U IC CC e rv ic al C ancer In itia tiv e

Transcripción

UICC Cervical Cancer Initiative
August 2008
Supporting improved
cervical cancer
prevention worldwide
D O S S I E R O F S U P P O RT
Support cervical cancer prevention
Supporting improved cervical cancer
prevention worldwide
Vers une prévention organisée contre
le cancer du col de l’utérus
Hacia una prevención integral del
cáncer cérvico-uterino
For further information please contact
International Union Against Cancer (UICC)
Cervical Cancer Initiative
62 rte de Frontenex
1207 Geneva
Switzerland
TEL: +41 22 809 18 11
Fax +41 22 809 18 10
E-mail: [email protected]
www.uicc.org/cervicalcancer
Index
Letters from UICC members.. .......................................................................A1
Africa........................................................................................A1
Burundi . ............................................................................................................................... A2
Ethiopia................................................................................................................................. A3
Niger..................................................................................................................................... A5
Nigeria................................................................................................................................... A7
Tunisia................................................................................................................................... A10
Uganda.................................................................................................................................. A11
B.
C.
Europe.. .......................................................................................C1
Belgium................................................................................................................................. C2
Denmark................................................................................................................................ C3
Estonia . ................................................................................................................................ C5
France .................................................................................................................................. C6
Germany . ............................................................................................................................. C8
Italy....................................................................................................................................... C10
Northern Ireland ................................................................................................................... C12
Norway . ............................................................................................................................... C13
Portugal . .............................................................................................................................. C14
Slovakia ................................................................................................................................ C15
Spain..................................................................................................................................... C16
Switzerland ........................................................................................................................... C19
Turkey .................................................................................................................................. C21
United Kingdom..................................................................................................................... C22
Initiative
Australasia/ Asia........................................................................B1
Australia................................................................................................................................ B2
Bangladesh............................................................................................................................ B6
India...................................................................................................................................... B8
Indonesian............................................................................................................................. B12
Malaysia................................................................................................................................ B13
Pakistan................................................................................................................................. B14
Taiwan................................................................................................................................... B16
Vietnam . .............................................................................................................................. B17
Cancer
A.
Cervical
Foreword............................................................................................................................... 1
UICC cervical cancer initiative................................................................................................. 2
World Cancer Declaration 2008.............................................................................................. 3
UICC cervical cancer concept paper........................................................................................ 7
Burden of HPV DNA 16 or 18 in women with and without cervical cancer by world region...... 12
D.
Latin America & Caribbean.........................................................D1
Argentina............................................................................................................................... D2
Bolivia . ................................................................................................................................. D7
Dominican Republic............................................................................................................... D9
Guatemala............................................................................................................................. D11
Honduras .............................................................................................................................. D12
Mexico.................................................................................................................................. D15
Uruguay ............................................................................................................................... D17
E.
Middle East.................................................................................E1
Israel . ................................................................................................................................... E2
Lebanon................................................................................................................................ E3
F.
North America..............................................................................F1
Canada.................................................................................................................................. F2
United States of America........................................................................................................ F9
Annex 1. Example of country work on cervical cancer by members - - - G1
Australia................................................................................................................................ G2
Bangladesh............................................................................................................................ G4
Nigeria................................................................................................................................... G6
United States of America........................................................................................................ G8
European Union..................................................................................................................... G9
Uruguay................................................................................................................................ G10
Annex 2. Evidence of Country Support for Improved Cervical Cancer Prevention - G13
Annex 3. ECCA European Cervical Cancer Association. -
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Annex 4. Useful links -
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Annex 5. References from concept paper Annex 6 Model letters -
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Foreword
The received letters are here compiled along
with the UICC position paper on cervical
cancer, the World Cancer Declaration 2008,
newsletters and articles, and other statements.
These letters have also been shared with the
Cervical Cancer Action (CCA) coalition to
form a united and comprehensive advocacy
dossier for improved cervical cancer prevention
worldwide. This comprehensive dossier will be
submitted to the World Health Organization
(WHO) and other agencies working on
cervical cancer prevention. A digital version
of the UICC dossier will be available on the
UICC website for members and partners’ own
advocacy efforts.
WHO/P. Virot
Sincerely,
New
Isabel Mortara
Executive Director
Initiative
UICC is calling for comprehensive and locally
appropriate programmes including improved
screening and treatment, vaccination, and
public education. We thus asked our members,
colleagues and influential partners to send a
letter to UICC in support of comprehensive
cervical cancer prevention worldwide,
especially in the developing world, which
suffers the highest incidence and mortality.
Old
We hope this joint effort will increase the
impact of UICC advocacy and showcase the
commitment of the global cancer community.
Cancer
In April 2007 the UICC board of directors
adopted a cervical cancer concept paper and
