Muñoz Nubia, Franco Eduardo L, Herrero Rolando, Andrus Jon Kim, de Quadros Ciro, Goldie Sue J, Bosch F Xavier
Instituto Nacional de Cancerología, Bogotá, Colombia.
Vaccine. 2008 Aug 19;26 Suppl 11:L96-L107. doi: 10.1016/j.vaccine.2008.05.062.
Cervical cancer control in the Latin America and Caribbean (LAC) region has been, and remains, a priority and a major public health challenge. It also provides the opportunity for the advancement of research into novel cervical cancer preventative tools including the use of prophylactic human papillomavirus (HPV) vaccines, HPV-based screening options and low technology visual inspection methods. The challenges for prevention are compounded because cervical cancer cases continue to cluster in the low socio-economic and rural populations, thus requiring strong political and social commitments to ensure effective implementation in the region. Although cytology-based screening activities exist in the majority of LAC countries, these have been largely based on opportunistic screening services. Evaluation of the impact of screening is often focused on assessing coverage of the population with Pap smears. However, regardless of the chosen technology a screening program requires a complex set of activities that must also be of high quality such us ensuring access of the underserved populations to the program, maintaining routine quality controls of the screening procedures and organizing the proper follow-up of women with abnormal screening results. The cost of the HPV vaccine and of the delivery infrastructure required is currently a significant obstacle for widespread introduction that will require collaborative resolve between public health organizations, governments and vaccine manufacturers. It is important to ensure that HPV vaccines are made available to the wider public, not only to those who can afford it. This monograph and the associated regional reports have carefully identified and discussed the many challenges and opportunities to be considered for policy decisions, in particular the complex interplay between vaccination strategies and subsequent screening requirements. An advanced cost-benefit analysis, using models calibrated to specific countries in the region, presents the range of options and relative costs thus providing evidence-based scientific guidance to governments and providers in the context of a significant and systematic international review effort.
拉丁美洲和加勒比地区（LAC）的宫颈癌防治一直是，并且仍然是一项优先事项和重大的公共卫生挑战。它也为推进新型宫颈癌预防工具的研究提供了机会，这些工具包括预防性人乳头瘤病毒（HPV）疫苗的使用、基于HPV的筛查方法以及低技术的视觉检查方法。由于宫颈癌病例继续集中在社会经济地位较低的农村人口中，预防工作面临的挑战更加复杂，因此需要强有力的政治和社会承诺，以确保在该地区有效实施。尽管大多数拉美国家都开展了基于细胞学的筛查活动，但这些活动大多基于机会性筛查服务。对筛查影响的评估往往侧重于评估巴氏涂片检查的人群覆盖率。然而，无论选择何种技术，筛查计划都需要一系列复杂且必须高质量的活动，比如确保服务不足人群能够参与该计划、维持筛查程序的常规质量控制以及对筛查结果异常的女性进行适当的后续跟进。目前，HPV疫苗及其所需的交付基础设施成本是广泛推广的重大障碍，这需要公共卫生组织、政府和疫苗制造商之间共同解决。确保HPV疫苗不仅能提供给有能力购买的人，也能更广泛地提供给公众非常重要。本专题论文及相关区域报告已仔细确定并讨论了政策决策中需要考虑的诸多挑战和机遇，特别是疫苗接种策略与后续筛查要求之间的复杂相互作用。一项先进的成本效益分析，使用针对该地区特定国家校准的模型，展示了各种选择和相对成本，从而在重大而系统的国际审查工作背景下，为政府和提供者提供基于证据的科学指导。
