biología Molecular, Departamento de Patología Clínica, Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
| | - Arianis Tatiana Ramírez
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | | | - Franco Doimi
- Laboratorio de Patología Oncológica SAC, Lima, Peru
| | - María Ramón
- Laboratorio de Patología Oncológica SAC, Lima, Peru
| | | | - Michael Zúñiga
- Agencia Costarricense de Investigaciones Biomédicas (ACIB), Fundación Inciensa, San José, Guanacaste, Costa Rica
| | | | | | - Lucía Cardinal
- Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Joan Valls
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Eric Lucas
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Armando Baena
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Laura Fleider
- Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Gino Venegas
- Clínica Angloamericana, Lima, Peru
- Liga contra el Cáncer, Lima, Peru
| | | | | | - Alejandro Calderón
- Caja Costarricense de Seguro Social (CCSS), Región Pacífico Central, San José, Costa Rica
| | | | - Silvana Luciani
- Pan American Health Organization (PAHO), Washington, DC, United States
| | - Nathalie Broutet
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Rolando Herrero
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
- Agencia Costarricense de Investigaciones Biomédicas (ACIB), Fundación Inciensa, San José, Guanacaste, Costa Rica
| | - Maribel Almonte
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Veljkovikj I, Ilbawi AM, Roitberg F, Luciani S, Barango P, Corbex M, Dorji G, Gunawardena N, Johnson S, Juric A, Siewert K, Saporiti G, Nobile M, Sauvaget C, Vidanapathirana J, Wright B, Lishimpi K, Kaidarova D, Pomata A, Malick A, Dangou JM, Abdel-Wahab M, Weiderpass E, Mikkelsen B, Stevens LM. Evolution of the joint International Atomic Energy Agency (IAEA), International Agency for Research on Cancer (IARC), and WHO cancer control assessments (imPACT Reviews). Lancet Oncol 2022; 23:e459-e468. [DOI: 10.1016/s1470-2045(22)00387-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/09/2022] [Accepted: 06/20/2022] [Indexed: 11/30/2022]
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24
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Villanueva G, Sampor C, Palma J, Villarroel M, Valencia D, Lombardi MG, Garcia WG, Caceres EL, Sobrero V, Garcia L, Cabrera V, Maza I, Velasquez T, Ugaz C, Vasquez JM, Coronado RD, Gonzalez N, Aguiar S, Dabezies A, Moreno F, Sardinas S, Gamboa Y, Maradiegue E, Fu L, Gassant P, Moreno K, Gonzales O, Schelotto M, Luna‐Fineman S, Antoneli CG, Fuentes‐Alabi S, Luciani S, Cappellano A, Chantada G, Vasquez L. Impact of COVID-19 in pediatric oncology care in Latin America during the first year of the pandemic. Pediatr Blood Cancer 2022; 69:e29748. [PMID: 35593012 PMCID: PMC9347956 DOI: 10.1002/pbc.29748] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 03/23/2022] [Accepted: 04/04/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND The ongoing coronavirus 2019 disease (COVID-19) pandemic strained medical systems worldwide. We report on the impact on pediatric oncology care in Latin American (LATAM) during its first year. METHOD Four cross-sectional surveys were electronically distributed among pediatric onco-hematologists in April/June/October 2020, and April/2021 through the Latin American Society of Pediatric Oncology (SLAOP) email list and St Jude Global regional partners. RESULTS Four hundred fifty-three pediatric onco-hematologists from 20 countries responded to the first survey, with subsequent surveys response rates above 85%. More than 95% of participants reported that treatment continued without interruption for new and active ongoing patients, though with disruptions in treatment availability. During the first three surveys, respondents reported suspensions of outpatient procedures (54.2%), a decrease in oncologic surgeries (43.6%), radiotherapy (28.4%), stem cell transplants (SCT) (69.3%), and surveillance consultations (81.2%). Logistic regression analysis showed that at the beginning of the first wave, participants from countries with healthcare expenditure below 7% were more likely to report a decrease in outpatient procedures (odds ratio [OR]: 1.84, 95% CI: 1.19-2.8), surgeries (OR: 3, 95% CI: 1.9-4.6) and radiotherapy (OR: 6, 95% CI: 3.5-10.4). Suspension of surveillance consultations was higher in countries with COVID-19 case fatality rates above 2% (OR: 3, 95% CI: 1.4-6.2) and SCT suspensions in countries with COVID-19 incidence rate above 100 cases per 100,000 (OR: 3.48, 95% CI: 1.6-7.45). Paradoxically, at the beginning of the second wave with COVID-19 cases rising exponentially, most participants reported improvements in cancer services availability. CONCLUSION Our data show the medium-term collateral effects of the pandemic on pediatric oncology care in LATAM, which might help delineate oncology care delivery amid current and future challenges posed by the pandemic.
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Affiliation(s)
| | - Claudia Sampor
- Service of Hematology/OncologyHospital J.P GarrahanBuenos AiresArgentina
| | - Julia Palma
- Pediatric OncologyHospital Luis Calvo MackennaSantiagoChile
| | | | - Diana Valencia
- Pediatric OncologyHospital Universitario de Santander IMAT OncomedicaMonteriaColombia,Pediatric OncologyIMAT OncomédicaColombia
| | | | - Wendy Gomez Garcia
- Hematology‐OncologyDr. Robert Reid Cabral Children's HospitalSanto DomingoDominican Republic
| | - Eva Lezcano Caceres
- Pediatric OncologyHospital Central Instituto de Prevision SocialAsunciónParaguay
| | - Victoria Sobrero
- Pediatric OncologyHospital Ramon CarrilloSan Carlos de BarilocheArgentina
| | - Lilia Garcia
- Centro Universitario Contra el Cáncer UANLMonterreyMexico
| | - Victor Cabrera
- Pediatric OncologyHospital Regional Río BlancoOrizabaMexico
| | - Ivan Maza
- Pediatric OncologyHospital RebagliatiLimaPeru
| | - Thelma Velasquez
- Pediatric OncologyUnidad Nacional de Oncología PediátricaGuatemala CityGuatemala
| | - Cecilia Ugaz
- Instituto Nacional de Enfermedades NeoplásicasLimaPeru
| | | | | | | | | | | | - Florencia Moreno
- Registro Onco‐Pediatrico Hospitalario Argentino (ROHA, Hospital based Pediatric Cancer Registry from Argentina)Buenos AiresArgentina,Instituto Nacional del CancerBuenos AiresArgentina
| | | | - Yessika Gamboa
- Pediatric OncologyHospital Nacional de NiñosSan JoséCosta Rica
| | | | - Ligia Fu
- Hemato‐OncologiaHospital Escuela UniversitarioTegucigalpaHonduras
| | | | - Katiuska Moreno
- Docente de pregrado de hematologia universidad laica Eloy Alfaro de ManabiHospital Verdi Cevallos Balda ‐ Hospital especialidades PortoviejoManabiEcuador
| | - Oscar Gonzales
- Hospital Civil de Guadalajara Dr. Juan I MenchacaGuadalajaraJaliscoMéxico
| | | | - Sandra Luna‐Fineman
- University of Colorado School of MedicineAuroraColoradoUSA,Department for the Management of Noncommunicable Diseases, Disability, Violence and Injury PreventionWorld Health OrganizationGenevaSwitzerland
| | | | - Soad Fuentes‐Alabi
- Non‐Communicable DiseasesPan American Health OrganizationWashingtonDistrict of ColumbiaUSA,Pediatric OncologyHospital Nacional de Niños Benjamin Bloom y Fundacion Ayudame a Vivir Pro‐ Ninos con Cancer de El SalvadorSan SalvadorEl Salvador
| | - Silvana Luciani
- Non‐Communicable DiseasesPan American Health OrganizationWashingtonDistrict of ColumbiaUSA
| | - Andrea Cappellano
- Department of Pediatric Neuro‐OncologyInstituto de Oncologia Pediátrica ‐ IOP/GRAACC/UNIFESPSão PauloBrazil
| | - Guillermo Chantada
- Pediatrics Hematology and OncologyHospital AustralPilarArgentina,Pediatric OncologyHospital Pereira RossellMontevideoUruguay,Fundación Perez ScreminiMontevideoUruguay
| | - Liliana Vasquez
- Non‐Communicable DiseasesPan American Health OrganizationWashingtonDistrict of ColumbiaUSA,Facultad de MedicinaCentro de Investigación de Medicina de Precisión, Universidad de San Martín de PorresLimaPerú
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De Oliveira LH, Janusz CB, Da Costa MT, El Omeiri N, Bloem P, Lewis M, Luciani S. HPV vaccine introduction in the Americas: a decade of progress and lessons learned. Expert Rev Vaccines 2022; 21:1569-1580. [PMID: 36154390 DOI: 10.1080/14760584.2022.2125383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Human papillomavirus (HPV) is an important public health concern due to its causative role in many cancers, especially cervical cancer, and other conditions that lead to serious health consequences in both men and women. In Latin America and the Caribbean, nearly 60,000 new cases of cervical cancer and another 7,000 HPV-associated cancers are diagnosed annually. AREAS COVERED HPV vaccination combined with comprehensive cervical cancer control programmingis paving the way for eliminating cervical cancer as a major public health problem and drastically reducing other HPV-associated diseases. To date, 44 countries and territories in the Americas have introduced HPV vaccines as part of their national immunization programs and cervical cancer control strategies. Early lessons from HPV vaccine introduction suggest that transparent and credible evidence-based decision-making, information, education and communication about HPV and cervical cancer, coordination with existing cervical cancer control initiatives, and precise planning for ensuring effective uptake of the vaccine in target groups are all critical elements of success. EXPERT OPINION There is an urgent need for strategies to increase HPV vaccine coverage, and as the integrated control programs evolve and other HPV-associated disease becomes important for public health, there will be a need for continued program and policy evaluation.