launched a cervical cancer initiative, outlining
priority areas for effective cervical cancer
prevention and appropriate interventions.
UICC is therefore working with different
coalitions and organizations in the global effort
to eliminate cervical cancer and provide those
who need it most with affordable and effective
prevention strategies.
Cervical
Cervical cancer is the second largest cause of
death from cancer in women worldwide. For
women in developing countries it is the biggest
cancer killer.
UICC cervical cancer initiative
UICC is working in partnership with
international organizations, professional
associations and NGOs to give cervical cancer
prevention and control a high priority on the
global health agenda.
Information and awareness
campaign
Advocacy
• the Global Cancer Control Community for
discussion and information sharing
• the World Cancer Campaign theme
for 2010 focusing on the link between
infections and cancer
UICC supports all efforts and works with
partners to make affordable and effective
HPV vaccines, screening technologies and
treatments available for all women globally,
especially in resource-constrained
countries, through:
• advocacy sessions at the World Cancer
Congresses in 2008 and 2010
• providing UICC members with tools to
advance their own advocacy efforts
• tracking progress in implementing the
World Cancer Declaration by region
Professional education
UICC provides training opportunities for health
professionals and decision makers from both
developed and developing countries through:
• UICC fellowships and training workshops
• development of a comprehensive cervical
cancer educational training package
UICC reaches different networks and target
audiences such as children, youth, teachers,
women and patients through:
UICC pilot project
UICC is planning a comprehensive pilot project
in a high-risk country, the pilot will include
professional and public education, prevention
and early detection in partnership with local,
regional and global partners.
UICC:
» advocates for affordable and
appropriate cervical cancer
prevention and control
» provides educational resources and
training opportunities to health
professionals and decision makers
» raises awareness through public
information, education and
campaigns
» assists in the implementation of
specific actions at the country level
For further information, please contact us at [email protected]
Or visit www.uicc.org/cervicalcancer
www.uicc.org/fellowships
World Cancer Declaration 2008
A worsening global crisis
4. Millions of lives that could be saved will be
lost unless action is taken to raise awareness
about cancer, galvanize political leadership,
and develop practical strategies. Most
countries have neither the strategy nor the
political will to tackle cancer – few even know
how many of their citizens are affected.
5. There are significant weaknesses in the
global response to cancer. The global
healthcommunity, which has a huge
influence over national priority setting
and resource allocation, has for decades
focused almost exclusively on infectious
diseases. Consequently, the world is poorly
prepared and ill equipped to confront this
impending disaster.
Initiative
2. Although there are significant differences
in cancer burden, mix and trend across the
world, the rapidly increasing cancer burden
affects all the world’s populations – not just
high-income countries. Currently, cancer is the
second leading cause of death in developed
countries and the third leading cause of death
in the developing world. In affluent countries,
despite increasing incidence, cancer survival
rates are rising because more cancers are
detected early and treated appropriately. In
stark contrast, incidence and mortality rates
. Cancer deprives families of caregivers
and income earners. It causes appalling
suffering and often spells economic ruin, as
families sink all their resources into paying
for treatment that is often inappropriate
and delivered too late.
Cancer
1. Cancer kills more people than AIDS, TB and
malaria combined, and the death toll is set
to rise dramatically over coming decades
unless concerted action is taken now. In the
few years since the start of the 21st century,
cancer has already cost almost as many lives
as the whole of World War II – the single
deadliest conflict the world has ever seen.
The global cancer burden is increasing rapidly
with growth driven largely by the ageing
of the world’s population. By 2030 it is
estimated that over 12 million people will die
of this disease every year. More than 70% of
these deaths will occur in low- and middleincome countries, where resources available
for cancer control are limited or nonexistent.
are rapidly increasing in less affluent countries
but there has been no significant
improvement in survival.
Cervical
A call to action from the
global cancer community 1
1 At the World Cancer Congress in Washington DC in July 2006 the global cancer community united behind a call for
urgent action to deal with the worldwide cancer crisis by launching the first World Cancer Declaration, which outlines
the steps needed to begin to reverse the global cancer crisis by 2020. The Declaration is a tool, regularly revised, to
help cancer advocates bring the growing cancer crisis to the attention of health policymakers at a national, regional
and global level. It represents a consensus between foundations, national and international non-governmental and
governmental organizations, professional bodies, the private sector, academia and civil society from all continents
that are committed to the vision of eliminating cancer as a major threat for future generations. The World Cancer
Declaration builds on Charter of Paris, which was the first effort to mobilize the global cancer community to address the
growing cancer crisis worldwide.
We the global cancer community call on
governments, international governmental
organizations, the international donor
community, development agencies, the private
sector and all civil society to take immediate
steps to slow, and ultimately reverse, the
growth in deaths from cancer, by committing
to the goals and targets set out below and
providing resources and political backing for
the priority actions needed to achieve them.
Targets
By 2020:
• Sustainable delivery systems will be in place
to ensure that effective cancer control
programmes are available in all countries
• The measurement of the global cancer
burden and the impact of cancer control
interventions will have improved significantly
• Global tobacco consumption, obesity
and alcohol intake levels will have fallen
significantly
• Populations in the areas affected by HPV
and HBV will be covered by universal
vaccination programmes
• Public attitudes towards cancer will improve
and damaging myths and misconceptions
about the disease will be dispelled
• Many more cancers will be diagnosed when
still localized through the provision of screening
and early detection programmes and high levels
of public and professional awareness about
important cancer warning signs
• Access to accurate cancer diagnosis,
appropriate cancer treatments, supportive
care, rehabilitation services and palliative care
will have improved for all patients worldwide
• Effective pain control measures will
be available universally to all cancer
patients in pain
• The number of training opportunities
available for health professionals in
different aspects of cancer control will
have improved significantly
• Emigration of health workers with
specialist training in cancer control will
have reduced dramatically
• There will be major improvements in
cancer survival rates in all countries
These targets are ambitious. During the past
few years, however, there is growing evidence
that concerted action can make a difference in
a short time. We believe, therefore, that the
targets can be achieved provided a number of
priority actions are implemented.
Health policy
Initiative
Cancer prevention and early
detection
Cancer treatment
Cancer
• Place cancer on the development agenda.
Increase the political priority given to
cancer by demonstrating that a country’s
investment in dealing with its growing
cancer problem is an investment in the
economic and social well-being of the
country. Organizations concerned with
cancer control should work with the global
donor community, development agencies,
the private sector and all civil society to
invest in cancer control
• Mobilize stakeholders to ensure that
strategies to control cancer globally are
targeted at those who are most in need.
Involve all major stakeholder groups in
the development, or updating, of national
cancer control policies
• Implement strategies that have been proven
to bridge existing cancer surveillance gaps
• Increase efforts to involve cancer patients
in cancer control planning at a local and
national level
• Raise awareness about the need for
culturally sensitive cancer risk reduction
campaigns, along with public and
professional education about cancer
warning signs. Push governments to
implement policies that will support riskreducing strategies at a community level
and enable individuals to make more
informed consumption choices and adopt
healthier behaviour
• Encourage governments to implement
measures to reduce people’s exposure
to environmental and occupational
carcinogens
• Undertake actions to ensure that vaccines
and other strategies that are shown
• to prevent cancer-causing infections are
made more widely available Advocate
for the provision of affordable screening
programmes for which there is evidence
of efficacy in the population in question.
Undertake pilot projects that are designed
to evaluate the feasibility and efficacy
in populations in which the screening
technology has not yet been tested
Cervical
Priority actions
• Promote the development and use of cancer
treatment guidelines that are relevant to
local needs and resources. Ensure that
sufficient treatment, rehabilitation and
palliative care facilities and well-trained staff
are available to meet the physical, social
and emotional needs of patients with cancer
