Epidemiology of cervical cancer in Colombia
Abstract
Worldwide, cervical cancer is the third most common cancer in women, and the first or second most common in developing countries. Cervical cancer remains in Colombia the first cause of cancer mortality and the second cause of cancer incidence among women, despite the existence of screening programs during the last 3 decades. Bucaramanga, Manizales and Cali reported rates around 20 per 100,000 and Pasto 27 per 100,000. The Cali cancer registry has reported a progressive decrease in the age standardized incidence and mortality rates of cervical cancer over the past 40 years. Reasons for the decline in incidence and mortality of cervical cancer are multiple and probably include: improvement in socio-economic conditions, decrease in parity rates and some effect of screening programs.
Human papilloma Virus is the main cause of cervical cancer, HPV natural history studies have now revealed that HPVs are the commonest of the sexually transmitted infections in most populations. Most HPV exposures result in spontaneous clearance without clinical manifestations and only a small fraction of the infected persons, known as chronic or persistent carriers, will retain the virus and progress to precancerous and cancer. HPV 16 and 18 account for 70% of cervical cancer and the 8 most common types. (HPV 16, 18, 45, 33, 31, 52, 58 and 35) account for about 90% of cervical cancer. Case-control studies also allowed the identification of the following cofactors that acting together with HPV increase the risk of progression from HPV persistent infection to cervical cancer: tobacco, high parity, long term use of oral contraceptives and past infections with herpes simplex type 2 and Chlamydia trachomatis. The demonstration that infection with certain types of human papillomavirus (HPV) is not only the main cause but also a necessary cause of cervical cancer has led to great advances in the prevention of this disease on two fronts: (i) Primary prevention by the use of prophylactic HPV vaccines; and (ii) secondary prevention by increasing the accuracy of cervical cancer screening.
Authors
Downloads
Keywords
- Oncology
References
1. Ferlay J, Shin HR, Bray F, Forman D, Mathers C and Parkin DM. GLOBOCAN 2008 v2.0, Cancer Incidence and Mortality World¬wide: IARC CancerBase No. 10 [Internet]. Lyon, France: Inter¬national Agency for Research on Cancer; 2010. Available from: http://globocan.iarc.fr, accessed on 05/06/2012.
2. Almonte M, Sánchez GI, Jerónimo J, Salmerón J, Ferreccio C, Lazcano-Ponce E, et al. Nuevos paradigmas y desafíos en la prevención y control del cáncer de cuello uterino en América Latina. Salud Publica Mex. 2010; 52(6): 544-59.
3. Pardo C, Cendales R. Incidencia estimada y mortalidad por cáncer en Colombia 2002-2006. Bogotá; Instituto Nacional de Cancerología; 2010.
4. Murillo R, Wiesner C, Cendales R, Pineros M, Tovar S. Comprehensive evaluation of cervical cancer screening programs: the case of Colombia. Salud Publica Mex. 2011; 53(6): 469-77.
5. Piñeros-Petersen M, Pardo-Ramos C, Gamboa-Garay Ó, Hernández-Suárez G. Atlas de mortalidad por cáncer en Colombia. Bogotá: Instituto Nacional de Cancerología-ESE, Instituto Geográfico Agustín Codazzi; 2010.
6. Yepez MC, Bravo LE, Hidalgo A, Jurado DN, Bravo LM, Cancer incidence and mortality in the municipality of Pasto, 1998-2007.Colomb Med. 2012; 43(4): 256-66.
7. Lopez G, Arias N, Arboleda W. Cancer incidence and mortality in Manizales, 2003-2007. Colomb Med. 2012; 43 (4): 281-9
8. Muñoz N. From causality to prevention. The example of cervical cancer: my personal contribution to this fascinating history. Public Health Genomics. 2009;12: 368-71.
9. Muñoz N, Bosch X, Kaldor JM. Does human papillomavirus cause cervical cancer? The state of the epidemiological evidence. Br J Cancer 1988; 57 (1): 1-5.
10. Muñoz N, Bosch FX, de Sanjosé S, Tafur L, Izarzugaza I. The causal link between human papillomavirus and invasive cervical cancer: a population based case control study in Colombia and Spain. Int J Cancer. 1992; 52: 743-49.
11. Bosch FX, Muñoz N, de Sanjosé S, Navarro C, Moreo P, Ascunce N, et al. Human papillomavirus and cervical intraepithelial neoplasia grade III/carcinoma in situ: a case-control study in Spain and Colombia. Cancer Epidemiol Biomarkers Prev. 1993; 2: 415-22.
12. Muñoz N, Bosch FX, de Sanjosé S, Herrero R. For the International Agency for Research on Cancer Multicenter Cervical Cancer Study Group. Epidemiologic classification of human papillomavirus types associated with cervical cancer. N Engl J Med. 2003; 348(6): 518-27.
13. Bouvard V, Baan R, Straif K, Grosse Y, Secretan B, El Ghissassi F, et al. A review of human carcinogens. Part B: biological agents. Lancet Oncol. 2009; 10(4): 321-2.
