Cervical cancer

Mexico’s experience

Dr. Maki Esther Ortiz DomínguezViceminister of Integration and Development of the Public Health Sector

Mexican Ministry of Health

Rate per 100,000 women mortality of cervical cancer

Rates per 100,000 women per year. Standardised rates have been estimated using the direct method and the World population as the reference.

Data sources:IARC, Globocan 2008. Age-specific data from GLOBOCAN 2008 were obtained from IARC, personal communication.

260 thousand deaths, per year.

Rates per 100,000 women per year. Standardised rates have been estimated using the direct method and the World population as the reference.

Data sources:IARC, Globocan 2008. Age-specific data from GLOBOCAN 2008 were obtained from IARC, personal communication.

Most of the cases are detected in the developing countries.

Cases of cervical cancer

Mexico: Principal causes of death in women, 2009

Types of Cancer

Breast cancer

Cervical cancer

2009

Cervical cancer trends progress in Mexico

Mortality rate per 100,000 women mortality from breast and cervical cancer

Source: Knaul FM, et. al., Salud Pública de México, 2009.

National policy (Official Mexican Standard: NOM-014)

19.57

18.58

17.3316.94

16.21 15.88

15.01

14.3113.98 13.90 13.75

10.00

11.00

12.00

13.00

14.00

15.00

16.00

17.00

18.00

19.00

20.00

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Mortality rate of women aged 25 and over

From 19.57 to 13.75 in 10 years

National policy

Education for the population to get awareness, and self responsibility.

Cytological sample as universal detection method.

Positive HPV sent to a colposcopy center.

Official Mexican Standard (NOM-014) for Prevention, Treatment and Control of Cervical Cancer.

Prevention and early detection actions

PAP screening implemented in all public health care services. 35% detection coverage in 1989,

75% detection coverage in 2010.

13 Cytology laboratories (tests of HPV DNA to high risk women from 35 to 64 years).

Campeche

Veracruz

GuerreroMichoacán

Oaxaca

Puebla

DFEdo México

Nuevo León

Sinaloa

GuanajuatoJalisco

Sonora

Hybrid Capture Test

Started in 2007

Applied in 125 counties with less Human Development Index

2009-2010: 1.9 millions tests in all country to women from 35 –

64 years old.

2011: 2 millions of tests.

Home vaginal self take test: Advantages

More accuracy and sensitivity to identify NIC2+, and cervical injuries.

Quick increase of coverage

Available technology in the poorest areas

Better diagnosis quality that only use of PAP.

VPH Vaccine (Recombinant Human Papillomavirus Quadrivalent Vaccine)

Started in 2008.

Complete schemes of 3 doses of HPV vaccine.

125 regions (municipalities) with the lowest human development index.

400,000 complete schemes of VPH vaccines to girls from 9 – 12 years old in 2008-2010.

20 % coverage in girls 9-12 years old.

Actions for the poorest women in poor communities

“Caravanas de la Salud” Program

Health promotion HPV Vaccination

Cervical Cytology and Acid Acetic direct visualization.

Biomolecular tests: Hybrid Capture, and RPC (Resistive plate chambers), as a cytology complement.

Women in 25 to 64 years with positive results, are referred to a Colposcopy Center, Dysplasia center, or a Oncological Center.

Treatment of Cervical cancer

Universal financial coverage of treatment since 2004 to 2010.

12,251 cases under “Seguro Popular” coverage to women without any health insurance.

Goals and perspective

Incorporate the HPV vaccine to the basic vaccination scheme.

Reach in 5 years, a coverage detection for high risk HPV of 65 % in 35-64 women.

National goal 2012: Reduce mortality to 10.9 deaths per 100,000 women aged 25 and over (27% from 2006 to 2012).

Continue efforts to reach levels of developed countries with death rates per 100,000 women (3 to 5).

Cervical cancer is preventable using the available screening, diagnosis and

treatment.

Health is not everything, but without health, everything is nothing.

(Schopenhauer)