Between 800 to 900 women a year die in Ecuador from malignant neoplasm of the uterus, that is, cancer in that part of the female body. During 2021 alone, 882 deaths were registered, more than the 790 reported in 2018.
The number increased in 2019 and 2020 with 909 and 922 deaths, in that order. 57% of the deaths in 2021 correspond to cancer located in the cervix, according to the latest figures available from the National Institute of Statistics and Censuses (INEC).
The incidence and mortality of this and other types of cancer that affect the female population increased throughout the region during the COVID-19 pandemic, as reported at Roche Press Day 2022: Women, Health and Equality, which met at the beginning of this month in Cartagena (Colombia) to several Latin American experts on the subject.
Cervical cancer is one of the most prevalent in women over 30 and 40 years of age, says I-Li Huang, professor of Gynecology and Obstetrics at the San Francisco de Quito University.
This disease has a longer diagnosis time before it worsens, which is why most of those who die correspond to totally preventable deaths, he adds. “Cervical cancer is slow growing, in other words, there is time to look for the precursors before it gets too far. We are talking about three to five years at least that you have”.
That is to say, those that develop the ailment is because in general they did not have screening such as the papanicolaouwhich detects early cell changes that can lead to cervical cancer, during the last three years or never.
The updated guidelines indicate that the Women between the ages of 21 and 30 should have this Pap smear test at least every three years. Y those over 30 also add the human papillomavirus (HPV) test every five years. This sexually transmitted disease is the cause of 85% of cases of cervical cancer.
A study carried out in Cuenca reports on the time it takes for a diagnosis from the appearance of the first symptoms of five types of cancer (breast, prostate, cervix, stomach and thyroid).
Diego Jimbo, national coordinator of the Agreement Against Cancer and the Observatory of Catastrophic Diseases, indicates that the average time is 8.9 months. In the rest of the country it would be higher due to inconveniences and delays in accessing health services.
“In the specific case of cervical cancer, the time is nine months from the start of symptoms until treatment is started.. This is too much, because the maximum period should be one month now that technology has advanced. These types of cancer were chosen because they are the ones prioritized by the Ministry of Public Health (MSP), but also because they have a higher incidence,” says Jimbo.
The investigation was carried out by Families United for Cancer Patients (Fupec) and the Cantonal Council for the Protection of Rights of Cuenca.
The Primary prevention is immunization to protect minors from HPV before they start their sexual life. This is the best way to prevent the incidence in the long term, but vaccination coverage has decreased.
Of From 2019 to 2020, we went from covering 66.8% to 44.5% of the target group, which are girls from 9 years to 10 years and six monthsas reported by the MSP to this newspaper.
The impact of the pandemic led to education being online due to the confinement measures established to reduce infections by COVID-19, which halted the vaccination campaign to prevent HPV, which included immunization in the classroom, which in the present is resumed little by little.
Huang indicates that the high cost of vaccines slows down a mass immunization that covers a larger population. “In the private part, the last of nine strains costs $100 each and there are three doses. This has to be constant, every year, so they will have protection against high-risk strains of HPV for cancer.”
The Acuerdo Contra el Cáncer collective and the Observatory asked the MSP that the vaccine be extended to all girls between the ages of 9 and 12 and that boys, who are also carriers and transmitters of HPV, not be left aside, says Jimbo.
The MSP plans to present at the beginning of next December the National Plan for the Prevention of Cervical Cancer from the country.
The objective is to have molecular biology tests in the public health network to more directly and accurately test the HPV genotypes that generate this type of cancer.
The plan will be part of a State policy and one of its purposes is diagnose cancer-prone HPV in 70% of women aged 30-65 over the next four yearswho are part of the target group of the measure.
Studies indicate that genotypes 16 and 18 are associated with 70% of cancer cases, but in total there are 14of the more than 200 described, those who are at high oncogenic risk.
The idea is to follow up on these cases, since those infected must follow a roadmap that includes colposcopy, more frequent pap smears, and specific treatments in order to stop the development of cancer in time and prevent deaths.
The pilot project is to have these more precise tests in the Vicente Corral Moscoso hospital in Cuenca, the Verdi Cevallos Specialties Hospital in Portoviejo and the General Teaching Hospital in Calderón, in Quito. In the first stage there will be 41,334 tests available and in the first year it will seek to diagnose 2% of the target group.
The goals established by the World Health Organization in 2021 are for countries to achieve the 90-70-90 strategy by 2030, which consists of 90% of girls fully vaccinated between the ages of 9 and 14, 70% of women screened (tested) before age 35 and again before age 45 using a highly accurate HPV test, and 90% of women diagnosed with cancer of the cervix with treatment.
The unfortunate thing about deaths from cervical cancer is that they are perfectly preventable and curable if detected early. Hence the importance of making molecular biology tests available on the public network, says Huang, since the Pap smear is not as sensitive. “Your detection rate can vary from 20% to 80%, so it’s not the most accurate. The problem is with the number of tests and the budget that will be available, because forty thousand will be finished in a short time. It has to be a massive application”, adds the specialist.
The HPV test costs between $50 and $150 in the private network. The pap smear is cheaper since its cost starts at $10 and up and is free for the public.
Jéssica Medina, a pharmaceutical chemist at Roche laboratories, indicates that the period from 30 to 65 years of age is when HPV permeates the body’s cells, which is why it is the best time to detect it. “Those most at risk are those who have several sexual partners and those who are sexually active. Also smokers and those who do not exercise, that is, those who lead unhealthy lifestyles, because the immune system is depressed and therefore HPV gains more strength and stays in them.
The available molecular biology tests include the real-time PCR technique, adds the specialist. “It is a technique validated by the FDA (United States agency responsible for regulating food, health products and services), it is highly sensitive and specific. The sample is taken, as in a pap smear, with a brush that is washed in a vial (sample collection medium) which is the one that directly enters the equipment in which it is detected”.
Jimbo points out that there is little political will to prevent this type of cancer, which is expected to change from the application of the announced guide. “We must remember that political will often also moves with the needs of the people.”
Cervical cancer is the second most frequent gynecological cancer in Ecuador, only surpassed by breast cancer. (YO)
Source: Eluniverso
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