• Increase efforts to reduce tobacco
consumption by encouraging governments
to fully implement and enforce the FCTC
• Take steps to tackle the many barriers
to optimal pain control. Work with
governments to address the over-regulation
of pain medicines. Cooperate with
international organizations, including the
International Narcotics Control Board and
the World Health Organization, to ensure
that global implementation of the UN’s
international drug control conventions do
not unduly interfere with legitimate efforts
to advance access to pain medicines for
cancer patients in pain
• Work with the pharmaceutical industry to
increase access to cancer medicines that are
affordable and of assured quality
• Increase the number of health professionals
with expertise in all aspects of cancer
control by providing specialist training
opportunities and fellowships to enable
professionals to study in specialist settings
• Raise awareness about the impact of health
worker emigration on the ability of countries
to provide adequate levels of cancer care
and work collectively to address global and
national health workforce shortages and the
resultant deepening of inequity
Cancer research
• Increase investment in independent basic
and applied cancer research and accelerate
the translation of research findings into
clinical and public health practice
• Encourage cancer research organizations
in different countries to collaborate, share
data and define complementary research
objectives to optimize the use of the limited
funds available for cancer research and
reduce duplication of effort
Progressing towards the
2020 targets
• Through its member organizations, now
more than 300 in over 100 countries, the
International Union against Cancer (UICC)
will promote partnerships and international
collaboration aimed at accelerating progress
towards achieving the 2020 targets
• Given the huge variability in cancer burden
and service provision throughout the world,
UICC will encourage members to use the
World Cancer Declaration as a template
to develop regional or national cancer
declarations that can better reflect local
needs and priorities and allow for more
accurate quantification of targets where
data exists
• UICC will take responsibility for preparing
a report every two years on the progress
made towards achieving the 2020 targets.
These reports will be presented at the
biennial World Cancer Congress
For more information and to download the
full declaration please visit the website
http://www.uicc.org/index.php?option=com_
content&task=view&id=14227&Itemid=356
UICC cervical cancer concept paper
The paper is open for comment and review.
To submit your comments or questions:
[email protected]
It is the vision of UICC to eliminate cervical
cancer (presently the second most frequent
cancer in women globally), other high risk
HPV-linked cancers, and their respective
precursor lesions. UICC is willing to play
a leading role in building collaboration
and cooperation towards effective HPV
prevention and vaccination.
Disease burden due to
anogenital HPV infections
The global incidence of cervical cancer has
been estimated to be in the range of 493,000
to 510,000 newly diagnosed cases annually.3,4,5
Between 234,000 and 288,000 of those
women will die of the disease. In a country
covered by screening programmes (e.g. the
USA), the annual incidence of advanced
Besides cancer of the cervix, 80-90% of anal
and perianal cancers are caused mainly by HPV
16 and also by HPV 18,8,9 as well as about
50% of vulvar, vaginal, and penile cancers.10,11
In addition, about 25% of oropharyngeal
(including up to 50% of tonsillar) cancers are
linked to HPV 16, and occasionally also to HPV
18 and HPV 33 infections.12,13,14
Genital warts occur at a similar frequency
to CIN 2 and 3 lesions. Approximately 90%
are caused by HPV 6 and HPV 11.15,16 They
rarely become locally invasive and require
in these cases extensive surgery.17 Juvenile
laryngeal papillomatosis represents a rare
condition, mainly caused by HPV 11 and
HPV 6, which exceptionally may convert into
carcinomas of the larynx, bronchi or even the
oesophagus.18,19
Initiative
UICC strategy
Approximately 83% of cervical cancers
occur in resource-constrained populations,4
with accompanying high mortality rates.
Particularly high rates of cervical cancers occur
in sub-Saharan Africa, Central and South
America, and regions of Southeast Asia.4
Underprivileged populations, even in countries
with functioning screening surveillance, also
suffer from higher cervical cancer rates.7
Cancer
In countries where screening is regularly
and competently performed, cervical cancer
incidence has been substantially reduced.
The screening procedures, however, did
not affect the incidence of early precursor
lesions of cervical cancer. The identification of
specific papillomavirus types causing cervical
cancer1,2 opened the way for the development
of vaccines and created an unprecedented
opportunity to prevent cervical and other
anogenital HPV-linked cancers.
precursor lesions (CIN 2 and 3) requiring
surgical intervention exceeds the number of
cervical cancer cases by a factor of 10 to 50.6
Cervical
This concept paper was first adopted by the
UICC board of directors in May 2007 and
published in HPV Today (11), June 2007. It
was last updated in December 2007.
Efficacy of screening
Introduction of screening programmes reduced
the rate of cervical cancer by 60 to 90% within
three years of implementation.3,20 However,
imperfect sensitivity of cytology testing is
estimated to be responsible for up to 30%
of all cervical cancers in the United States.3,21
Even under conditions of optimal screening,
an incidence of two to three cervical
cancer cases per 100,000 women can be
expected. 20 Screening results provide an
indication for surgical intervention for
advanced precursor lesions.
HPV transmission and
natural history of cervical
and other HPV-related
malignancies
Fifty to 60% of squamous cell carcinomas of
the cervix are caused by HPV 16 infections,
15 to 20% by HPV 18.22 Adenocarcinomas of
the cervix reveal a slightly different pattern.
Although HPV 16 appears to account for 40%
of these cases, HPV 18 occurs here at higher
frequency (about 30% of all cases).23
About 15 of more than 40 HPV types infecting
the anogenital tract are considered high-risk
types. Most HPV infections – even high-risk
types – are transient and are cleared by the
host’s immune system within one or two years.
Close to 10% of high-risk infections persist.
These pose a risk that the carrier may develop
cervical cancer, usually after 15 to 25 years. The
long transition period from primary infection
to invasive cancer reflects the requirement for
additional mutational changes of HPV DNAcarrying cells within the host cell genome,
affecting specific signalling cascades.24
Anogenital HPV infections are commonly
transmitted by vaginal (or anal) intercourse.
More than one half of sexually active women
become infected within a 10-year period
following the onset of sexual activity.25,26 Oralgenital contacts are the likely route of oral
lesions caused by anogenital HPV.
Protection by condom use
The use of condoms protects against the
transmission of high risk types of HPV at best
only partially, because lesions appear at places
not completely protected by condoms.27
HPV incidence and
prevalence
HPV is the most common sexually transmitted
infection globally,5 with regional variation even
in regions with close proximity and common
ancestry.3,28 This seems to reflect differences
in sexual and cultural habits. In the US, it has
been estimated that approximately 15% of the
population is currently infected by all identified
types of anogenital HPV.29,30 Most of these
infections occur in the 15 to 25 age group. It
has been calculated that up to 80% of women
will become infected by the age of 50.31
HPV vaccination
Two vaccines are presently available: one
vaccine inducing strong immunological
reactivity against HPV types 6, 11, 16, and
18 (Gardasil®, Merck) and a second one
covering the HPV types 16 and 18 (Cervarix®,
GlaxoSmithKline). Both are presently licensed
and available in many countries.
The present availability of a vaccine, covering
the most prevalent high-risk types of human
papillomaviruses (HPV 16 and 18), as well as
the HPV types mainly responsible for anogenital
warts (HPV 6 and 11), promises to prevent a
substantial proportion of cervical cancers (~70%
globally) as well as the respective precursor
lesions and anogenital warts.
Vaccination will be most efficient if done prior
to the onset of sexual activity. This resulted
initially in the proposal to vaccinate girls aged 9
to 15. Clearly, however, even women in older
age groups, if not previously engaged in sexual
intercourse, will profit from vaccination. Since
the risk for anogenital HPV infections increases
with the number of sexual partners, 37,38,39,40
women within these age groups who have been
sexually active before may decide on vaccination
based on their personal sexual history.3
The onset of sexual activity depends on
cultural and regional habits. Thus, decisions on
the optimal age for vaccination will require a
consideration of these differences.
A three-shot vaccination protocol results in
high antibody titres that persist for at least five
years and exceed the titres observed in natural
infection with anogenital HPV types, even
after regression of the respective lesions.35
During this period the vaccinated women were
protected against persistent infections and
CIN lesions caused by the types present in the
vaccine.35 In view of the limited observation
time, it is difficult at present to predict whether
or when booster vaccinations may be required.
Initiative
Duration of protection
Cancer
Reports on safety of the vaccine reported as
most common side effects erythema, pain and
swelling at the injection site. Other adverse
experiences, like fever, headache, and nausea
occurred at similar frequency in placebovaccinated recipients. A recent report suggests
that additional side effects may involve