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Affiliation(s)
- Lucia H De Oliveira
- Antimicrobial Resitance Unit, Pan American Health Organization, Washington, DC, USA
| | - Cara B Janusz
- Department of Pediatrics, School of Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Nathalie El Omeiri
- Antimicrobial Resitance Unit, Pan American Health Organization, Washington, DC, USA
| | - Paul Bloem
- Department of Immunizations, Biologicals, and Vaccines, World Health Organization, Geneva, Switzerland
| | - Merle Lewis
- Pan American Health Organization, Washington, DC, USA
| | - Silvana Luciani
- Non-communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
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Espinal MA, Alonso M, Sereno L, Escalada R, Saboya M, Ropero AM, Bascolo E, Perez F, Vigilato M, Soares A, Luciani S, Vicari A, Castellanos LG, Ghidinelli M, Barbosa J. Sustaining communicable disease elimination efforts in the Americas in the wake of COVID-19. Lancet Reg Health Am 2022; 13:100313. [PMID: 35856071 PMCID: PMC9279131 DOI: 10.1016/j.lana.2022.100313] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The COVID-19 pandemic has disrupted implementation of health interventions and set back priority programs aiming to control and eliminate communicable diseases. At the same time, the pandemic has opened up opportunities to expedite innovations in health service delivery to increase effectiveness and position health on the development and political agendas of leaders and policy makers. In this context, we present an integrated, sustainable approach to accelerate elimination of more than 35 communicable diseases and related conditions in the region of the Americas. The Elimination Initiative promotes a life-course, person-centred approach based on four dimensions - preventing new infections, ending mortality and morbidity, and preventing disability - and four critical lines of action including strengthening health systems integration and service delivery, strengthening health surveillance and information systems, addressing environmental and social determinants of health, and furthering governance, stewardship, and finance. We present key actions and operational considerations according to each line of action that countries can take advantage of to further advance disease elimination in the region.
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Affiliation(s)
- Marcos A. Espinal
- Department of Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization, Washington DC, USA
| | - Monica Alonso
- Department of Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization, Washington DC, USA
| | - Leandro Sereno
- Department of Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization, Washington DC, USA
| | - Rainier Escalada
- Department of Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization, Washington DC, USA
| | - Martha Saboya
- Department of Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization, Washington DC, USA
| | - Alba M. Ropero
- Department of Family, Health Promotion and Life Course, Pan American Health Organization, Washington DC, USA
| | - Ernesto Bascolo
- Department of Health Systems and Services, Pan American Health Organization, Washington DC, USA
| | - Freddy Perez
- Department of Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization, Washington DC, USA
| | - Marco Vigilato
- Pan American Center for Foot & Mouth Disease, Pan American Health Organization, Duque de Caxias, Rio de Janeiro, Brazil
| | - Agnes Soares
- Department of Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization, Washington DC, USA
| | - Silvana Luciani
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington DC, USA
| | - Andrea Vicari
- Department of Health Emergencies, Pan American Health Organization, Washington DC, USA
| | - Luis G. Castellanos
- Department of Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization, Washington DC, USA
| | - Massimo Ghidinelli
- Department of Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization, Washington DC, USA
| | - Jarbas Barbosa
- Assistant Director Office, Pan American Health Organization, Washington DC, USA
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27
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Luciani S, Agurto I, Caixeta R, Hennis A. Prioritizing noncommunicable diseases in the Americas region in the era of COVID-19. Rev Panam Salud Publica 2022; 46:e83. [PMID: 35875322 PMCID: PMC9299393 DOI: 10.26633/rpsp.2022.83] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/24/2022] [Indexed: 01/14/2023] Open
Abstract
This article describes the situation of noncommunicable diseases (NCDs) in the Americas, implementation of NCD interventions according to key progress indicators, the impact of COVID-19 on NCD services, and ways to reprioritize NCDs following COVID-19. Information was retrieved from institutional data and through a supplementary scoping review of published articles related to NCDs and COVID-19 in the Americas published April 2020–November 2021. While NCDs account for 80.7% of all deaths in the Americas, implementation of a key set of NCD interventions has been limited, with only three countries reporting implementation of 12 or more of the 19 NCD indicators. By mid-May 2022, the Americas had reported about 29.9% of all COVID-19 cases in the world (154 million of 515 million) and 43.5% all COVID-19 deaths (2.7 million of 6.2 million). This pandemic has hampered progress on NCDs and significantly disrupted services for people who require ongoing care. Adaptive strategies, such as telehealth and mobile pharmacies, have been used to mitigate service disruptions. However, NCD prevention and management must be an integral part of recovering from the COVID-19 pandemic. This will require scaled up efforts to establish/re-establish and enforce policies on NCD risk factors, especially for tobacco control and obesity prevention, as well as greater investment in primary care and expansion of telemedicine and digital health solutions for continuous care for people with NCDs. Lastly, limited data are available on the impact of COVID-19 on NCDs, and hence NCD data and surveillance need to be strengthened.
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Affiliation(s)
- Silvana Luciani
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States of America
| | - Irene Agurto
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States of America
| | - Roberta Caixeta
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States of America
| | - Anselm Hennis
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States of America
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Hennis AJM, Coates A, Del Pino S, Ghidinelli M, Gomez Ponce de Leon R, Bolastig E, Castellanos L, Oliveira E Souza R, Luciani S. COVID-19 and inequities in the Americas: lessons learned and implications for essential health services. Rev Panam Salud Publica 2022; 45:e130. [PMID: 34987555 PMCID: PMC8713468 DOI: 10.26633/rpsp.2021.130] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/07/2021] [Indexed: 12/30/2022] Open
Abstract
The COVID-19 pandemic has exacerbated social, economic, and health-related disparities, which disproportionately affect persons living in conditions of vulnerability. Such populations include ethnic groups who face discrimination and experience barriers to accessing comprehensive health care. The COVID-19 pandemic has exposed these health disparities, and disruptions of essential health services have further widened the gaps in access to health care. Noncommunicable diseases are more prevalent among groups most impacted by poor social determinants of health and have been associated with an increased likelihood of severe COVID-19 disease and higher mortality. Disruptions in the provision of essential health services for noncommunicable diseases, mental health, communicable diseases such as HIV, tuberculosis, and malaria, and maternal and child health services (including sexual and reproductive health), are projected to also increase poor health outcomes. Other challenges have been an increased frequency of interpersonal violence and food insecurity. Countries in the Americas have responded to the disruptions caused by the pandemic by means of health service delivery through telemedicine and other digital solutions and stepping up social service support interventions. As vaccinations for COVID-19 create the opportunity to overcome the pandemic, countries must strengthen primary health care and essential health services with a view to ensuring equity, if the region is to achieve universal health coverage in fulfillment of the Sustainable Development Goals.