14. Muñoz N, Castellsagué X, de González AB, Gismann L. HPV in the etiology of human cancer. Vaccine 2006; 24(3): 1-10.
15. Muñoz N, Castellsagué X, Bosch FX, Tafur L, de Sanjosé S, Aristizábal N, et al. Difficulty in elucidating the male role in Colombia, a high-risk area for cervical cancer. J Natl Cancer Inst. 1996; 88: 1068-75.
16. Walboomers JMM, Jacobs MV, Manos MM, Bosch FX, Kummer JA, Shah KV, et al. (1999) Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol. 1999; 189: 12-9.
17. Muñoz N, Bosch FX, Castellsagué X, Díaz M, de Sanjosé S, Hammouda D, et al. Against which human papillomavirus types shall we vaccinate and screen? The international perspective. Int J Cancer. 2004; 111: 278-85.
18. de Sanjose S, Quint WG, Alemany L, Geraets DT, Klaustermeier JE, Lloveras B, et al. Human papillomavirus genotype attribution in invasive cervical cancer. Lancet Oncol. 2010; 11: 1048-56.
19. Muñoz N, Kjaer SK, Sigurdsson K, Iversen OE, Hernandez-Avila M, Wheeler CM, et al. Impact of human papillomavirus (HPV)-6/11/16/18 vaccine on all HPV-associated genital diseases in young women. Natl Cancer Inst. 2010; 102(5): 325-39.
20. Lehtinen M, Paavonen J, Wheeler CM, Jaisamrarn U, Garland SM, Castellsague X, et al. Overall efficacy of HPV-16/18 AS04-adjuvanted vaccine against grade 3 or greater cervical intraepithelial neoplasia: 4-year end-of-study analysis of the randomised, double-blind PATRICIA trial. Lancet Oncol. 2012; 13(1): 89-99.
21. Palefsky JM, Giuliano AR, Goldstone S, Moreira ED Jr, Aranda C, Jessen H, et al. HPV vaccine against anal HP infection and anal intraepithelial neoplasia. N Engl J Med. 2011; 365(17): 1576-85.
22. Kreimer AR, González P, Katki HA, Porras C, Schiffman M, Rodríguez AC. Efficacy of a bivalent HPV 16/18 vaccine against anal HPV 16/18 infection among young women: a nested analysis within the Costa Rica Vaccine Trial. Lancet Oncol. 2011; 12(9): 862.
23. World Health Organization. Human papillomavirus vaccines. WHO position paper. Wkly Epidemiol Rec. 2009; 84: 118-31.
24. GAVI Alliance. Human papillomavirus vaccine. New and underused vaccines support. Types of support. Geneva, Switzerland. GAVI Alliance; 2012.
25. Kreimer AR, Rodríguez AC, Hildesheim A, Herrero R, Porras C, Schiffman M. Proof-of-principle evaluation of the efficacy of fewer than three doses of a bivalent HPV16/18 vaccine. J Natl Cancer Inst. 2011; 103(19): 1444-51.
26. Murillo R, Almonte M, Pereira A.Cervical cancer screening programs in Latin America and the Caribbean. Vaccine 2008; 26(Suppl 11): L37-48.
27. Cuzick, J, Arbyn M, Sankaranarayanan R, Tsu V, Ronco G, Mayrand MH, et al. Overview of human papillomavirus-based and other novel options for cervical. Vaccine. 2008. 26(Supp 10): K29-41.
28. Sankaranarayanan R, Nene BM, Shastri SS. HPV screening for cervical cancer in rural India. N Engl J Med. 2009; 360(14): 1385-94.
29. Gamboa O.,Chicaíza L, García-Molina M, Díaz J, González M, Murillo. Cost-effectiveness of conventional cytology and HPV DNA testing for cervical cancer screening in Colombia. Salud Publica Mex. 2008; 50: 276-85.
30. Murillo R, Luna J, Gamboa O, Osorio E, Bonilla J, Cendales R. Cervical cancer screening with naked-eye visual inspection in Colombia. Int J Gynaecol Obstet. 2010;109:230-4.
31. Muñoz N, Herrero R. Prevention of cervical cancer in women;s hands: Mexico leads the way. Lancet. 2011; 378:1829-31
32. Qiao YL, Sellors JW, Eder PS, Bao YO, Lim JM, Zhao FH. et al. A new HPV-DNAtest for cervical cancer screening in developing regions: a cross-sectional study of clinical accuracy in rural Chin. Lancet Oncology 2008; 9: 929-36
33. Muñoz N, Franco, EL, Herrero R, Andrus JK, de Quadros CA, Bosch FX. Recommendations for cervical cancer prevention in Latin America and the Caribbean. Vaccine. 2008; 26(11): L96-107.
The copy rights of the articles published in Colombia Médica belong to the Universidad del Valle. The contents of the articles that appear in the Journal are exclusively the responsibility of the authors and do not necessarily reflect the opinions of the Editorial Committee of the Journal. It is allowed to reproduce the material published in Colombia Médica without prior authorization for non-commercial use