University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico, United States of America; Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico, United States of America.
Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico, United States of America; Department of Biochemistry, School of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico, United States of America.
Prev Med. 2021 Mar;144:106336. doi: 10.1016/j.ypmed.2020.106336. Epub 2021 Mar 4.
Cervical cancer remains a major burden for women around the world. In 2018, the World Health Organization called for the elimination of cervical cancer worldwide (<4 cases per 100,000 women-years), within the 21st century. In the U.S., despite great progress toward this goal, existing disparities among racial/ethnic groups in cervical cancer raise concerns about whether elimination can be achieved for all women. We describe: 1) disparities in cervical cancer among Hispanics in the U.S. and factors that contribute to their increased risk, 2) prevention and control efforts to increase equity in the elimination of cervical cancer in this population, and 3) cervical cancer control efforts in Puerto Rico (PR), a U.S. territory, as a case study for cervical cancer elimination among a minority and underserved Hispanic population. Hispanics have the highest incidence rates of cervical cancer among all racial/ethnic groups in the U.S. Despite being more likely to complete HPV vaccination series, lower cervical cancer screening and access to treatment may lead to a higher cervical cancer mortality in Hispanics compared to non-Hispanic White women. These disparities are influenced by multiple individual-, sociocultural-, and system-level factors. To achieve the goal of cervical cancer elimination in the U.S., systematic elimination plans that consider the needs of Hispanic populations should be included within the Comprehensive Cancer Control Plans of each state. Because PR has implemented coordinated efforts for the prevention and control of cervical cancer, it represents a notable case study for examining strategies that can lead to cervical cancer elimination among Hispanics.
宫颈癌仍然是全世界女性的主要负担。2018 年，世界卫生组织呼吁在 21 世纪全球消除宫颈癌（每 10 万名妇女年<4 例）。在美国，尽管在实现这一目标方面取得了巨大进展，但不同种族/族裔群体之间在宫颈癌方面存在的差异，令人担忧是否所有女性都能实现消除宫颈癌的目标。我们描述了：1）美国西班牙裔中宫颈癌的差异以及导致其风险增加的因素，2）为增加该人群中宫颈癌消除的公平性而开展的预防和控制工作，以及 3）波多黎各（PR）作为少数族裔和服务不足的西班牙裔人口中宫颈癌消除的案例研究，在该地区开展的宫颈癌控制工作。西班牙裔是美国所有种族/族裔群体中宫颈癌发病率最高的群体。尽管他们更有可能完成 HPV 疫苗接种系列，但较低的宫颈癌筛查率和治疗机会可能导致西班牙裔的宫颈癌死亡率高于非西班牙裔白人女性。这些差异受到多种个人、社会文化和系统层面因素的影响。为了实现美国消除宫颈癌的目标，应在每个州的综合癌症控制计划中纳入系统消除计划，以满足西班牙裔人群的需求。由于 PR 已经实施了协调一致的宫颈癌预防和控制工作，因此它是一个值得研究的案例研究，可以检验在西班牙裔中消除宫颈癌的策略。