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Affiliation(s)
- Anselm J M Hennis
- Pan American Health Organization Washington, D.C. United States of America Pan American Health Organization, Washington, D.C., United States of America
| | - Anna Coates
- Pan American Health Organization Washington, D.C. United States of America Pan American Health Organization, Washington, D.C., United States of America
| | - Sandra Del Pino
- Pan American Health Organization Washington, D.C. United States of America Pan American Health Organization, Washington, D.C., United States of America
| | - Massimo Ghidinelli
- Pan American Health Organization Washington, D.C. United States of America Pan American Health Organization, Washington, D.C., United States of America
| | - Rodolfo Gomez Ponce de Leon
- Pan American Health Organization Washington, D.C. United States of America Pan American Health Organization, Washington, D.C., United States of America
| | - Edwin Bolastig
- Pan American Health Organization Washington, D.C. United States of America Pan American Health Organization, Washington, D.C., United States of America
| | - Luis Castellanos
- Pan American Health Organization Washington, D.C. United States of America Pan American Health Organization, Washington, D.C., United States of America
| | - Renato Oliveira E Souza
- Pan American Health Organization Washington, D.C. United States of America Pan American Health Organization, Washington, D.C., United States of America
| | - Silvana Luciani
- Pan American Health Organization Washington, D.C. United States of America Pan American Health Organization, Washington, D.C., United States of America
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29
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Cantò C, Pennese E, Di Nicola M, Ricciuti G, Restuccia F, Luciani S, Angrilli F. 838P Rituximab and non-pegylated liposomial doxorubincin (R-NPLD) treatment in patients 80 years of age or older affected by diffuse large B-cell lymphoma (DLBCL): A 2020 update and implications of clinical and pathological factors. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Vasquez L, Maradiegue E, Rojas N, Montoya J, Zapata A, Ugaz C, Pascual C, Santillán C, Wachtel A, Celis E, Bernedo H, Rossi J, Saldaña L, Diaz R, Morales R, Perez V, Metzger ML, Luciani S. Catalyzing Childhood Cancer Care in Peru After One Year of the Global Initiative for Childhood Cancer. JCO Glob Oncol 2021; 7:187-189. [PMID: 33539174 PMCID: PMC8081553 DOI: 10.1200/go.20.00601] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Liliana Vasquez
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Lima, Peru
| | - Essy Maradiegue
- Department of Pediatrics, National Institute of Neoplastic Diseases, Lima, Peru
| | - Ninoska Rojas
- Pediatric Hematology Unit, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - Jacqueline Montoya
- Department of Pediatrics, National Institute of Neoplastic Diseases, Lima, Peru
| | - Arturo Zapata
- Department of Pediatrics, National Institute of Neoplastic Diseases, Lima, Peru
| | - Cecilia Ugaz
- Department of Pediatrics, National Institute of Neoplastic Diseases, Lima, Peru
| | - Claudia Pascual
- Pediatric Oncology Unit, Hospital Nacional Guillermo Almenara, Lima, Peru
| | - Carlos Santillán
- Department of Epidemiology, National Institute of Children, San Borja, Lima, Peru
| | | | - Edinho Celis
- Department of Nursing, National Institute of Neoplastic Diseases, Lima, Peru
| | - Hernan Bernedo
- Department of Psychology, National Institute of Neoplastic Diseases, Lima, Peru
| | - Jonathan Rossi
- Executive Director, Ronald McDonald Association in Peru, Lima, Peru
| | - Lily Saldaña
- Department of Surgery, National Institute of Children, San Borja, Lima, Peru
| | - Rosdali Diaz
- Department of Pediatrics, National Institute of Neoplastic Diseases, Lima, Peru
| | - Roxana Morales
- Department of Pediatrics, National Institute of Neoplastic Diseases, Lima, Peru
| | - Vivian Perez
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Lima, Peru
| | - Monika L Metzger
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Silvana Luciani
- Unit of Noncommunicable Diseases, Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC
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Miguel-Majors SLS, Trimble EL, Lowy D, Lopez-Varon M, Baker E, Schmeler K, Arrossi S, Oliveira MTDC, Maza M, Montealegre JR, Salcedo MP, de Oliveira LH, Luciani S. Abstract 53: Promoting WHO's Cervical Cancer Elimination Goals ‘90-70-90' by Developing, Implementing, and Evaluating the ECHO Latin America (ECHO ELA) Program. Cancer Epidemiol Biomarkers Prev 2021. [DOI: 10.1158/1538-7755.asgcr21-53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Purpose: Cervical cancer is one of the leading causes of cancer deaths among women in some countries in the Region of the Americas.1 Cervical cancer is preventable through HPV vaccination, screening and treatment of precancerous lesions, and can be effectively treated if diagnosed early.2
Methods: Under the framework of the Global Strategy to Accelerate the Elimination of Cervical Cancer as a Public Health Problem, the US National Cancer Institute (NCI), the University of Texas MD Anderson Cancer Center (MD Anderson) and the Pan American Health Organization/World Health Organization (PAHO/WHO) partnered to develop ECHO Latin America (ECHO ELA). ECHO ELA is modeled on Project ECHO® (Extension of Community Healthcare Outcomes) a hub-and-spoke knowledge-sharing approach where expert teams lead virtual didactic lectures and case discussions, amplifying the capacity for participants to deliver best practice programs to their regions. ECHO ELA consists of monthly, Spanish-language telementoring conferences about cervical cancer prevention and control. The program targets Ministries of Health, Immunization Program Managers and key cervical cancer stakeholders in Latin American (LA) countries. Its primary goal is to assist countries in reaching their WHO cervical cancer elimination goals “90-70-90:” vaccinating 90 percent of girls against HPV by the age of 15, screening 70 percent of women for cervical cancer at ages 35 and 45, and treating 90 percent of women diagnosed with pre-invasive cervical lesions or cervical cancer.
Results: To date, 222 participants from 21 countries have registered. Seven sessions have been held averaging 93 participants per session. 85 participants completed the baseline survey addressing priorities, capacity, and desired outcomes. Baseline, mid-year evaluation results, within the COVID-19 context, and learned lessons will be presented.
Conclusion: ECHO ELA is potentially an effective tool to convene participants from multiple countries to enhance collaboration and support countries' progress towards the elimination of cervical cancer in the Americas.
Citation Format: Sandra L. San Miguel-Majors, Edward L. Trimble, Doug Lowy, Melissa Lopez-Varon, Ellen Baker, Kathleen Schmeler, Silvina Arrossi, Maria Tereza da Costa Oliveira, Mauricio Maza, Jane R. Montealegre, Mila P. Salcedo, Lucia Helena de Oliveira, Silvana Luciani. Promoting WHO's Cervical Cancer Elimination Goals ‘90-70-90' by Developing, Implementing, and Evaluating the ECHO Latin America (ECHO ELA) Program [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 53.
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Affiliation(s)
| | | | | | | | - Ellen Baker
- 2The University of Texas MD Anderson Cancer Center,
| | | | - Silvina Arrossi
- 3Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnica,
| | | | | | | | | | | | - Silvana Luciani
- 4the Pan American Health Organization/World Health Organization,
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Cantò C, Pennese E, Di Nicola M, Ricciuti G, Restuccia F, Luciani S, Angrilli F. RITUXIMAB AND NONPEGYLATED LIPOSOMIAL DOXORUBINCIN (R‐NPLD) TREATMENT IN PATIENTS 80 YEARS OF AGE OR OLDER AFFECTED BY DIFFUSE LARGE B CELL LYMPHOMA (DLBCL): A 2020 UPDATE AND IMPLICATIONS OF CLINICAL AND PATHOLOGICAL FACTORS. Hematol Oncol 2021. [DOI: 10.1002/hon.64_2881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- C. Cantò
- Civic Hospital "Santo Spirito" Pescara Center for the Diagnosis and Treatment of Lymphomas Department of Oncology and Hematology Pescara Italy
| | - E. Pennese
- Civic Hospital "Santo Spirito" Pescara Center for the Diagnosis and Treatment of Lymphomas Department of Oncology and Hematology Pescara Italy
| | - M. Di Nicola
- “G. d'Annunzio” University Department of Medical, Oral and Biotechnological Sciences Chieti Italy
| | - G. Ricciuti
- IRCCS "Casa Sollievo della Sofferenza" Department of Hematology San Giovanni Rotondo FG Italy
| | - F. Restuccia
- Civic Hospital "Santo Spirito" Pescara Center for the Diagnosis and Treatment of Lymphomas Department of Oncology and Hematology Pescara Italy
| | - S. Luciani
- Civic Hospital "Santo Spirito" Pescara Center for the Diagnosis and Treatment of Lymphomas Department of Oncology and Hematology Pescara Italy
| | - F. Angrilli
- Civic Hospital "Santo Spirito" Pescara Center for the Diagnosis and Treatment of Lymphomas Department of Oncology and Hematology Pescara Italy
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Hunt D, Hemmingsen B, Matzke A, Varghese C, Hammerich A, Luciani S, Hennis A, Branca F, Bull F, Berdzuli N, Dangou JM, Pendse R, Pratt A, Mikkelsen B. The WHO Global Diabetes Compact: a new initiative to support people living with diabetes. Lancet Diabetes Endocrinol 2021; 9:325-327. [PMID: 33862005 DOI: 10.1016/s2213-8587(21)00111-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 04/01/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Daniel Hunt
- Department for Noncommunicable Diseases, World Health Organization, Geneva, Switzerland.
| | - Bianca Hemmingsen
- Department for Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Alena Matzke
- Department for Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Cherian Varghese
- Department for Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Asmus Hammerich
- World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Silvana Luciani
- World Health Organization Regional Office for the Americas, Washington, DC, USA
| | - Anselm Hennis
- World Health Organization Regional Office for the Americas, Washington, DC, USA
| | - Francesco Branca
- Department for Health Promotion, World Health Organization, Geneva, Switzerland
| | - Fiona Bull
- Department for Health Promotion, World Health Organization, Geneva, Switzerland
| | - Nino Berdzuli
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Jean-Marie Dangou
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Razia Pendse
- World Health Organization Country Office for Sri Lanka, Colombo, Sri Lanka
| | - Angela Pratt
- World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Bente Mikkelsen
- Department for Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
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Piñeros M, Abriata MG, de Vries E, Barrios E, Bravo LE, Cueva P, de Camargo Cancela M, Fernández L, Gil E, Luciani S, Pardo C, Zoss W, Bray F, Mery L. Progress, challenges and ways forward supporting cancer surveillance in Latin America. Int J Cancer 2020; 149:12-20. [PMID: 33231289 DOI: 10.1002/ijc.33407] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/22/2020] [Accepted: 11/11/2020] [Indexed: 12/22/2022]
Abstract
Population-based cancer registries (PBCRs) are the only means to provide reliable incidence and survival data as a basis for policy-making and resource allocations within cancer care. Yet, less than 3% and 10% of the respective populations of Central America and South America are covered by high-quality cancer registries. The Global Initiative for Cancer Registry Development provides support to improve this situation via the International Agency for Research on Cancer Regional Hub for Latin America. In this paper, we summarize activities (advocacy, technical assistance, training and research) over the last 5 years, their impact and current challenges, including the implementation of new PBCR in four countries in the region. Despite the favorable political support to cancer registration in many countries, the sustainability of cancer registration remains vulnerable. Renewed efforts are needed to improve data quality in Latin America while ensuring maximum visibility of the data collected by disseminating and promoting their use in cancer control.