collapsing and fainting, tingling, numbness
and loss of sensation in fingers and limps,
even seizures, and rare cases of Guillain-Barré
syndrome (http://mailcontent.pharmalive.
com/cc.asp?b5). The frequency of the last
does not seem to exceed their occurrence
in non-vaccinated populations. Reports of
these complications require, however, further
surveillance studies.
Age groups for vaccination
Cervical
High-grade cervical intraepithelial neoplasias
(CIN) are considered as essential precursor
lesions of cervical cancer. This is further
supported by screening data which show
that detection and removal of these lesions
substantially reduce cervical cancer risks and
mortality. Thus, CIN 2/3 are accepted as
intermediate disease endpoints to determine
the efficacy of anogenital HPV vaccines. The
available studies demonstrated more than 90%
efficacy in the prevention of persistent HPV
infections covered by the vaccine in previously
uninfected women who did not violate the
study protocol, and also of CIN2/3 for a period
of up to 6 years.32,33,34,35 This also accounted
for external genital lesions. The data available
are less convincing for previously not HPVtested female populations. In vaccinations of
women with evidence of current or past HPV
infection there was no clear-cut evidence for
protection from subsequent disease.36
10
Male vaccination
Data on the efficacy and immunogenicity of
Gardasil in boys aged 9 to 15 are supposed
to become available in 2007. Their outcome
should indicate whether there exist gender
differences in the immune response to HPV
vaccines.
At present, some arguments favour the
inclusion of boys or young male adults in
vaccination protocols:
• Anogenital warts are as frequent in males as
in females
• Anal and perianal cancers, about 25% of
head and neck cancers, and about 50%
of penile cancers are etiologically linked to
anogenital HPV infections (mainly HPV16)
• The vaccination of males prevents the
transmission of the respective HPV types to
their female (or male) partners
Inclusion of males would, however, increase
the costs of the vaccination programme. In
addition, mathematical modelling indicates
that where there is high vaccination coverage
of women, the benefit of vaccinating males is
small.41,42,43,44
Screening recommendations,
advice for under-screened
populations
Screening for cervical cancer and its precursor
lesions will remain important in spite of the
availability and application of HPV vaccines.
The current vaccines cover HPV types
responsible for approximately 70% of the
global cervical cancer incidence. In view of
some cross-protection of HPV16 vaccine also
against HPV 31 and of HPV 18 vaccine against
HPV 4537, the rate of protection may go up
close to 80%. Screening for additional HPV
infections remains important. The discussion
on type replacement after effectively
preventing HPV 16 and 18 infections
finds little scientific support at present. In
longitudinal studies, other high-risk HPV types
require much longer time periods for malignant
conversion than HPV types 16 and 18.45,46
Other factors underlining the importance
of continued screening are the degree of
vaccination coverage of the population at
risk, the duration of protection, and the future
inclusion of additional anogenital HPV types in
the preventive vaccine.
In populations where effective screening
programmes are not available, early
vaccination prior to the onset of sexual activity
will be of primary importance. A reduction
of the high costs for vaccination will be an
additional mandatory factor here.
• information of all adolescents on
possibilities of prevention of HPV-linked
human cancers
• mobilization of local, regional, national and
international UICC member and advocacy
organizations to lobby governments in
support of vaccination and screening
programmes
• mobilization of financial/human/technical
resources through partnerships with NGOs
and governmental agencies
• development of the infrastructure for an
effective vaccination of children in selected
target groups
• identification of specific target countries
for a vaccination programme with UICC
participation – only useful in case of
availability of funds or support by the local
government or NGOs.
Initiative
• initiation of acceptability studies for
vaccines based on cultural and regional
habits and on differences in the sexual
debut of the female and male population.
This requires the support of epidemiological
studies covering these aspects
• encourage visual inspection (VIA) and
cryotherapy as an affordable and accessible
intervention in resource constrained
settings47
Cancer
• global efforts in education of health
professionals, politicians, local communities,
teachers and schools to create an awareness
of the importance of HPV infections
and their consequences and to teach
the possibilities of cancer prevention by
vaccination and screening programmes.
This requires, in particular, the setting up of
teams in high-risk areas of cervical cancer
(sub-Saharan Africa, Southeast Asia, Central
and South America)
• encouragement of companies to develop
effective, affordable and easy to handle
kits for HPV testing which could partially
replace cytological screening
Cervical
UICC will concentrate on
• support of all efforts to establish an
affordable and effective HPV vaccine
acceptable for resource-constrained
countries. In particular encouragement of
pharmaceutical companies to develop a
next generation of vaccines, economically
applicable to resource-constrained countries
in the greatest need. Emphasis on vaccines
not requiring cold chains or invasive
application.
11
Burden of HPV DNA 16 or 18 in women with
and without cervical cancer by world region
http://www.who.int/hpvcentre/statistics/en/
12
Letters from UICC members
Africa
Burundi
Alliance Burundaise contre le cancer -
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-
-
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-
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- A2
Ethiopia
Mathiwos Wondu YeEthiopia Cancer Society -
-
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-
-
-
-
-
-
-
-
A3
Niger
Tous unis contre le cancer - - - - - - - - - - - - - - - -
A5
Lagos State Government Ministry of Health / Care Organisation Public enlightenment (COPE)
A7
Society of Oncology and Cancer Research of Nigeria - - - - - - - - - A9
Tunisia
A10
Cancer
Nigeria
Association Tunisienne de lutte contre le cancer - - - - - - - - - -
Cervical
A.
Uganda
A11
Initiative
Uganda Women’s Cancer Support Organisation - - - - - - - - - -
A1
Burundi
Alliance Burundaise contre le cancer
A2
ABCC
Alliance Burundaise Contre le Cancer
Burundi, Mai 2008
Lettre de soutient pour le dossier de l’UICC
À l’attention de l’Union Internationale Contre le Cancer – UICC
Nous soutenons l’effort de mobilisation de l’UICC au niveau mondial et local en
faveur d’une prévention organisée contre le cancer du col de l’utérus. Cette lettre
témoigne de notre engagement dans l’effort pour éliminer le cancer du col dans le
monde et donner accès à des stratégies de prévention efficaces et abordables aux
femmes qui en ont le plus besoin.
Le cancer du col est la deuxième cause de mortalité par cancer pour les femmes du
monde entier. Pour les femmes des pays en voie de développement, c’est le cancer
le plus meurtrier. Pratiquement tous les cas de cancer du col sont dus à une infection
par le virus Papilloma humain (HPV), l’infection des organes génitaux la plus
fréquente
Dans les pays industrialisés, l’extension des dépistages et les traitements des lésions
précancéreuses a contribué à une baisse spectaculaire des taux de cancer du col de
l’utérus durant les soixante dernières années. Cela contraste avec la situation des
pays en voie de développement qui sont lourdement touchés par 85% des cas de
cancer du col et où les taux continuent d’augmenter, alors que la majeure partie des
femmes de ces régions ne sont jamais ni dépistées ni traitées.
Après évaluation du potentiel préventif des nouveaux vaccins contre le cancer du col,
la Déclaration Mondiale Contre le Cancer réclame des programmes de vaccination
contre le HPV pour les pays à faibles et moyens revenus. Elle réclame également des
mesures spécifiques pour réduire les coûts, former les professionnels de la santé, et
informer la population.
Néanmoins, il est clair que les programmes de vaccination doivent être développés
en fonction de ce qui est abordable, réalisable et culturellement acceptable dans
chaque pays, de plus, la vaccination ne se substitue pas au dépistage.
Le cancer du col de l’utérus n’est pas une fatalité et les nouvelles technologies
fournissent désormais les moyens nécessaires pour modifier le cours de ces cancers.
Aujourd’hui, la vaccination des jeunes filles contre le HPV permet d’éviter les
conséquences d’infections futures et de sauver bon nombre de vies durant les
décennies à venir. De plus, une adaptation des méthodes de dépistage peut faire du
dépistage une réalité, même dans les pays les plus défavorisés.
Nous soutenons votre engagement auprès des gouvernements et des autres
institutions pour faire de la prévention contre le cancer du col de l’utérus une réalité.
DR MANARIYO Rosa Paula, Présidente
Alliance Burundaise Contre le Cancer - ABCC
Ethiopia
Mathiwos Wondu YeEthiopia Cancer Society
Cervical
Cancer
Initiative
A3
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Niger
Tous unis contre le cancer
ORGANISATION NON GOUVERNEMENTALE
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B.P: 255 - TEL : 2074 31 31 –96 99.31.31
Email : [email protected]
Cervical
REPUBLIQUE DU NIGER
Compte Bancaire :N°06/10 111- B C N - NIAMEY
À L’ATTENTION DE L’UNION INTERNATIONALE
CONTRE LE CANCER – UICC
Nous soutenons l’effort de mobilisation de l’UICC au niveau mondial et local en
Cancer
Niamey le 26 Mai 2008
faveur d’une prévention organisée contre le cancer du col de l’utérus. Cette
dans le monde et donner accès à des stratégies de prévention efficaces et
abordables aux femmes qui en ont le plus besoin.
Le cancer du col est la deuxième cause de mortalité par cancer pour les femmes
