Duncan Jacqueline, Harris Michelle, Skyers Nicola, Bailey Althea, Figueroa John Peter
University of the West Indies, Mona Campus: Jamaica.
Pan American Health Organization.
Lancet Reg Health Am. 2021 Oct;2:None. doi: 10.1016/j.lana.2021.100036.
The World Health Organization has called for the global elimination of cervical cancer. While high income countries have made significant progress, the incidence and mortality due to cervical cancer is unacceptably high in low and middle income countries (LMIC). Jamaica is an upper middle income country with cervical cancer incidence and mortality of 21.6/100,000 and 13.6/100,000 person years respectively compared to 14.9/100,000 and 7.6/100,000 person years in Latin America and the Caribbean. Jamaica's pathway to reducing the burden of cervical cancer highlights challenges and opportunities for other LMIC. High prevalence of HPV infection (54% women attending primary care clinics), low levels of cervical cancer screening (<50% women 15 to 54 years old screened in the last 3 years) and suboptimal uptake of HPV vaccination (approximately 30%) are persistent barriers to achieving this goal. Lessons learned from the response to the human immunodeficiency virus (HIV) epidemic confirm the need for serious political commitment by global and national leaders, meaningful engagement of stakeholders and innovative strategies to improve uptake of HPV vaccination and cervical cancer screening. Commitment of technical and financial resources are critical for establishing robust cancer registries and strengthening monitoring and evaluation systems in LMIC.
世界卫生组织呼吁在全球范围内消除宫颈癌。虽然高收入国家已取得显著进展，但在低收入和中等收入国家（LMIC），宫颈癌的发病率和死亡率高得令人无法接受。牙买加是一个中高收入国家，宫颈癌发病率和死亡率分别为每10万人年21.6例和13.6例，而拉丁美洲和加勒比地区的这一数字分别为每10万人年14.9例和7.6例。牙买加减轻宫颈癌负担的途径凸显了其他低收入和中等收入国家面临的挑战与机遇。人乳头瘤病毒（HPV）感染率高（在初级保健诊所就诊的女性中占54%）、宫颈癌筛查水平低（过去3年中15至54岁女性的筛查率低于50%）以及HPV疫苗接种率不理想（约30%），仍是实现这一目标的持续障碍。从应对人类免疫缺陷病毒（HIV）疫情中吸取的经验教训证实，全球和国家领导人需要做出认真的政治承诺，利益相关者要有意义地参与，以及采取创新战略来提高HPV疫苗接种率和宫颈癌筛查率。投入技术和财政资源对于在低收入和中等收入国家建立强大的癌症登记系统以及加强监测和评估系统至关重要。