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Affiliation(s)
- Marion Piñeros
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - María Graciela Abriata
- Non-communicable Diseases DIrection, National Ministry of Health, Buenos Aires, Argentina
| | - Esther de Vries
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Enrique Barrios
- National Cancer Registry of Uruguay, Comisión Honoraria de Lucha contra el Cáncer, Montevideo, Uruguay
| | - Luis Eduardo Bravo
- Population-Based Cancer Registry of Cali, Department of Pathology, Faculty of Medicine, UNiversidad del Valle, Cali, Colombia
| | | | - Marianna de Camargo Cancela
- Division of Cancer Surveillance and Situation Analysis, National Cancer Institute INCA, Rio de Janeiro, Brazil
| | | | - Enrique Gil
- Non-communicable Diseases, PAHO Subregional Office for South America, Lima, Peru
| | - Silvana Luciani
- Unit of Non-communicable Diseases, Violence and Injuries, PAHO Regional Office, Washington, District of Columbia, USA
| | - Constanza Pardo
- Unit of Cancer Surveillance, National Cancer Institute, INC Bogotá, Colombia
| | - Walter Zoss
- Network of National Cancer Institutes of Latin America and The Caribbean (RINC-ALC), Rio de Janeiro, Brazil
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Les Mery
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
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35
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Almonte M, Murillo R, Sánchez GI, González P, Ferrera A, Picconi MA, Wiesner C, Cruz-Valdez A, Lazcano-Ponce E, Jerónimo J, Ferreccio C, Kasamatsu E, Mendoza L, Rodríguez G, Calderón A, Venegas G, Villagra V, Tatti S, Fleider L, Terán C, Baena A, Hernández MDLL, Rol ML, Lucas E, Barbier S, Ramírez AT, Arrossi S, Rodríguez MI, González E, Celis M, Martínez S, Salgado Y, Ortega M, Beracochea AV, Pérez N, Rodríguez de la Peña M, Ramón M, Hernández-Nevarez P, Arboleda-Naranjo M, Cabrera Y, Salgado B, García L, Retana MA, Colucci MC, Arias-Stella J, Bellido-Fuentes Y, Bobadilla ML, Olmedo G, Brito-García I, Méndez-Herrera A, Cardinal L, Flores B, Peñaranda J, Martínez-Better J, Soilán A, Figueroa J, Caserta B, Sosa C, Moreno A, Mural J, Doimi F, Giménez D, Rodríguez H, Lora O, Luciani S, Broutet N, Darragh T, Herrero R. Multicentric study of cervical cancer screening with human papillomavirus testing and assessment of triage methods in Latin America: the ESTAMPA screening study protocol. BMJ Open 2020; 10:e035796. [PMID: 32448795 PMCID: PMC7252979 DOI: 10.1136/bmjopen-2019-035796] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 03/18/2020] [Accepted: 04/03/2020] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Human papillomavirus (HPV) testing is replacing cytology in primary screening. Its limited specificity demands using a second (triage) test to better identify women at high-risk of cervical disease. Cytology represents the immediate triage but its low sensitivity might hamper HPV testing sensitivity, particularly in low-income and middle-income countries (LMICs), where cytology performance has been suboptimal. The ESTAMPA (EStudio multicéntrico de TAMizaje y triaje de cáncer de cuello uterino con pruebas del virus del PApiloma humano; Spanish acronym) study will: (1) evaluate the performance of different triage techniques to detect cervical precancer and (2) inform on how to implement HPV-based screening programmes in LMIC. METHODS AND ANALYSIS Women aged 30-64 years are screened with HPV testing and Pap across 12 study centres in Latin America. Screened positives have colposcopy with biopsy and treatment of lesions. Women with no evident disease are recalled 18 months later for another HPV test; those HPV-positive undergo colposcopy with biopsy and treatment as needed. Biological specimens are collected in different visits for triage testing, which is not used for clinical management. The study outcome is histological high-grade squamous intraepithelial or worse lesions (HSIL+) under the lower anogenital squamous terminology. About 50 000 women will be screened and 500 HSIL+ cases detected (at initial and 18 months screening). Performance measures (sensitivity, specificity and predictive values) of triage techniques to detect HSIL+ will be estimated and compared with adjustment by age and study centre. ETHICS AND DISSEMINATION The study protocol has been approved by the Ethics Committee of the International Agency for Research on Cancer (IARC), of the Pan American Health Organisation (PAHO) and by those in each participating centre. A Data and Safety Monitoring Board (DSMB) has been established to monitor progress of the study, assure participant safety, advice on scientific conduct and analysis and suggest protocol improvements. Study findings will be published in peer-reviewed journals and presented at scientific meetings. TRIAL REGISTRATION NUMBER NCT01881659.
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Affiliation(s)
- Maribel Almonte
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
| | - Raúl Murillo
- Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - Paula González
- Agencia Costarricense de Investigaciones Biomédicas (ACIB), Fundación Inciensa, Guanacaste, Costa Rica
| | - Annabelle Ferrera
- Instituto de Investigaciones en Microbiología, Universidad Nacional Autónoma de Honduras (UNAH), Tegucigalpa, Honduras
| | | | | | | | | | | | - Catterina Ferreccio
- Advanced Center for Chronic Diseases, ACCDiS, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Elena Kasamatsu
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Laura Mendoza
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | | | - Alejandro Calderón
- Caja Costarricense de Seguro Social (CCSS), Región Pacífico Central, San José, Costa Rica
| | - Gino Venegas
- Clínica Angloamericana, Lima, Perú
- Escuela de Medicina Humana, Universidad de Piura, Lima, Perú
| | | | - Silvio Tatti
- Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Laura Fleider
- Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Carolina Terán
- Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia
| | - Armando Baena
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
| | - María de la Luz Hernández
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
- SMS-Oncology, Amsterdam, The Netherlands
| | - Mary Luz Rol
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
| | - Eric Lucas
- Screening Group, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
| | - Sylvaine Barbier
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
| | - Arianis Tatiana Ramírez
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
| | - Silvina Arrossi
- Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - María Isabel Rodríguez
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | | | - Marcela Celis
- Instituto Nacional de Cancerología, Bogotá, Colombia
| | | | - Yuly Salgado
- Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Marina Ortega
- Hospital Nacional, Ministerio de Salud Pública y Bienestar Social, Itauguá, Paraguay
- Instituto Nacional del Cáncer, Ministerio de Salud Pública y Bienestar Social, Capiatá, Paraguay
| | - Andrea Verónica Beracochea
- Centro de Salud Ciudad de la Costa, ASSE, Ciudad de la Costa, Uruguay
- Hospital Policial, DNASS, Montevideo, Uruguay
| | - Natalia Pérez
- Hospital de Clínicas, Facultad de Medicina, UDELAR, Montevideo, Uruguay
| | | | | | | | | | - Yessy Cabrera
- Instituto de Investigaciones en Microbiología, Universidad Nacional Autónoma de Honduras (UNAH), Tegucigalpa, Honduras
| | | | - Laura García
- Laboratorio de Biología Molecular, Departamento de Patología Clínica, Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
| | | | - María Celeste Colucci
- Instituto Nacional de Enfermedades Infecciosas - ANLIS Malbrán, Buenos Aires, Argentina
| | | | | | | | - Gladys Olmedo
- Laboratorio Central de Salud Pública, Asunción, Paraguay
| | | | | | - Lucía Cardinal
- Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Betsy Flores
- Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia
| | - Jhacquelin Peñaranda
- Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia
| | | | - Ana Soilán
- Hospital Nacional, Ministerio de Salud Pública y Bienestar Social, Itauguá, Paraguay
- Hospital Materno Infantil de San Lorenzo, Ministerio de Salud Pública y Bienestar Social, San Lorenzo, Paraguay
| | | | - Benedicta Caserta
- Departamento de Anatomía Patológica y Citología, Hospital de la Mujer, Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
| | - Carlos Sosa
- Hospital Monseñor Víctor Manuel Sanabria Martínez, CCSS, Puntarenas, Costa Rica
| | - Adrián Moreno
- Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | - Juan Mural
- Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | | | - Diana Giménez
- Hospital Materno Infantil de Trinidad, Ministerio de Salud Pública y Bienestar Social, Asunción, Paraguay
| | - Hernando Rodríguez
- Hospital Materno Infantil de Trinidad, Ministerio de Salud Pública y Bienestar Social, Asunción, Paraguay
| | - Oscar Lora
- Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia
- Hospital Gineco-Obstétrico y Neonatal "Dr Jaime Sánchez Porcel", Sucre, Bolivia
| | - Silvana Luciani
- Pan American Health Organization (PAHO), Washington, District of Columbia, USA
| | - Nathalie Broutet
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Teresa Darragh
- Department of Pathology, University of California, San Francisco, California, USA
| | - Rolando Herrero
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
- Agencia Costarricense de Investigaciones Biomédicas (ACIB), Fundación Inciensa, Guanacaste, Costa Rica
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Pilleron S, Cabasag CJ, Ferlay J, Bray F, Luciani S, Almonte M, Piñeros M. Cervical cancer burden in Latin America and the Caribbean: Where are we? Int J Cancer 2020; 147:1638-1648. [PMID: 32150288 DOI: 10.1002/ijc.32956] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/19/2020] [Accepted: 03/02/2020] [Indexed: 12/24/2022]
Abstract
In May 2018, the World Health Organization (WHO) called for the elimination of cervical cancer. To monitor this initiative, we examined cervical cancer incidence and mortality in the Latin America and Caribbean (LAC) region using GLOBOCAN 2018, Cancer Incidence in Five Continents Series, and the WHO Mortality Database. We estimated the number of cases and age-standardized rates (ASRs) for cervical cancer incidence and mortality for 2018. We also presented the ASRs for recorded cervical cancer incidence from the period 2008 to 2012. We calculated annual rates and analyzed trends in cervical cancer incidence and mortality for all ages combined and for the following age groups: 0-29, 30-49, 50-64 and 65+. Finally, we calculated the estimated average annual percentage change in incidence and mortality rates for the past 10 years. In 2018, an estimated 56,000 new cervical cancer cases and 28,000 cervical cancer deaths occurred among women in LAC with great variations between subregions and countries/territories. Overall, trends in cervical cancer incidence and mortality have decreased over the past decade; however, the rates are still above the elimination threshold of 4 per 100,000 in most LAC countries/territories. Despite the encouraging trends observed, achieving the elimination of cervical cancer in the region still requests substantial political commitment and economic effort. Population-based cancer registries are critical in monitoring the elimination initiative.