du monde entier. Pour les femmes des pays en voie de développement, c’est le
cancer le plus meurtrier. Pratiquement tous les cas de cancer du col sont dus à
une infection par le virus Papilloma humain (HPV), l’infection des organes
Initiative
lettre témoigne de notre engagement dans l’effort pour éliminer le cancer du col
génitaux la plus fréquente
Dans les pays industrialisés, l’extension des dépistages et les traitements des
lésions précancéreuses a contribué à une baisse spectaculaire des taux de cancer
du col de l’utérus durant les soixante dernières années. Cela contraste avec la
situation des pays en voie de développement qui sont lourdement touchés par
85% des cas de cancer du col et où les taux continuent d’augmenter, alors que la
majeure partie des femmes de ces régions ne sont jamais ni dépistées ni traitées.
A5
A6
Après évaluation du potentiel préventif des nouveaux vaccins contre le cancer
du col, la Déclaration Mondiale Contre le Cancer réclame des programmes de
vaccination contre le HPV pour les pays à faibles et moyens revenus. Elle
réclame également des mesures spécifiques pour réduire les coûts, former les
professionnels de la santé, et informer la population.
Néanmoins, il est clair que les programmes de vaccination doivent être
développés en fonction de ce qui est abordable, réalisable et culturellement
acceptable dans chaque pays, de plus, la vaccination ne se substitue pas au
dépistage.
Le cancer du col de l’utérus n’est pas une fatalité et les nouvelles technologies
fournissent désormais les moyens nécessaires pour modifier le cours de ces
cancers. Aujourd’hui, la vaccination des jeunes filles contre le HPV permet
d’éviter les conséquences d’infections futures et de sauver bon nombre de vies
durant les décennies à venir. De plus, une adaptation des méthodes de dépistage
peut faire du dépistage une réalité, même dans les pays les plus défavorisés.
Nous soutenons votre engagement auprès des gouvernements et des autres
institutions pour faire de la prévention contre le cancer du col de l’utérus une
réalité.
Nigeria
Lagos State Government Ministry of Health / Care Organisation Public enlightenment (COPE)
Cervical
Cancer
Initiative
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Society of Oncology and Cancer Research of Nigeria
Cervical
Cancer
Initiative
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Tunisia
Association Tunisienne de lutte contre le cancer
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Uganda
Uganda Women’s Cancer Support Organisation
Cervical
Cancer
Initiative
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Australasia/ Asia
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Bangladesh
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Cervical
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Indonesian Cancer Foundation -
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Breast Cancer Welfare Association -
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Taiwan
HOPE society for cancer care -
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Ho Chi Mihn Oncology Hospital -
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Vietnam
Initiative
Pakistan
Cancer
Cancer Institute (W.I.A) - - - - - - - - - - - - - - - - - B8
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Australia
The Cancer Council - Australia
B2
62 route de Frontenex, 1207 Geneva, Switzerland
Re: Cancer Council Australia commitment to cervical cancer control
To the Secretariat of the UICC Cervical Cancer Initiative,
I write to express Cancer Council Queensland’s full support for the global effort to reduce
cervical cancer burden worldwide by providing girls and women at highest risk with affordable
and effective prevention strategies.
As committed UICC members, we are well aware that cervical cancer is the second-biggest
cause of cancer death in women globally, in large part because screening programs are
unavailable in many developing countries. Improved screening methods and HPV tests could
make efficient screening a reality, even in the most remote settings. HPV vaccines given to
young girls now can prevent future infections and save numbers of lives for decades to come.
We fully support reduced inequities in cervical cancer outcomes globally, just as we do
domestically. Australia has one of the world’s lowest cervical cancer mortality rates, due
largely to the effectiveness of our population-based screening program.
The World Cancer Declaration calls for HPV vaccination programs in low and middle-income
countries where the burden of cervical cancer is high, calling for action to reduce costs and
provide public and professional education, public policy and research. We recognise that
vaccination programs need to be based on what is affordable, feasible and culturally
acceptable in each country and that vaccination is not a substitute for screening.
Significant reduction in the cost of HPV vaccines and new screening technologies is essential
to preventing cervical cancer in countries with very limited resources.
Cancer Council Queensland supports partnerships with the global community to make
effective cervical cancer prevention technologies available to girls and women who need them
most.
Yours sincerely,
Prof Jeff Dunn
Chief Executive Officer
Cancer Council Queensland
The Cancer Council - Queensland
To the Secretariat of the UICC Cervical Cancer Initiative
Re: Cancer Council Australia commitment to cervical cancer control
I write to express Cancer Council Australia’s full support for the global effort to reduce cervical
cancer burden worldwide by providing girls and women at highest risk with the most
affordable, effective prevention strategies.
The situation in areas of the developing world is reflected in Australia in our Indigenous
communities, where unacceptable inequity in screening access has led to far higher rates of
cervical cancer mortality among Aboriginal and Torres Strait Islander women. We fully
support reduced inequities in cervical cancer outcomes globally, just as we do domestically.
In 2005, we urged the Australian Government to examine the potential to prevent cervical
cancer as part of a review of its regional aid program. With cervical cancer causing avoidable
and premature deaths among women who are essential to the viability of communities in a
number of our neighbouring nations, Cancer Council Australia will continue to engage with
our government to prioritise cervical cancer prevention as a key regional aid issue.
The World Cancer Declaration calls for HPV vaccination programs in low and middle-income
countries where the burden of cervical cancer is high and calls for specific actions to reduce
costs and provide public and professional education, public policy and research. We
recognise that vaccination programs need to be based on what is affordable, feasible and
culturally acceptable in each country and that vaccination is not a substitute for screening.
Improved screening methods and HPV tests could make efficient screening a reality, even in
the most remote settings. HPV vaccines given to young girls now can prevent future
infections and save numbers of lives for decades to come.
Initiative
The global cervical cancer burden is in our view particularly unacceptable in the knowledge
that population-based screening and, more recently, vaccines against human papilloma virus
infection, could dramatically reduce cervical cancer incidence. (Cancer Council Australia’s
President, Professor Ian Frazer, headed the research team that developed the HPV vaccines,
so we well understand the potential to control cervical cancer through immunisation.)
Cancer
Australia has one of the world’s lowest cervical cancer mortality rates, due largely to the
effectiveness of our population-based screening program. As committed UICC members, we
are however well aware that cervical cancer is the second-biggest cause of cancer death in
women globally, in large part because screening programs are unavailable in many
developing countries.
Cervical
62 route de Frontenex, 1207 Geneva, Switzerland
Significant reduction in the cost of HPV vaccines and new screening technologies is essential
to preventing cervical cancer in countries with very limited resources.
Cancer Council Australia supports partnerships with the global community to make effective
cervical cancer prevention technologies available to girls and women who need them most.
Yours faithfully
Professor Ian Olver
The Cancer Council Australia is a member of the International Union Against Cancer
Australian Cancer Society Inc.
ABN: 50 003 171 836
Level 5, Medical Foundation Building
92 Parramatta Road
Camperdown NSW 2050
Telephone: (02) 9036 3100
Facsimile: (02) 9036 3101
Email: [email protected]
Website: www.cancer.org.au
B3
The Cancer Council - South Australia
B4
The Cancer Council - Victoria
13 June 2008
Re: The Global Cervical Cancer Initiative
The Cancer Council Victoria supports the commitment to the global effort to
eliminate cervical cancer worldwide and provide those who are at greatest risk with
affordable and effective vaccination and screening programs.
Prevention interventions have dramatically reduced cervical cancer rates over the
last 60 years in industrialized countries. However 85% of cervical cancer occurs in
developing countries, where the majority of women will never attend screening or
access the vaccine.
Almost all cases of cervical cancer can be attributed to an infection with the human
papilloma virus (HPV). HPV is so common that it is estimated that 4 out 5 women
will have HPV at some point in their lives. There are vaccines available to prevent
infection with HPV that if given to young girls, prior to commencement of sexual
activity can prevent infections and significantly reduce their risk of cervical cancer.
Initiative
Cervical cancer is one of the most preventable cancers and yet it is the second
largest cause of death in women worldwide.
Cancer
Isabel Mortara
Executive Director
62 route de Frontenex
1207 Geneva
Switzerland
Cervical

