Unit No. 3 The prevention of cervical cancer: the role of The first level of care, Some complex health problems 45 Introduction cancer of the cervix can be prevented almost completely thanks to the knowledge and technologies currently available, however, it is the second most common type of cancer among women worldwide and the leading cause of cancer death in developing countries.
Although effective prevention methods exist, in our country, as in the rest of Latin America, mortality from cervical cancer has not decreased significantly in the last forty years. Each year, about 4,000 new cases of cervical cancer1 are diagnosed and about 1,800 women die from the disease.
The prevention of cervical cancer
Although it is the second leading cause of death-due to cancer – in women aged 35-64, not the entire population of women aged 35-64 is equally affected. This disease expresses cruelly the social inequalities in health, as an example: mortality rates in the provinces of the NOA and NEA regions are three to four times higher (15/100000) than those in the city of Buenos Aires (4/100000).
If the incidence of cervical cancer is high, as well as the mortality it produces, it is because key prevention strategies to reduce the incidence of the disease have not been effective. The difference between cervical cancer mortality data between jurisdictions with good access to health services and those where such access is not guaranteed supports this assumption.
This is why the National Programme for the Prevention of cervical cancer promotes as a screening method the performance of the Pap test (PAP) to all women from the age of 25, and especially between the ages of 35 and 64, in order to identify those at greater risk of developing the disease.
The strategies that today the Ministry of health
The first level of care is in an excellent position to promote prevention actions and, it is essential that all those who work there understand and share the importance of improving the recruitment of women so that the screening strategy is effective.
In this unit we present cervical cancer as a public health problem and the strategies that today the Ministry of health of the nation implements to reduce the incidence and mortality from this disease. At the end of this unit you will be able to: recognize the inequalities in Health expressed by the incidence and mortality from cervical cancer in women in our country. Identify the population to be captured for screening as a method of cervical cancer prevention. 1. Ferlay, J,, Bray, F,, Pisani, P,, Parkin, D. M.: GLOBOCAN 2002.
Cancer Incidence, Mortality and Prevalence Worldwide. IARC Cancer base No. 5. Version 2.0, IARC Press; 2004. 2.National Programme for the Prevention of cervical-uterine cancer. En http://www.msal.gov.ar / cervical-uterine cancer / epidemiological data. asp 46 course in social and Community Health 3. All the concepts exposed in this Unit have been taken from the materials of the National Program of Cervical Cancer the Ministry of Health of the Nation: a Programme Guide Abridged for the Prevention of Cancer of Neck of Uterus, “Strategy ” A time to talk about the PAP”: Primer for health professionals, What women think: knowledge and perceptions about cervical cancer and the PAP and Brochures: Let’s make reality the right to health of all women, The two need a PAP, I did a PAP smear, now what?, Lesbians and bisexual women.
HPV is a very common virus between men
Assess the intake of PAP and the return of its results as a secondary prevention strategy at the first level of care. Implement strategies to find women from the age of 25, and especially between the ages of 35 and 64, to ensure that a PAP is performed. To know the strategy (s) implemented by the Ministry of Health through the National Program for the Prevention of cervical-uterine cancer. To be aware of the role of the community team in the strategy of active search for women for the realization of PAP and, therefore, of its importance in the success of the strategy of prevention of cervical uterine cancer.
Cervical cancer: its natural evolution cancer is an abnormal growth of cells, in this case of the cervix. This growth is slow, which allows it to be detected in very early stages, facilitating the healing of the sammo3 .
Cervical cancer is mainly caused by some types of human papillomavirus (HPV), better known by its acronym in English as HPV. Different studies have found that human papillomavirus (HPV) infection is a necessary cause of cervical cancer. HPV is a very common virus between men and women and is usually transmitted through sexual contact. It is estimated that more than 80% of men and women will be affected by the virus at some point in their lives.
HPV is classified into 2 groups according to the risk they have of causing precancerous lesions and cancer – – HPV of low oncogenic risk, and-HPV of high oncogenic risk.
Low-risk HPV can cause benign lesions, such as warts and some low-grade lesions. Most warts do not cause discomfort and will disappear on their own. These HPV are not related to cancer. High-risk HPV can also cause benign lesions, but they have almost the exclusivity in the appearance of malignant lesions in the genital organs. In women, high-risk HPV can cause precancerous neck injuries 47 some complex health problems 4. For more information on this primary prevention strategy, consult the PRONACEI (National Programme for the control of Immunoprevenible diseases), Ministry of Health. In site of the uterus. In males, HPV-related cancers are very rare (penis, anus). Cervical infection with high-risk HPV can cause dysplasia (changes in cervical cells).
It is quite common for HPV to cause low-grade dysplasias after months or years of infection. Most low-risk injuries experience regression or fail to progress, especially in younger women with transient infections. This happens when the body’s defense mechanisms eradicate the virus. It is estimated that 5% of women infected with high-risk HPV develop persistent infections. These lesions that persist, if left untreated, can eventually turn into cancer. High-risk lesions are less common and can arise either from a progression of low-grade dysplasias, or directly from persistent HPV infection.