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Affiliation(s)
- Sophie Pilleron
- Prevention and Implementation Group, Section of Early Detection and Prevention, International Agency for Research on Cancer, Lyon, France
| | - Citadel J Cabasag
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Jacques Ferlay
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Silvana Luciani
- Unit of Non-communicable Diseases, Violence and Injuries Prevention, PAHO, Washington, District of Columbia, USA, USA
| | - Maribel Almonte
- Prevention and Implementation Group, Section of Early Detection and Prevention, International Agency for Research on Cancer, Lyon, France
| | - Marion Piñeros
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
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37
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Baezconde-Garbanati L, Agurto I, Gravitt PE, Luciani S, Murphy S, Ochoa C, Gallegos K, Barahona R, Rodríguez Y. Barriers and innovative interventions for early detection of cervical cancer. Salud Publica Mex 2020; 61:456-460. [PMID: 31430087 DOI: 10.21149/10425] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 06/19/2019] [Indexed: 11/06/2022] Open
Abstract
Cervical cancer has decreased significantly over the past 30 years in some countries. However, it remains among the leading causes of cancer deaths in low-income, and racial/ethnic minority women. Cervical cancer prevention technologies are not always available. Laboratories are often not well equipped to use them. HPV information has not been widely disseminated. WHO guidelines, and US and Latin American data provide context for strategies on effective interventions to reduce cervical cancer disparities. Systemic, personal and cultural barriers, combined with decision-making guidelines, and impactful messaging can accelerate reductions in cervical cancer health inequities in the Americas.
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Affiliation(s)
- Lourdes Baezconde-Garbanati
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California. Los Angeles, California, USA.,Department of Preventive Medicine, Keck School of Medicine, University of Southern California. Los Angeles, California, USA.,Center for Health Equity in the Americas, Keck School of Medicine, University of Southern California. Los Angeles, California, USA
| | - Irene Agurto
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization. Chile
| | - Patti E Gravitt
- Department of Global Health, George Washington University Milken Institute School of Public Health. Washington DC, USA
| | - Silvana Luciani
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization. Chile
| | - Sheila Murphy
- Annenberg School for Communication and Journalism, University of Southern California. Los Angeles, California, USA
| | - Carol Ochoa
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California. Los Angeles, California, USA
| | - Katia Gallegos
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California. Los Angeles, California, USA.,Instituto Mexicano de Seguro Social. Mexico City, Mexico
| | - Rosa Barahona
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California. Los Angeles, California, USA.,Department of Preventive Medicine, Keck School of Medicine, University of Southern California. Los Angeles, California, USA.,Center for Health Equity in the Americas, Keck School of Medicine, University of Southern California. Los Angeles, California, USA
| | - Yaneth Rodríguez
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California. Los Angeles, California, USA.,Center for Health Equity in the Americas, Keck School of Medicine, University of Southern California. Los Angeles, California, USA
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38
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Sarfati D, Dyer R, Vivili P, Herman J, Spence D, Sullivan R, Weller D, Bray F, Hill S, Bates C, Foliaki S, Palafox N, Luciani S, Ekeroma A, Hospedales J. Cancer control in small island nations: from local challenges to global action. Lancet Oncol 2019; 20:e535-e548. [PMID: 31395475 PMCID: PMC7746435 DOI: 10.1016/s1470-2045(19)30511-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/13/2019] [Accepted: 06/13/2019] [Indexed: 12/16/2022]
Abstract
Cancer is a leading cause of death in small island nations and is forecast to increase substantially over the coming years. Governments, regional agencies, and health services of these nations face daunting challenges, including small and fragile economies, unequal distribution of resources, weak or fragmented health services, small population sizes that make sustainable workforce and service development problematic, and the unavailability of specialised cancer services to large parts of the population. Action is required to prevent large human and economic costs relating to cancer. This final Series paper highlights the challenges and opportunities for small island nations, and identifies ways in which the international community can support efforts to improve cancer control in these settings. Our recommendations focus on funding and investment opportunities to strengthen cancer-related health systems to improve sharing of technical assistance for research, surveillance, workforce, and service development, and to support small island nations with policy changes to reduce the consumption of commodities (eg, tobacco and unhealthy food products) that increase cancer risk.
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Affiliation(s)
- Diana Sarfati
- Department of Public Health, University of Otago, Wellington, Wellington, New Zealand.
| | - Rachel Dyer
- Department of Public Health, University of Otago, Wellington, Wellington, New Zealand
| | - Paula Vivili
- Public Health Division, Pacific Community, Noumea, New Caledonia
| | | | | | - Richard Sullivan
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - David Weller
- James Mackenzie Professor of General Practice, Usher Institute of Population Health, Sciences and Informatics, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Freddie Bray
- Cancer Surveillance Section, International Agency for Research on Cancer, Lyon, France
| | - Sarah Hill
- Global Health Policy Unit, University of Edinburgh, Edinburgh, UK
| | - Christopher Bates
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, Melbourne, VIC, Australia
| | - Sunia Foliaki
- Centre for Public Health Research, Massey University-Wellington Campus, Wellington, New Zealand
| | - Neal Palafox
- Pacific Regional Cancer Programs, Department of Family Medicine and Community Health, John A Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA; Population Sciences in the Pacific Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Silvana Luciani
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Alec Ekeroma
- Obstetrics and Gynaecology, University of Otago, Wellington, Wellington, New Zealand; National University of Samoa, Le Papaigalagala Campus, To'omatagi, Samoa
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Spence D, Dyer R, Andall-Brereton G, Barton M, Stanway S, Argentieri MA, Bray F, Cawich S, Edwards-Bennett S, Fosker C, Gabriel O, Greaves N, Hanchard B, Hospedales J, Luciani S, Martin D, Nimrod M, Ragin C, Simeon D, Tortolero-Luna G, Wharfe G, Sarfati D. Cancer control in the Caribbean island countries and territories: some progress but the journey continues. Lancet Oncol 2019; 20:e503-e521. [PMID: 31395473 DOI: 10.1016/s1470-2045(19)30512-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/10/2019] [Accepted: 06/11/2019] [Indexed: 12/24/2022]
Abstract
Cancer causes a fifth of deaths in the Caribbean region and its incidence is increasing. Incidence and mortality patterns of cancer in the Caribbean reflect globally widespread epidemiological transitions, and show cancer profiles that are unique to the region. Providing comprehensive and locally responsive cancer care is particularly challenging in the Caribbean because of the geographical spread of the islands, the frequently under-resourced health-care systems, and the absence of a cohesive approach to cancer control. In many Caribbean countries and territories, cancer surveillance systems are poorly developed, advanced disease presentations are commonplace, and access to cancer screening, diagnostics, and treatment is often suboptimal, with many patients with cancer seeking treatment abroad. Capacity building across the cancer-control continuum in the region is urgently needed and can be accomplished through collaborative efforts and increased investment in health care and cancer control.
