Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France.
Pan American Health Organization, Washington, DC, USA.
Cancer Med. 2023 Oct;12(19):19935-19948. doi: 10.1002/cam4.6492. Epub 2023 Sep 28.
In the Community of Latin American and Caribbean States (CELAC), breast cancer and cervical cancer are the first and third causes of cancer death among females. The objectives are to assess the characteristics of the cervical and breast cancer screening programmes in CELAC, their level of organization, and the association of screening organization and coverage of essential health services.
Representatives of the Ministries of Health of 33 countries were invited to the CanScreen5 project. Twenty-seven countries participated in a "Train The Trainers" programme on cancer screening, and 26 submitted data using standardized questionnaires. Data were discussed and validated. The level of organization of the screening programmes was examined adapting the list of essential elements of organized screening programmes identified in a recently published IARC study.
Twenty-one countries reported a screening programme for cervical cancer and 15 for breast cancer. For cervical cancer, 14 countries dedicated budget for screening (66.7%), and women had to pay in 3 countries for screening (14.3%), 9 for diagnosis (42.9%) and 8 for treatment (38.1%). Only 4 countries had a system to invite women individually (19.0%). For breast cancer, 8 countries dedicated budget for screening (53.3%), and women had to pay for screening in 3 countries (20.0%), diagnosis in 7 (46.7%) and treatment in 6 (40.0%). One country (6.7%) invited women individually. There was variability in the level of organization of both cancer screening programmes. The level of organization of cervical cancer screening and coverage of essential health services were correlated.
Large gaps were identified in the organization of cervical and breast cancer screening services. CELAC governments need pragmatic public health policies and strengthened health systems. They should guarantee sustainable funding, and universal access to cancer diagnosis and treatment. Moreover, countries should enhance their health information system and ensure adequate monitoring and evaluation.
在拉美和加勒比国家共同体（拉加共同体）中，乳腺癌和宫颈癌是女性癌症死亡的第一和第三大原因。本研究旨在评估拉加共同体国家的宫颈癌和乳腺癌筛查项目的特征、组织水平，以及筛查组织与基本卫生服务覆盖情况的相关性。
邀请拉加共同体 33 个国家的卫生部代表参加 CanScreen5 项目。其中 27 个国家参加了关于癌症筛查的“培训培训者”项目，26 个国家使用标准化问卷提交了数据。对数据进行了讨论和验证。采用最近发表的国际癌症研究机构研究中确定的有组织筛查项目基本要素清单，评估筛查项目的组织水平。
21 个国家报告了宫颈癌筛查项目，15 个国家报告了乳腺癌筛查项目。在宫颈癌方面，14 个国家为筛查项目分配了预算（66.7%），3 个国家要求妇女支付筛查费用（14.3%）、诊断费用（42.9%）和治疗费用（38.1%）。仅有 4 个国家（19.0%）建立了针对女性的个体化邀请系统。在乳腺癌方面，8 个国家为筛查项目分配了预算（53.3%），3 个国家要求妇女支付筛查费用（20.0%）、诊断费用（46.7%）和治疗费用（40.0%）。1 个国家（6.7%）建立了个体化邀请系统。两种癌症筛查项目的组织水平存在差异。宫颈癌筛查的组织水平与基本卫生服务的覆盖情况呈正相关。
在宫颈癌和乳腺癌筛查服务的组织方面存在较大差距。拉加共同体各国政府需要制定务实的公共卫生政策和加强卫生系统。应确保可持续的资金投入，实现癌症诊断和治疗的全民覆盖。此外，各国应加强卫生信息系统，确保充分监测和评估。
