Rethinking Cervical Cancer Screening in Brazil Post COVID-19: A Global Opportunity to Adopt Higher Impact Strategies

Ana Ribeiro*, Flavia Corrêa, Arn Migowski, Aline Leal, Sandro Martins, Taina Raiol, Carla P. Marques, Katia L. Torres, Akiva P. Novetsky, Jenna Z. Marcus, Nicolas Wentzensen, Mark Schiffman, Ana Cecilia Rodriguez, Julia C. Gage

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

Abstract

The World Health Organization global call to eliminate cervical cancer encourages countries to consider introducing or improving cervical cancer screening programs. Brazil’s Unified Health System (SUS) is among the world’s largest public health systems offering free cytology testing, followup colposcopy, and treatment. Yet, health care networks across the country have unequal infrastructure, human resources, equipment, and supplies resulting in uneven program performance and large disparities in cervical cancer incidence and mortality. An effective screening program needs multiple strategies feasible for each community’s reality, facilitating coverage and follow-up adherence. Prioritizing those at highest risk with tests that better stratify risk will limit inefficiencies, improving program impact across different resource settings. Highly sensitive human papillomavirus (HPV)-DNA testing performs better than cytology and, with self-collection closer to homes and workplaces, improves access, even in remote regions. Molecular triage strategies like HPV genotyping can identify from the same self-collected sample, those at highest risk requiring follow-up. If proven acceptable, affordable, cost-effective, and efficient in the Brazilian context, these strategies would increase coverage while removing the need for speculum exams for routine screening and reducing follow-up visits. SUS could implement a nationwide organized program that accommodates heterogenous settings across Brazil, informing a variety of screening programs worldwide.

Original languageEnglish (US)
Pages (from-to)919-926
Number of pages8
JournalCancer Prevention Research
Volume14
Issue number10
DOIs
StatePublished - Oct 2021
Externally publishedYes

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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