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Affiliation(s)
- Dingle Spence
- Hope Institute Hospital, Kingston, Jamaica; Jamaica Cancer Care and Research Institute, University of the West Indies, Mona, Jamaica.
| | - Rachel Dyer
- Department of Public Health, University of Otago, Wellington, Wellington, New Zealand
| | | | - Michael Barton
- Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute for Applied Medical Research, University of New South Wales, NSW, Australia
| | | | - M Austin Argentieri
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; School of Anthropology and Museum Ethnography, University of Oxford, Oxford, UK; Jamaica Cancer Care and Research Institute, University of the West Indies, Mona, Jamaica
| | - Freddie Bray
- Cancer Surveillance Section, International Agency for Research on Cancer, Lyon, France
| | - Shamir Cawich
- Department of Surgery, University of the West Indies, St Augustine Campus, Trinidad and Tobago
| | | | - Christopher Fosker
- Bermuda Cancer and Health Centre and Bermuda Hospitals Board, Hamilton, Bermuda
| | - Owen Gabriel
- Department of Oncology Victoria Hospital, Castries, Saint Lucia
| | - Natalie Greaves
- Faculty of Medical Sciences, University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - Barrie Hanchard
- Department of Pathology, University of the West Indies, Kingston, Jamaica
| | | | - Silvana Luciani
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Damali Martin
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marisa Nimrod
- Caribbean Association for Oncology and Hematology, Port of Spain, Trinidad and Tobago
| | | | - Donald Simeon
- Caribbean Centre for Health Systems Research and Development, University of the West Indies, St Augustine Campus, Trinidad and Tobago
| | - Guillermo Tortolero-Luna
- Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Centre, Puerto Rico
| | - Gilian Wharfe
- Department of Pathology, University of the West Indies, Mona, Jamaica
| | - Diana Sarfati
- Department of Public Health, University of Otago, Wellington, Wellington, New Zealand
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Luciani S, Bruni L, Agurto I, Ruiz-Matus C. HPV vaccine implementation and monitoring in Latin America. Salud Publica Mex 2019; 60:683-692. [PMID: 30699273 DOI: 10.21149/9090] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 03/08/2018] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To describe HPV vaccine program implementation, monitoring and evaluation experiences in Latin America. MATERIALS AND METHODS We reviewed published articles in peer-reviewed journals and reports from government web- sites, as well as the PAHO/WHO/UNICEF Joint Reporting form and the ICO/IARC HPV Information Centre database. RESULTS By December 2016, 13 countries/territories in Latin America (56%) have introduced HPV vaccines. The majority have done so in the past three years, targeting 10- 12 year old girls with a two dose schedule, through school programs. Vaccine coverage ranges from 30 to 87%. Safety monitoring is well established, but monitoring vaccine impact is not, and data are not available. CONCLUSIONS . Although Latin America is the most advanced developing region with HPV vaccine introduction, systems for its monitoring are weak and there is a paucity of consistently available coverage data for this vaccine. Challenges remain to introduce HPV vaccines in several countries, to achieve high coverage, and to strengthen monitoring, evaluation and reporting.
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Affiliation(s)
- Silvana Luciani
- Unit of Noncommunicable Diseases, Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization. Washington, DC, USA
| | - Laia Bruni
- Cancer Epidemiology Research Program, Catalan Institute of Oncology. Barcelona, Spain
| | - Irene Agurto
- Unit of Noncommunicable Diseases, Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization. Washington, DC, USA
| | - Cuauhtémoc Ruiz-Matus
- Unit of Comprehensive Family Immunization, Department of Family, Gender and Lifecourse, Pan American Health Organization. Washington, DC, USA
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Blanco S, Andisco D, Jiménez P, Luciani S. [Quality of mammography and breast cancer screening in ArgentinaQualidade da mamografia e prevenção do câncer de mama na Argentina]. Rev Panam Salud Publica 2019; 43:e63. [PMID: 31410087 PMCID: PMC6668659 DOI: 10.26633/rpsp.2019.63] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 06/05/2019] [Indexed: 11/24/2022] Open
Abstract
Se presentan los resultados del Plan de calidad en mamografía del Programa Nacional del Cáncer de Mama del Instituto Nacional del Cáncer de la República Argentina, enfocado en mejorar la calidad de la mamografía en el sector público de salud e implementar el tamizaje de cáncer de mama por este método diagnóstico. El Plan se comenzó a ejecutar en 2011 con base en la premisa de que una mamografía de mala calidad impide el diagnóstico temprano del cáncer de mama. En ese momento, en Argentina existía poca conciencia sobre la importancia de los controles de calidad, y los continuos cambios en los niveles jerárquicos del sistema de salud tendían a obstaculizar el desarrollo organizado del programa. El Plan consistió en la revisión y el control de calidad de las instalaciones de mamografía, la capacitación de recursos humanos técnicos y médicos y la puesta en marcha de un sistema de acreditación de los servicios de mamografía por parte del Instituto Nacional del Cáncer. La percepción de la importancia de la calidad en el personal involucrado ha mejorado y se obtuvo un panorama general del estado de la mamografía a nivel nacional en cuanto a la calidad, la tecnología, la cantidad de equipos y las posibilidades de implementación del tamizaje. Se capacitó al personal técnico y médico mediante el uso de diferentes metodologías y se impulsó la unificación de la lectura mamográfica en las provincias intervinientes.
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Affiliation(s)
- Susana Blanco
- Instituto Nacional del Cáncer Instituto Nacional del Cáncer Secretaría de Salud de la Nación Buenos Aires Argentina Instituto Nacional del Cáncer, Secretaría de Salud de la Nación, Buenos Aires, Argentina
| | - Daniel Andisco
- Instituto Nacional del Cáncer Instituto Nacional del Cáncer Secretaría de Salud de la Nación Buenos Aires Argentina Instituto Nacional del Cáncer, Secretaría de Salud de la Nación, Buenos Aires, Argentina
| | - Pablo Jiménez
- Organización Panamericana de la Salud Organización Panamericana de la Salud Washington, D.C. Estados Unidos de América. Organización Panamericana de la Salud, Washington, D.C., Estados Unidos de América
| | - Silvana Luciani
- Organización Panamericana de la Salud Organización Panamericana de la Salud Washington, D.C. Estados Unidos de América. Organización Panamericana de la Salud, Washington, D.C., Estados Unidos de América
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Cho M, Marchand M, Vega E, Holder R, Luciani S, Constansia-Kook J, Moya J. Health systems strengthening for noncommunicable disease control and healthy aging: integrated actions in Aruba and Curaçao. Rev Panam Salud Publica 2019; 43:e55. [PMID: 31171925 PMCID: PMC6548074 DOI: 10.26633/rpsp.2019.55] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 03/29/2019] [Indexed: 11/24/2022] Open
Abstract
Caribbean countries are experiencing social, epidemiological, and demographic transitions shaped by the growing elderly population and the rise of noncommunicable diseases (NCDs)-now responsible for 78% of all deaths. These circumstances demand rethinking the model of care to improve health outcomes and build more sustainable health systems with new orientations in policy, service delivery, organization, training, technology, and financing. Policy must be aimed towards healthy living, leveraging interventions that ensure healthy aging. The health system must proactively structure interventions to reduce the incidence of new NCD cases and to prevent related complications. Interventions should be focused on optimizing the individual's capacity, functional ability, and autonomy within adapted environments, as well as with the necessary preventive, long-term care, self-care, community care, and health system support.
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Affiliation(s)
- Malhi Cho
- Regional Office of the World Health Organization (WHO) for the AmericasRegional Office of the World Health Organization (WHO) for the AmericasPan American Health Organization (PAHO)Washington, DCUnited StatesPan American Health Organization (PAHO), Regional Office of the World Health Organization (WHO) for the Americas, Washington, DC, United States.
| | - Melissa Marchand
- PAHO consultantsPAHO consultantsWashington, DCUnited StatesPAHO consultants, Washington, DC, United States.
| | - Enrique Vega
- Regional Office of the World Health Organization (WHO) for the AmericasRegional Office of the World Health Organization (WHO) for the AmericasPan American Health Organization (PAHO)Washington, DCUnited StatesPan American Health Organization (PAHO), Regional Office of the World Health Organization (WHO) for the Americas, Washington, DC, United States.
| | - Reynaldo Holder
- PAHO consultantsPAHO consultantsWashington, DCUnited StatesPAHO consultants, Washington, DC, United States.
| | - Silvana Luciani
- Regional Office of the World Health Organization (WHO) for the AmericasRegional Office of the World Health Organization (WHO) for the AmericasPan American Health Organization (PAHO)Washington, DCUnited StatesPan American Health Organization (PAHO), Regional Office of the World Health Organization (WHO) for the Americas, Washington, DC, United States.
| | - Jeanine Constansia-Kook
- Ministry of Health, Environment, and NatureMinistry of Health, Environment, and NatureWillemstadCuraçaoMinistry of Health, Environment, and Nature, Willemstad, Curaçao.
| | - José Moya
- PAHO Country Office for the Bolivarian Republic of Venezuela and the Netherland AntillesPAHO Country Office for the Bolivarian Republic of Venezuela and the Netherland AntillesCaracasVenezuelaPAHO Country Office for the Bolivarian Republic of Venezuela and the Netherland Antilles, Caracas, Venezuela.