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We strongly support the implementation of HPV vaccination programs in low and
middle–income countries where the incidence and mortality due to cervical cancer
is unacceptably high.
We acknowledge that vaccination programs should reflect what is affordable,
feasible and culturally acceptable in each country and that vaccination is not a
substitute for adequate screening.
We join and support the global community to make appropriate and effective
technologies available to girls and women most at risk of cervical cancer to reduce
the burden and impact of this disease worldwide.
Yours sincerely
David Hill AM, PhD
Director
The Cancer Council Victoria
B5
Bangladesh
Bangladesh Cancer Society
Cervical Cancer Control Program of Bangladesh cancer Society
1. Professor Dr. Latifa Shamsuddin
2. Professor Dr. M. A. Majed
3. Professor. Dr. Md. Abdul Hai
Cervical cancer is the most common cancer in women worldwide and the leading cause of death from
cancer among women in the developing countries of the world. The most recent data indicate that an
estimated 466,000 new cases of cervical cancer occur every year, with 200,000 to 300,000 dying from
the disease annually. About eighty percent of these deaths are occurring in developing countries. In
central and south America, parts of India and sub-Saharan Africa, the incidence rate is between 2 and 5
times as high as in Western Europe (Parkin, 1992). In developed nations, with effective screening
programmes, around 80 percent of cervical cancer cases detected are cured. In contrast, it is estimated that
80 percent of cervical cancer cases detected in developing country women are incurable since the disease is
already greatly advanced by the time it is diagnosed.
In Bangladesh 200,000 new cases of cancer occur every year and among them 25.000 are cervical
cancer cases. Cervical cancer constitutes about 22-29% of the genital tract cancer in different areas
of the country. Data reveals that it is the most common cancer in female, followed by breast cancer
(16%). Among men lung cancer (27%) and oral cavity cancer (12%) are the common sites. The
diagnosed cases are managed mostly in few institutes and tertiary level hospitals either by surgery,
radiotherapy, chemotherapy or combined therapy.
An important reason for the sharply higher cervical cancer incidence in developing countries is the
lack of effective screening programs aimed at detecting and treating precancerous conditions.
Compared with women in developed countries, very few women in developing countries have
access to screening for precancerous lesions.
Cervical cancer progesses slowly from pre-invasive cervical intraepithelial neoplasia (CIN) to invasive
cervical cancer (ICC). It takes at least ten to twenty years for this progress to invasive state. In
Bangladesh, so far the prevalence of cervical cancer and CIN has not been established from any
population based study. However, data from the hospital statistics indicate that cervical cancer is a
major health problem among the Bangladeshi women and constitutes about 22- 29% of the genital tract
cancer .It Constitute 1/4th of female Cancer .
We have prepared a small book let in our own simple language so that the people can understand in
the Problem easily. This book will help the field workers of health profession to create awareness
among our people. It is important to develop awareness about cancer cervix among the population and
to make the people understand about the signs/ symptoms of the disease. This book will help them to
have a clear idea about the prevention of the disease and to receive treatment in early stage of the disease.
Cervical Cancer screening programme
An important reason for higher cervical cancer prevalence in developing countries is t h e
lack of awareness, public education and effective screening programmes aimed at prevention,
detection and treatment of precancerous conditions.
For a developing country like Bangladesh where cytological screening is not possible in near future, an
approach like visual inspection of cervix with application 4%-5% of acetic acid (VIA) is more
appropriate. This is a clinical approach for early detection of this disease. By this method the disease
can be detected in precancerous condition and less advanced stage. This can be taken as a pilot project
B6
Bangladesh Cancer Society is running cancer awareness program since 1975. Awareness is being
created among the people regarding the risk factors, symptoms of the disease and
prophylaxis/Prevention.
Prof. Dr. Latifa Shamsuddin
MBBS, FCPS(BD), FCPS(Pak), FICS(USA)
Head, Cervical Cancer Control Programme &
Central Executive Committee Member, Bangladesh Cancer Society.
Chairman & Head of the Dept. of Gynaecology & Obstertrics (Retd.)
BSMMU (P. G Hospital) Dhaka.
Prof. Dr. M. A. Majed
MBBS (Dhaka), DLO(London), FRCS (England), FCPS(BD), FCPS(Pak)
President, Bangladesh Cancer Society
FormerlyProfessor & Principal, Dhaka Medical College
Din of Faculty of Medicine, Dhaka University
President, Bangladesh Medical Associatiob
Regional Vice – President (South Asia), IPPNW
President, ENT Society
Initiative
Other necessary steps need to be taken:
1.
Mobile transportation - Mobile transportation for the programme is necessary.
2.
Equipped \ l i t h gynecological exam table, light, camera and m on it o r.
3.
Follow -up to prevent drop o ut , fi n an ci al support needed for poor patient.
4.
Central path olo gical laboratory may be developed in Bangladesh Cancer Society
5.
A modern Calposcape with its axillary aids, Specially teaching aids.
6.
Cervical cancer control center of Bangladesh Cancer Society will co-ordinate the
Cervical cancer screening program.
Cancer
Society has established a VIA training and service center in its own premises. Community female
volunteers are being trained here on VIA . In this regard a curriculum and booklets & leaflets have been
prepared. Volunteers will organize camp in the community for VIA in different areas of the Country
they will refer the VIA positive cases to Bangladesh Cancer Hospital & Welfare Home. Bangladesh
Cancer Hospital & Welfare Home for further management.
Cervical
for a country like ours. In this method Field level female Volunteers from the community can be
trained for a minimum period of two weeks and they will be able to identify any abnormality including
suspicious cervical lesions and refer the cases early lo centers where facilities exist for proper diagnosis
and treatment to pre-malignant and malignant lesions.
Prof. Dr. Md. Abdul Hai
MBBS, DMRT, FCPS
Director- Bangladesh Cancer Hospital & Welfare Home &
Central Executive Committee Member- Bangladesh Cancer Society
Head, Cancer Center, Khwaja Yunus Ali Medical College Hospital
Member, European Society for Medical Oncology (ESMO)
Member, American Society of Clinical Oncology (ASCO)
Former Director cum Professor of Radiation Oncology
National Institute of Cancer & Research Hospital
Former Director, Ahsania Mission Cancer Hospital
B7
India
Cancer Institute (W.I.A)
B8
Cervical
Cancer
Initiative
B9
Gujarat Cancer & Research Institute
B10
TATA Memorial Centre
Cervical
Cancer
Initiative
B11
Indonesian
Indonesian Cancer Foundation
B12
Malaysia
Breast Cancer Welfare Association
To the International Union Against Cancer (UICC),
We understand the UICC is gathering evidence for improved cervical cancer prevention. By
means of this letter, we would like to show our commitment to the global effort to eliminate
cervical cancer worldwide and provide those who need it most with affordable and effective
prevention strategies.
In industrialized countries, expanded screening and treatment have dramatically reduced
cervical cancer rates over the last 60 years. But in developing countries, where the vast
majority of women never have a pap smear, the incidence and death rates from cervical
cancer continues to rise.
Recognizing the potential of the new HPV vaccines to prevent cervical cancer, The World
Cancer Declaration calls for HPV vaccination programmes in low and middle-income
countries where the burden of cervical cancer is high and calls for specific actions to reduce
costs and provide public and professional education, public policy and research.
Initiative
Cervical cancer is the second largest cause of death from cancer in women worldwide. For
women in developing countries, it is the biggest cancer killer. Virtually all cervical cancer is
caused by infection with human papilloma virus (HPV), the most common viral infection of
the reproductive tract.
Cancer
16 May 2008
Cervical
BCWA
Breast Cancer Welfare Association
5th Floor, Bangunan Sultan
Salahuddin Abdul Aziz Shah
16 Jalan Utara, 46200 Petaling Jaya
Malaysia
Tel: 03 79540133 Fax: 03 79540122
We recognize that vaccination programmes need to be based on what is affordable, feasible,
and culturally acceptable in our country and that vaccination is not a substitute for
screening. Cervical cancer is preventable and we are now in an unprecedented position
where new technology provides us with the means to make a difference. HPV vaccines given
to young girls now can prevent future infections and save numbers of lives for decades to
come. Furthermore, improved screening methods could make efficient screening a reality,
even in the most remote settings.
We share your commitment to work with governments and other sectors to make cervical
cancer prevention work.
With regards,
Ranjit Kaur
President, Breast Cancer Welfare Association
Malaysia
B13
Pakistan
Shaukat Khanum Memorial Cancer Hospital & Research Centre
B14
Cervical
Cancer
Initiative
B15
Taiwan
HOPE society for cancer care
B16
Vietnam
Ho Chi Mihn Oncology Hospital
Ho Chi Minh Oncology Hospital
03 No Trang Long Street
Binh Thanh District
Ho Chi Minh City
Viet Nam
We understand the UICC is gathering evidence for improved cervical cancer
prevention. By means of this letter, we would like to show our commitment to the
global effort to eliminate cervical cancer worldwide and provide those who need it
most with affordable and effective prevention strategies.
Cervical cancer is the second largest cause of death from cancer in women
worldwide. For women in developing countries, it is the biggest cancer killer. Virtually
all cervical cancer is caused by infection with human papilloma virus (HPV), the most
common viral infection of the reproductive tract.
Recognizing the potential of the new HPV vaccines to prevent cervical cancer, The
World Cancer Declaration calls for HPV vaccination programmes in low and middleincome countries where the burden of cervical cancer is high and calls for specific
actions to reduce costs and provide public and professional education, public policy
and research.
We recognize that vaccination programmes need to be based on what is affordable,
feasible, and culturally acceptable in our country and that vaccination is not a
substitute for screening.
Initiative
In industrialized countries, expanded screening and treatment have dramatically
reduced cervical cancer rates over the last 60 years. But in developing countries,
where the vast majority of women never have a pap smear, the incidence and death
rates from cervical cancer continues to rise.
Cancer
Cervical
Geneva, May 2008
Cervical cancer is preventable and we are now in an unprecedented position where
new technology provides us with the means to make a difference. HPV vaccines
given to young girls now can prevent future infections and save numbers of lives for
decades to come. Furthermore, improved screening methods could make efficient
screening a reality, even in the most remote settings.
We share your commitment to work with governments and other sectors to make
cervical cancer prevention work.
Signed,
DANG HUY QUOC THINH
Vice Director
HCM City Oncology Hospital
Viet Nam
B17
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Europe
Fondation Contre le Cancer
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Denmark
Danish Cancer Society
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Estonian Cancer Society
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La Ligue
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German Cancer Research Center - DFKZ
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Italy
Associazione Italiana Malati di Cancro, parenti ed amici - AIMaC
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Associazione Italiana di Oncologia Medica - Aiom
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Norway
Norwegian Cancer Society
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Liga Portuguesa Contra O Cancro
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Slovakia
Liga Proti Rakovine SR
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Initiative
Northern Ireland
Cancer
Centre de Lutte Contre le Cancer d’Auvergne
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Cervical
Belgium
Spain
Asociación Española Contra el Cáncer - AEEC
Federació Catalana d’Entitats contra el Càncer - FECEC
Institut Català d’Oncologia - ICO
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Swiss League
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Turkish Association for Cancer Research and Control
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Turkey
United Kingdom
CLASP Institute for Women’s Health - UCL
Cancer Research UK - CRUK
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Belgium
Fondation Contre le Cancer
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Denmark
Danish Cancer Society
Cervical
Cancer
Initiative
C3
C4
Estonia
Estonian Cancer Society
Cervical
Cancer
Initiative
C5
France
La Ligue
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




