By Andrea Hargraves 
Cervical cancer screening saves the lives of many women – the sooner the primary lesion or cancer is detected, the greater the chances of cure, as well as the simpler and cheaper treatment. Today, in Brazil, screening is performed through cytology (microscopic analysis of material collected in a gynecological consultation), a test known as a Pap smear². Cervical cancer is the third most common type among females in the country, excluding cases of non-melanoma skin tumors, according to the National Cancer Institute (INCA)².
An effective and safe strategy to combat this type of cancer is vaccination. Responsible for almost all cases of the disease, HPV infection can be prevented with a vaccine freely available in the Unified Health System (SUS) since 20143 for girls and boys aged 9 to 14 years. “If everyone under the age of 15 was vaccinated, we would see a 70% to 90% reduction in the incidence of cervical cancer,” says Dr. Julio Cesar Teixeira, a professor and researcher at the State University of Campinas (Unicamp).
“The number of SUS cytology (Pap) tests will cover all women in the country, in both the public and private systems, aged 25 to 64 years. However, today coverage ranges from 15% to 30%, already taking into account healthcare Supplementary (medical insurance).)” explains the doctor. “In fact, the same women who repeat tests annually, instead of every three years, are taking them outside the recommended age range. There is a huge waste of tests.”
If there is funding for screening and prevention, why does the disease still kill so many women in Brazil?
Despite the existence of the Brazilian program since the 1980s and the many efforts made in this area, the doctor says that it is currently unknown who will take the exam or not. “Today it is an unregulated programme, we call it opportunistic. A Pap smear is only performed on the woman who seeks it out, and we take advantage of opportunities when they appear to do so. However, we do not have any control or online record of this information in the health service, and sometimes By taking the exam more than once unnecessarily.”
To organize patient care work, technological solutions already exist, e.g navify® for cervical cancer screeningdeveloped by Roche Diagnostics. The software supports the structuring of clinical workflow, helping clinicians decide who should perform the test and how often, and improves decision-making for reviewing cancer patient cases in multidisciplinary team meetings. The platform should evolve into more clinical decision support applications that address challenges such as cervical cancer.
In partnership with the Indayatuba City Council, in the interior of São Paulo, and with support from Roche, the Unicamp team headed by Dr. Teixeira developed a study to implement a structured program based on a high-risk DNA-HPV genotyping test for screening. The city’s population is female, and important findings have already been published in the scientific journal Lancet.
Because it is automated, i.e. performed by machines, and has high sensitivity, the HPV DNA test provides a more precise control for cervical cancer screening than does Pap smear cytology, allowing the presence of high-risk DNA to be identified. HPV genotypes (types 16 and 18 are responsible for 70% of cases), allowing adequate monitoring and measures that prevent the development of the disease³.
In the event of a negative result, the test does not need to be performed again until five years later, which contributes to the optimal use of resources and the sustainability of health systems. This screening method is already used in programs in the USA, Canada, Colombia, Dominican Republic, Argentina, Italy and Mexico, as a supplement to cell screening or as a primary test.
“We analyzed the additional amount spent per year of life gained by patients in this program, compared to the amount spent in the city and on cancer treatment at Unicamp, and made a comparison. The goal was to calculate cost-effectiveness, which is a benchmark for new technology that It will be approved by Conitec, where the government body is evaluating technologies for integration into the SUS (Unified Health System).The cost-effectiveness achieved by implementing the structured program of cervical cancer screening, through DNA-HPV genotyping by PCR, showed a dominant profile “That is, through the programme, it is possible to improve the quality of life of the population and improve the use of health resources, while reducing the associated costs,” highlights the doctor.
The expert also highlights the importance of vaccination. “It is the safest vaccine in the world, and one of the most attacked by humans. More than 500 million doses have already been administered, with no adverse effects. There is an argument against it, which is the liberalization of sexual intercourse among young people.” But hepatitis B, the vaccine for which is given to infants to prevent liver cancer in adults – a disease that we no longer see in Brazil precisely because we vaccinate against it – is also transmitted through sexual contact.
References
1. Ministry of Health Virtual Health Library Cervical Cancer. Available at: https://bvsms.saude.gov.br/cancer-do-colo-de-utero/. Accessed on: 5 December. 2023.
2. Inca. Data and figures on the Cervical Cancer Annual Report 2023. Available at https://www.inca.gov.br/sites/ufu.sti.inca.local/files//media/document//dados_e_numeros_colo_22marco2023.pdf. Accessed on: 5 December. 2023.
3. Inca. Cervical cancer. Available at: https://www.inca.gov.br/tipos-de-cancer/cancer-do-colo-do-utero. Accessed on: 5 December. 2023.
4. Teixeira JC, Valle DP, Campos CS, Bragança JF, Descaciati MJ, Zeferino LC. Regulating cervical cancer screening using HPV DNA testing affects early-stage cancer detection: a population-based explanatory study in a Brazilian city. Lancet Regional Health – Americas. 2021. Available in: [https://www.sciencedirect.com/science/article/pii/S2667193X21000806]
Published online 01/11/2021[[[[https://www.thelancet.com/journals/lanam/article/PIIS2667-193X(21)00080-6/fulltext. Accessed on: 5 December. 2023.
5. Pan American Health Organization. Human papillomavirus and cervical cancer. Available at: https://www.paho.org/pt/topicos/hpv-e-cancer-do-colo-do-utero. Accessed on: 5 December. 2023.
6. International Agency for Research on Cancer. from. Cancer today. Available at: https://gco.iarc.fr/today. Accessed on: 5 December. 2023.
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