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Cazap E, de Almeida LM, Arrossi S, García PJ, Garmendia ML, Gil E, Hassel T, Mayorga R, Mohar A, Murillo R, Owen GO, Paonessa D, Santamaría J, Tortolero-Luna G, Zoss W, Herrero R, Luciani S, Schüz J, Espina C. Latin America and the Caribbean Code Against Cancer: Developing Evidence-Based Recommendations to Reduce the Risk of Cancer in Latin America and the Caribbean. J Glob Oncol 2019; 5:1-3. [PMID: 31246551 PMCID: PMC6613664 DOI: 10.1200/jgo.19.00032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2019] [Indexed: 01/21/2023] Open
Affiliation(s)
- Eduardo Cazap
- Sociedad Latinoamericana y del Caribe de Oncología Médica, Buenos Aires, Argentina
| | - Liz Maria de Almeida
- Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, Brasil
| | - Silvina Arrossi
- Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina
| | | | - María Luisa Garmendia
- Instituto de Nutrición y Tecnología de los Alimentos, Universidad de Chile, Santiago, Chile
| | - Enrique Gil
- Subregional Program for South America Pan-American Health Organization, Lima, Perú
| | - Trevor Hassel
- Healthy Caribbean Coalition, Caribbean Catalyst, St Michael, Barbados
| | - Rubén Mayorga
- Subregional Program for South America Pan-American Health Organization, Lima, Perú
| | - Alejandro Mohar
- Unidad de Investigación Biomédica, Instituto Nacional de Cancerología UNAM, Tlalpan, México
| | - Raúl Murillo
- Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Gabriel O. Owen
- Healthy Caribbean Coalition, Caribbean Catalyst, St Michael, Barbados
| | - Diego Paonessa
- Liga Argentina de Lucha Contra el Cáncer, Buenos Aires, Argentina
| | | | | | - Walter Zoss
- Red de Institutos e Instituciones Nacionales de Cancer, Rio de Janeiro, Brasil
| | - Rolando Herrero
- Agencia Internacional para la Investigación del Cáncer, International Agency for Research on Cancer/WHO, Lyon, France
| | | | - Joachim Schüz
- Agencia Internacional para la Investigación del Cáncer, International Agency for Research on Cancer/WHO, Lyon, France
| | - Carolina Espina
- Agencia Internacional para la Investigación del Cáncer, International Agency for Research on Cancer/WHO, Lyon, France
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Abstract
Decision making in health requires the use of sound evidence and context-specific information, guided by a priority setting methodology or framework. For noncommunicable disease (NCD) prevention and control, a decision-making methodology has been applied by the World Health Organization to delineate priorities, and options for cost-effective NCD interventions. A set of 14 interventions considered very cost-effective, affordable and feasible for implementation in various resource level settings were identified. Among them, tobacco control through taxation, bans on tobacco advertising, plain packaging, and smoke free public spaces stands out as perhaps the single most important interventions to tackle NCDs.
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Affiliation(s)
- Silvana Luciani
- 1Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, 525 23rd St NW, Washington, DC USA
| | - Anselm Hennis
- 2Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, 525 23rd St NW, Washington, DC USA
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Frech S, Muha CA, Stevens LM, Trimble EL, Brew R, Perin DP, Luciani S, Mohar A, Piñeros M, Vidaurre T, Morgan DR, Hawk ET, Schmeler KM, Foxhall LE, Rabadan-Diehl C, Duran D, Rendler-Garcia M, Cazap EL, Santini L, Zoss W, Delgado LB, Pearlman PC, Given L, Hohman K, Lopez MS, Kostelecky B. Perspectives on Strengthening Cancer Research and Control in Latin America Through Partnerships and Diplomacy: Experience of the National Cancer Institute's Center for Global Health. J Glob Oncol 2018; 4:1-11. [PMID: 30241245 PMCID: PMC6223440 DOI: 10.1200/jgo.17.00149] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
According to the Pan American Health Organization, noncommunicable diseases, including cancer, are the leading causes of preventable and premature death in the Americas. Governments and health care systems in Latin America face numerous challenges as a result of increasing morbidity and mortality from cancer. Multiple international organizations have recognized the need for collaborative action on and technical support for cancer research and control in Latin America. The Center for Global Health at the US National Cancer Institute (NCI-CGH) is one entity among many that are working in the region and has sought to develop a strategy for working in Latin America that draws on and expands the collaborative potential of engaged, skilled, and diverse partners. NCI-CGH has worked toward developing and implementing initiatives in collaboration with global partners that share the common objectives of building a global cancer research community and translating research results into evidence-informed policy and practice. Both objectives are complementary and synergistic and are additionally supported by an overarching strategic framework that is focused on partnerships and science diplomacy. This work highlights the overall strategy for NCI-CGH engagement in Latin America through partnerships and diplomacy, and highlights selected collaborative efforts that are aimed at improving cancer outcomes in the region.
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Affiliation(s)
- Silvina Frech
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Catherine A. Muha
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Lisa M. Stevens
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Edward L. Trimble
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Roxanne Brew
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Doug Puricelli Perin
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Silvana Luciani
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Alejandro Mohar
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Marion Piñeros
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Tatiana Vidaurre
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Douglas R. Morgan
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Ernest T. Hawk
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Kathleen M. Schmeler
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Lewis E. Foxhall
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Cristina Rabadan-Diehl
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Denise Duran
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Melissa Rendler-Garcia
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Eduardo L. Cazap
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Luiz Santini
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Walter Zoss
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Lucia B. Delgado
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Paul C. Pearlman
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Leslie Given
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Karin Hohman
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Melissa S. Lopez
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Brenda Kostelecky
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
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46
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Abstract
Cancer prevention, screening and early detection can provide some of the greatest public health benefits for cancer control. In low resource settings, where cancer control is challenged by limited human, financial and technical resources, cancer prevention and screening are of utmost importance and can provide significant impacts on the cancer burden. Public policies, social, environmental and individual level interventions which promote and support healthy eating and physical activity can lower cancer risks. Tobacco use, a significant cancer risk factor, can be reduced through the application of key mandates of the World Health Organization Framework Convention on Tobacco Control. In addition, cancer screening programs, namely for cervical and breast cancers, can have a significant impact on reducing cancer mortality, including in low resource settings. Comprehensive cancer control programs require interventions for cancer prevention, screening and early detection, and involve sectors outside of health to create supportive environments for healthy ways of life. Sharing experiences in implementing cancer control programs in different settings can create opportunities for interchanging ideas and forming international alliances.
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Affiliation(s)
| | - Lianne Vardy
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Eugenio Paci
- Agency for Public Health of the Lazio Region, Rome, Italy
| | | | - Annie Sasco
- Institut National de la Santé et de la Recherche Médicale, Bordeaux, France
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47
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Fedorovsky JM, Cuervo LG, Luciani S. Pediatric cancer registries in Latin America: the case of Argentina's pediatric cancer registry. Rev Panam Salud Publica 2017; 41:e152. [PMID: 31384271 PMCID: PMC6645297 DOI: 10.26633/rpsp.2017.152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 05/22/2017] [Indexed: 01/03/2023] Open
Abstract
Despite its low incidence, pediatric cancer makes up a significant portion of childhood illnesses. Yet information on pediatric cancer in Latin America is scarce. Since the early 2000s the World Health Organization (WHO) has been highlighting the role of cancer registries in cancer surveillance and control. This article describes the main aspects of pediatric cancer registration in Latin America, highlighting the successes of Argentina's national pediatric cancer registry, Registro Oncopediátrico Hospitalario Argentino (ROHA), which allows for better health care and contributes to improved outcomes for children with cancer, to provide a rationale for the expansion and enhancement of pediatric cancer registration in other Latin American countries.
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Affiliation(s)
- Johanna Michelle Fedorovsky
- American University American University Washington, D.C. United States of America American University, Washington, D.C., United States of America
| | - Luis Gabriel Cuervo
- Pan American Health Organization Pan American Health Organization Washington, D.C United States of America Pan American Health Organization, Washington, D.C., United States of America
| | - Silvana Luciani
- American University American University Washington, D.C. United States of America American University, Washington, D.C., United States of America
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48
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Abstract
Breast cancer is the most common cancer in women worldwide, affecting > 1.6
million women each year, projected to increase to 2.2 million cases annually by
2025. A disproportionate number of the > 500,000 women who die as a result of
breast cancer each year reside in low-resource settings. Breast cancer control
is an important component of cancer control planning and women’s health
programs, and tools are needed across the care continuum to reduce the cancer
burden, especially in low-resource settings. Cancer control planning is complex
and multifaceted. Evidence shows that outcomes are improved when prevention,
early diagnosis, treatment, and palliation are integrated and synchronously
developed within a country/region’s health plan. The Knowledge Summaries
for Comprehensive Breast Cancer Control are the product of a multiyear
collaboration led by the Union for International Cancer Control, Breast Health
Global Initiative, Pan American Health Organization, and Center for Global
Health of the US National Cancer Institute. Fourteen knowledge summaries
distilled from evidence-based, resource-stratified guidelines, and aligned with
WHO guidance on breast cancer control, build a framework for resource
prioritization pathways and delivery systems for breast cancer control at four
levels of available resources: basic, limited, enhanced, and maximal. Each
summary contains relevant content to inform breast cancer policy, clinical care,
and advocacy, aiding in the development and implementation of policies and
programs. These tools provide a common platform for stakeholders, including
policymakers, administrators, clinicians, and advocates to engage in decision
making appropriate to their local setting. The goal is to facilitate
evidence-based policy actions and urgently advance implementation of an
integrated approach to reduce breast cancer mortality and improve quality of
life.