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    
               



            

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              
                 
 

             
               

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
                


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

               

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           

                 
              

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
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


C6

Centre de Lutte Contre le Cancer d’Auvergne
Cervical
Cancer
Initiative
C7
Germany
German Cancer Research Center - DFKZ
C8
Cervical
Cancer
Initiative
C9
Italy
Associazione Italiana Malati di Cancro, parenti ed amici - AIMaC
C10
Associazione Italiana di Oncologia Medica - Aiom
Cervical
Cancer
Initiative
C11
Northern Ireland
Ulster Cancer Foundation
C12
Norway
Norwegian Cancer Society
Cervical
Cancer
Initiative
C13
Portugal
Liga Portuguesa Contra O Cancro
C14
Slovakia
Liga Proti Rakovine SR
Cervical
Cancer
Initiative
C15
Spain
Asociación Española Contra el Cáncer - AEEC
A la Unión Internacional Contra el Cáncer (UICC),
La Asociación Española Contra el Cáncer (aecc) apoya el esfuerzo de movilización de la
UICC a nivel mundial y local a favor de una prevención integral del cáncer de cérvix. Por
medio de esta carta, queremos demostrar nuestro compromiso en el esfuerzo para eliminar
a nivel mundial el cáncer de cérvix y facilitar el acceso a estrategias de prevención,
accesibles y eficaces, a las mujeres que más lo necesitan.
Para las mujeres de los países en desarrollo, esta enfermedad es la primera causa de
mortalidad por cáncer y la segunda a nivel mundial. Prácticamente todos los casos de
cáncer de cérvix se deben al virus del papiloma humano (VPH), la infección viral más común
del tracto reproductivo femenino.
En países industrializados, la implementación de la detección precoz, y los programas de
cribado y tratamiento han reducido drásticamente las tasas de esta enfermedad neoplásica en
los últimos 60 años. Pero en los países en desarrollo, donde la gran mayoría de las mujeres
nunca se ha hecho un control médico, la incidencia y tasas de mortalidad por cáncer de
cérvix continúan creciendo.
Reconociendo el potencial de las nuevas vacunas contra el VPH para prevenir el cáncer de
cérvix, la Declaración Mundial del Cáncer reclama programas de vacunación contra el VPH
en países de bajos y medianos ingresos, donde la incidencia del cáncer de cérvix es alta. La
Declaración también reclama acciones específicas para reducir los costes de la vacuna,
información y educación a los ciudadanos y a los profesionales, políticas sanitarias públicas
e investigación.
Reconocemos que los programas de vacunación necesitan estar basados en la evidencia
científica, y en lo asequible, factible, y culturalmente aceptable en cada país, teniendo
siempre presente que la vacunación no sustituye al cribado.
El cáncer de cérvix es prevenible y estamos, actualmente, en una posición sin precedentes
donde las nuevas tecnologías nos proveen con los medios para un cambio significativo. Las
vacunas contra el VPH aplicadas a mujeres jóvenes ahora pueden prevenir infecciones
futuras y salvar gran cantidad de vidas en el futuro. Más aún, una mejor adaptación de los
métodos de cribado puede hacer realidad una detección precoz eficaz, aún en los lugares
más remotos.
Compartimos vuestro compromiso de trabajar con los gobiernos y otros sectores para hacer
que la prevención del cáncer de cérvix sea una realidad.
Firmado en Madrid (España), a 16 de junio de 2008.
Francisco González-Robatto
Presidente
ASOCIACION ESPAÑOLA CONTRA EL CANCER
Amador de Ríos 5, - 28010 Madrid
CIF: G-28/197564
www.todocancer.org
www.muchoxvivir.org
C16
Isabel Oriol Díaz de Bustamante
Vicepresidenta
Tels: 91 3194138
Fax: 91 3190966
Federació Catalana d’Entitats contra el Càncer - FECEC
Cervical
Cervical Cancer Initiative,
62 route de Frontenex,
1207 Geneva, Switzerland
Para las mujeres en países en desarrollo
el cáncer cervicouterino es la primera causa de
mortalidad por cáncer en mujeres y la segunda causa a nivel mundial. Prácticamente todos los
casos de cáncer cervicouterino se deben al virus de papiloma humano (VPH), la infección viral
más común del tracto reproductivo femenino.
Reconociendo el potencial de las nuevas vacunas contra el VPH para prevenir el cáncer
cervicouterino, la Declaración Mundial del Cáncer reclama programas de vacunación de VPH en
países de bajos y medianos ingresos, donde la incidencia del cáncer cervicouterino es alta. La
Declaración también reclama acciones específicas para reducir los costos de la vacuna y proveer
educación pública y profesional, normas públicas e investigación.
Reconocemos que los programas de vacunación necesitan estar basados en lo que es asequible,
factible, y culturalmente aceptable en nuestro país y que la vacunación no substituye al cribaje.
El cáncer cervicouterino es prevenible y estamos ahora en una posición sin precedentes donde las
nuevas tecnologías nos proveen con los medios para un cambio significativo. Las vacunas de VPH
aplicadas a mujeres jóvenes ahora pueden prevenir infecciones futuras y salvar gran cantidad de
vidas por décadas a venir. Más aún, una mejor adaptación de los métodos de cribaje pueden hacer
realidad la detección eficaz, aún en los escenarios más remotos.
Initiative
En países industrializados, la implementación de la detección temprana, programas de cribaje y
tratamiento ha reducido drásticamente las tasas de cáncer cervicouterino en los últimos 60 años. Pero
en los países en desarrollo, donde la gran mayoría de mujeres nunca se han hecho un control, la
incidencia y tasas de mortalidad de cáncer cervicouterino continúan creciendo.
Cancer
Apoyamos el esfuerzo de movilización de la UICC a nivel mundial y local a favor de una prevención
integral del cáncer cervicouterino.
Por medio de esta carta, queremos demostrar nuestro
compromiso en el esfuerzo para eliminar a nivel mundial el cáncer cervicouterino y dar acceso a
estrategias de prevención accesibles y efectivas a las mujeres que tienen la mayor necesidad.
Compartimos vuestro compromiso de trabajar con los gobiernos y otros sectores para hacer que la
prevención del cáncer cervicouterino sea una realidad.
Atentamente
Josep Morell
President
Federació Catalana Entitats contra el Càncer (FECEC)
Espanya
Barcelona, 20 junio 2008
C17
Institut Català d’Oncologia - ICO
C18
Switzerland
Swiss League
Cancer du col de l'utérus
Madame, Monsieur,
Le cancer du col est la deuxième cause de mortalité par cancer pour les femmes du
monde entier. Pour les femmes des pays en voie de développement, c’est le cancer le
plus meurtrier. Pratiquement tous les cas de cancer du col sont dus à une infection par le
virus Papilloma humain (HPV), l’infection des organes génitaux la plus fréquente
précancéreuses ont contribué à une baisse spectaculaire des taux de cancer du col de
l’utérus durant les soixante dernières années. Cela contraste avec la situation des pays
en voie de développement qui sont lourdement touchés par 85% des cas de cancer du col
et où les taux continuent d’augmenter, alors que la majeure partie des femmes de ces
régions ne sont jamais ni dépistées ni traitées.
Initiative
Nous soutenons l’effort de mobilisation de l’UICC au niveau mondial et local en faveur
d’une prévention organisée contre le cancer du col de l’utérus. Cette lettre témoigne de
notre engagement dans l’effort pour éliminer le cancer du col dans le monde et donner
accès à des stratégies de prévention efficaces et abordables aux femmes qui en ont le
plus besoin.
Cancer
Berne, le 1 juin 2008/BM/ste
Cervical
Union International Contre le Cancer (UICC)
62, route de Frontenex
1207 Genève
Après évaluation du potentiel préventif des nouveaux vaccins contre le cancer du col, la
Déclaration Mondiale Contre le Cancer réclame des programmes de vaccination contre le
HPV pour les pays à faibles et moyens revenus. Elle réclame également des mesures
spécifiques pour réduire les coûts, former les professionnels de la santé, et informer la
population.
Néanmoins, il est clair que les programmes de vaccination doivent être développés en
fonction de ce qui est abordable, réalisable et culturellement acceptable dans chaque
pays, de plus, la vaccination ne se substitue pas au dépistage.
C19
C20
Le cancer du col de l’utérus n’est pas une fatalité et les nouvelles technologies fournissent