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Affiliation(s)
- Jo Anne Zujewski
- Jo Anne Zujewski, Consultant for Leidos Biomedical Research, Frederick; Lisa Stevens, National Cancer Institute, Bethesda, MD, Benjamin O. Anderson, Fred Hutchinson Cancer Research Center; Allison L. Dvaladze, University of Washington, Seattle, WA, Andre M. Ilbawi, World Health Organization European Observatory on Health Systems and Policies, Brussels, Belgium; Silvana Luciani, Pan American Health Organization, Washington, DC; and Julie Torode, Union for International Cancer Control, Geneva, Switzerland
| | - Allison L Dvaladze
- Jo Anne Zujewski, Consultant for Leidos Biomedical Research, Frederick; Lisa Stevens, National Cancer Institute, Bethesda, MD, Benjamin O. Anderson, Fred Hutchinson Cancer Research Center; Allison L. Dvaladze, University of Washington, Seattle, WA, Andre M. Ilbawi, World Health Organization European Observatory on Health Systems and Policies, Brussels, Belgium; Silvana Luciani, Pan American Health Organization, Washington, DC; and Julie Torode, Union for International Cancer Control, Geneva, Switzerland
| | - Andre Ilbawi
- Jo Anne Zujewski, Consultant for Leidos Biomedical Research, Frederick; Lisa Stevens, National Cancer Institute, Bethesda, MD, Benjamin O. Anderson, Fred Hutchinson Cancer Research Center; Allison L. Dvaladze, University of Washington, Seattle, WA, Andre M. Ilbawi, World Health Organization European Observatory on Health Systems and Policies, Brussels, Belgium; Silvana Luciani, Pan American Health Organization, Washington, DC; and Julie Torode, Union for International Cancer Control, Geneva, Switzerland
| | - Benjamin O Anderson
- Jo Anne Zujewski, Consultant for Leidos Biomedical Research, Frederick; Lisa Stevens, National Cancer Institute, Bethesda, MD, Benjamin O. Anderson, Fred Hutchinson Cancer Research Center; Allison L. Dvaladze, University of Washington, Seattle, WA, Andre M. Ilbawi, World Health Organization European Observatory on Health Systems and Policies, Brussels, Belgium; Silvana Luciani, Pan American Health Organization, Washington, DC; and Julie Torode, Union for International Cancer Control, Geneva, Switzerland
| | - Silvana Luciani
- Jo Anne Zujewski, Consultant for Leidos Biomedical Research, Frederick; Lisa Stevens, National Cancer Institute, Bethesda, MD, Benjamin O. Anderson, Fred Hutchinson Cancer Research Center; Allison L. Dvaladze, University of Washington, Seattle, WA, Andre M. Ilbawi, World Health Organization European Observatory on Health Systems and Policies, Brussels, Belgium; Silvana Luciani, Pan American Health Organization, Washington, DC; and Julie Torode, Union for International Cancer Control, Geneva, Switzerland
| | - Lisa Stevens
- Jo Anne Zujewski, Consultant for Leidos Biomedical Research, Frederick; Lisa Stevens, National Cancer Institute, Bethesda, MD, Benjamin O. Anderson, Fred Hutchinson Cancer Research Center; Allison L. Dvaladze, University of Washington, Seattle, WA, Andre M. Ilbawi, World Health Organization European Observatory on Health Systems and Policies, Brussels, Belgium; Silvana Luciani, Pan American Health Organization, Washington, DC; and Julie Torode, Union for International Cancer Control, Geneva, Switzerland
| | - Julie Torode
- Jo Anne Zujewski, Consultant for Leidos Biomedical Research, Frederick; Lisa Stevens, National Cancer Institute, Bethesda, MD, Benjamin O. Anderson, Fred Hutchinson Cancer Research Center; Allison L. Dvaladze, University of Washington, Seattle, WA, Andre M. Ilbawi, World Health Organization European Observatory on Health Systems and Policies, Brussels, Belgium; Silvana Luciani, Pan American Health Organization, Washington, DC; and Julie Torode, Union for International Cancer Control, Geneva, Switzerland
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49
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Llanos AAM, Warner WA, Luciani S, Lee TY, Bajracharya S, Slovacek S, Roach V, Lamont-Greene M. Gynecologic cancer mortality in Trinidad and Tobago and comparisons of mortality-to-incidence rate ratios across global regions. Cancer Causes Control 2017; 28:1251-1263. [PMID: 28917021 PMCID: PMC5909810 DOI: 10.1007/s10552-017-0961-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 09/08/2017] [Indexed: 12/30/2022]
Abstract
PURPOSE To examine the factors associated with gynecologic cancer mortality risks, to estimate the mortality-to-incidence rate ratios (MIR) in Trinidad and Tobago (TT), and to compare the MIRs to those of select countries. METHODS Data on 3,915 incident gynecologic cancers reported to the National Cancer Registry of TT from 1 January 1995 to 31 December 2009 were analyzed using proportional hazards models to determine factors associated with mortality. MIRs for cervical, endometrial, and ovarian cancers were calculated using cancer registry data (TT), GLOBOCAN 2012 incidence data, and WHO Mortality Database 2012 data (WHO regions and select countries). RESULTS Among the 3,915 incident gynecologic cancers diagnosed in TT during the study period, 1,795 (45.8%) were cervical, 1,259 (32.2%) were endometrial, and 861 (22.0%) were ovarian cancers. Older age, African ancestry, geographic residence, tumor stage, and treatment non-receipt were associated with increased gynecologic cancer mortality in TT. Compared to GLOBOCAN 2012 data, TT MIR estimates for cervical (0.49 vs. 0.53), endometrial (0.61 vs. 0.65), and ovarian cancers (0.32 vs. 0.48) were elevated. While the Caribbean region had intermediate gynecologic cancer MIRs, MIRs in TT were among the highest of the countries examined in the Caribbean region. CONCLUSIONS Given its status as a high-income economy, the relatively high gynecologic cancer MIRs observed in TT are striking. These findings highlight the urgent need for improved cancer surveillance, screening, and treatment for these (and other) cancers in this Caribbean nation.
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Affiliation(s)
- Adana A M Llanos
- Department of Epidemiology, Rutgers School of Public Health and Division of Population Science, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, USA.
- Department of Epidemiology, Rutgers School of Public Health, 683 Hoes Lane West, Room 211, Piscataway, NJ, 08854, USA.
| | - Wayne A Warner
- Oncology Division, Department of Cell Biology and Physiology, Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Silvana Luciani
- Cancer Prevention and Control, Pan American Health Organization, Washington, DC, USA
| | - Tammy Y Lee
- Division of Applied and Advanced Studies in Education, California State University, Los Angeles, CA, USA
| | - Smriti Bajracharya
- Center for Public Health Systems Science, George Warren Brown School of Social Work, Washington University, St. Louis, MO, USA
| | - Simeon Slovacek
- Division of Applied and Advanced Studies in Education, California State University, Los Angeles, CA, USA
| | - Veronica Roach
- Dr. Elizabeth Quamina Cancer Registry, Eric Williams Medical Sciences Complex, Mt. Hope, Trinidad and Tobago
| | - Marjorie Lamont-Greene
- Dr. Elizabeth Quamina Cancer Registry, Eric Williams Medical Sciences Complex, Mt. Hope, Trinidad and Tobago
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50
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Wittet S, Aylward J, Cowal S, Drope J, Franca E, Goltz S, Kuo T, Larson H, Luciani S, Mugisha E, Schocken C, Torode J. Advocacy, communication, and partnerships: Mobilizing for effective, widespread cervical cancer prevention. Int J Gynaecol Obstet 2017; 138 Suppl 1:57-62. [PMID: 28691332 DOI: 10.1002/ijgo.12189] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Both human papillomavirus (HPV) vaccination and screening/treatment are relatively simple and inexpensive to implement at all resource levels, and cervical cancer screening has been acknowledged as a "best buy" by the WHO. However, coverage with these interventions is low where they are needed most. Failure to launch or expand cervical cancer prevention programs is by and large due to the absence of dedicated funding, along with a lack of recognition of the urgent need to update policies that can hinder access to services. Clear and sustained communication, robust advocacy, and strategic partnerships are needed to inspire national governments and international bodies to action, including identifying and allocating sustainable program resources. There is significant momentum for expanding coverage of HPV vaccination and screening/preventive treatment in low-resource settings as evidenced by new global partnerships espousing this goal, and the participation of groups that previously had not focused on this critical health issue.
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Affiliation(s)
| | | | | | | | | | | | - Taona Kuo
- Every Woman Every Child, New York, NY, USA
| | - Heidi Larson
- London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | - Julie Torode
- Union for International Cancer Control, Geneva, Switzerland
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