désormais les moyens nécessaires pour modifier le cours de ces cancers. Aujourd’hui, la
vaccination des jeunes filles contre le HPV permet d’éviter les conséquences d’infections
futures et de sauver bon nombre de vies durant les décennies à venir. De plus, une
adaptation des méthodes de dépistage peut faire du dépistage une réalité, même dans
les pays les plus défavorisés.
Nous soutenons votre engagement auprès des gouvernements et des autres institutions
pour faire de la prévention contre le cancer du col de l’utérus une réalité.
Ligue suisse contre le cancer
Bruno Meili
Directeur
Turkey
Turkish Association for Cancer Research and Control
We understand the UICC is gathering evidence for improved cervical
cancer prevention. By means of this letter, we would like to show our
commitment to the global effort to eliminate cervical cancer worldwide and
provide those who need it most with affordable and effective prevention
strategies.
Cervical cancer
worldwide. For
killer. Virtually
papilloma virus
tract.
is the second largest cause of death from cancer in women
women in developing countries, it is the biggest cancer
all cervical cancer is caused by infection with human
(HPV), the most common viral infection of the reproductive
Recognizing the potential of the new HPV vaccines to prevent cervical
cancer, The World Cancer Declaration calls for HPV vaccination
programmes in low and middle-income countries where the burden of
cervical cancer is high and calls for specific actions to reduce costs and
provide public and professional education, public policy and research.
We recognize that vaccination programmes need to be based on what is
affordable, feasible, and culturally acceptable in our country and that
vaccination is not a substitute for screening.
Initiative
In industrialized countries, expanded screening and treatment have
dramatically reduced cervical cancer rates over the last 60 years. But in
developing countries, where the vast majority of women never have a pap
smear, the incidence and death rates from cervical cancer continues to
rise.
Cancer
Cervical
24 April 2008
Cervical cancer is preventable and we are now in an unprecedented
position where new technology provides us with the means to make a
difference. HPV vaccines given to young girls now can prevent future
infections and save numbers of lives for decades to come. Furthermore,
improved screening methods could make efficient screening a reality, even
in the most remote settings.
We share your commitment to work with governments and other sectors to
make cervical cancer prevention work.
Prof. Tezer Kutluk, MD PhD
President, Turkish Association for Cancer Research and Control
Atac Sokak No: 21/1
06410 Ankara-Turkey
Phone: 90-312-431 2950
e-mail: [email protected]
C21
United Kingdom
C22
Cancer Research UK - CRUK
Cervical
Cancer
Initiative
C23
C24
D.
Latin A merica & Caribbean
Instituto Henry Moore
-
-
-
-
-
-
Liga Argentina de Lucha Contra el Cáncer - LALCEC
-
-
-
-
Sociedad Latinoamericana y del Caribe de Oncología Médica - SLACOM
-
D2
- D5
-
-
-
D6
Bolivia
Fundación Boliviana Contra el Cáncer
- - - - - - - - D7
- - - - - - - - D9
Dominican Republic
Insituto Oncologico regional del Cibao
Liga Nacional Contra el Cáncer
-
-
-
-
-
-
-
-
-
- D11
Honduras
Asociación Hondureña de lucha contra el cáncer
-
-
-
-
-
-
D12
Mexico
Asociación Mexicana de Lucha contra el Cáncer (AMLCC)
-
-
-
-
-
-
-
-
-
-
- D15
-
-
D16
Uruguay
Comisión Honoraria de Lucha Contra el Cáncer
-
-
-
-
-
-
- D17
Initiative
Instituto Nacional de Cancerología
-
Cancer
Guatemala
Cervical
Argentina
D1
Argentina
Instituto Henry Moore
D2
Cervical
Cancer
Initiative
D3
D4
Liga Argentina de Lucha Contra el Cáncer - LALCEC
Para las mujeres en países en desarrollo el cáncer cervicouterino es la primera causa de mortalidad
por cáncer en mujeres y la segunda causa a nivel mundial. Prácticamente todos los casos de cáncer
cervicouterino se deben al virus de papiloma humano (VPH), la infección viral más común del tracto
reproductivo femenino.
Reconociendo el potencial de las nuevas vacunas contra el VPH para prevenir el cáncer cervicouterino,
la Declaración Mundial del Cáncer reclama programas de vacunación de VPH en países de bajos y
medianos ingresos, donde la incidencia del cáncer cervicouterino es alta. La Declaración también
reclama acciones específicas para reducir los costos de la vacuna y proveer educación pública y
profesional, normas públicas e investigación.
factible, y culturalmente aceptable en nuestro país y que la vacunación no substituye al tamizaje.
vidas por décadas a venir. Más aún, una mejor adaptación de los métodos de tamizaje pueden hacer
realidad la detección eficaz, aún en los escenarios más remotos.
Initiative
En países industrializados, la implementación de la detección temprana, programas de tamizaje y
tratamiento ha reducido dramáticamente las tasas de cáncer cervicouterino en los últimos 60 años. Pero
en los países en desarrollo, donde la gran mayoría de mujeres nunca se han hecho un control, la
incidencia y tasas de mortalidad de cáncer cervicouterino continúan creciendo.
Cancer
Apoyamos el esfuerzo de movilización de la UICC a nivel mundial y local a favor de una prevención
integral del cáncer cervicouterino. Por medio de esta carta, queremos demostrar nuestro compromiso
en el esfuerzo para eliminar a nivel mundial el cáncer cervicouterino y dar acceso a estrategias de
prevención accesibles y efectivas a las mujeres que tienen la mayor necesidad.
Cervical
Buenos Aires, 2 de junio, 2008
María Inés M. de Ucke
Presidente
LALCEC - ARGENTINA
Aráoz 2380 – C1425DGJ – Buenos Aires – Argentina - Tel/Fax: (54 11) 4832-4800
www.lalcec.org.ar - [email protected]
Personería Jurídica C-698 I.P.G.J. - Registro Entidades Bien Público Nº 474 - Registro Nacional Obligatorio de ONG Nº 8686 –
CENOC-Presidencia de la Nación - Miembro de la Unión Internacional de Lucha contra el Cáncer (UICC) – Fundada en 1921
D5
Sociedad Latinoamericana y del Caribe de Oncología Médica - SLACOM
SLAC
M
Sociedad Latinoamericana y del Caribe de Oncología Médica
Latin American and Caribbean Society of Medical Oncology
Buenos Aires, Mayo 2008
Entendemos que la UICC está recopilando evidencia para la prevención mejorada del
cáncer cervical. Por medio de esta carta, queremos demostrar nuestro compromiso
con el esfuerzo global para eliminar a nivel mundial el cáncer cervical y proveer a
aquellos que más lo necesitan con estrategias de prevención accesibles y efectivas.
El cáncer cervical es la segunda mayor causa de muerte por cáncer en mujeres a nivel
mundial. Para las mujeres en países en desarrollo, es el más grande asesino por
cáncer. Virtualmente todo cáncer cervical es causado por la infección a través del
virus de papiloma humano (VPH), la infección viral del tracto reproductivo más
común.
En países industrializados, el screening y tratamiento mejorados han reducido
dramáticamente las tasas del cáncer cervical en los últimos 60 años. Pero en los
países en desarrollo, donde la vasta mayoría de mujeres nunca se han hecho un Pap,
la incidencia y tasas de mortandad del cáncer cervical continúan subiendo.
Reconociendo el potencial de las nuevas vacunas de VPH para prevenir el cáncer
cervical, la Declaración Mundial del Cáncer exige programas de vacunación de VPH en
países de bajos y medianos ingresos, donde la incidencia del cáncer cervical es alta y
pide acciones específicas para reducir costos y proveer educación pública y
profesional, normas públicas e investigación.
Reconocemos que los programas de vacunación necesitan estar basados en lo que es
accesible, factible, y culturalmente aceptable en nuestro país y que la vacunación no
es un sustituto del screening.
El cáncer cervical es prevenible y estamos ahora en una posición sin precedentes
donde la nueva tecnología nos provee con los medios para hacer la diferencia. Las
vacunas de VPH aplicadas a mujeres jóvenes ahora pueden prevenir infecciones
futuras y salvar gran cantidad de vidas por décadas por venir. Más aún, los métodos
mejorados de screening pueden hacer realidad el screening eficaz, aún en los más
remotos escenarios.
Compartimos vuestro compromiso de trabajar con los gobiernos y otros sectores para
hacer que la prevención del cáncer cervical funcione.
Simon Gozar
Director Ejecutivo
SLACOM
Argentina
Avda. Córdoba 2415 – 5º Piso – C1120AAG Cdad. de Buenos Aires
Telefax: (54-11) 4961-0981
www.slacom.org
D6
Bolivia
Fundación Boliviana Contra el Cáncer
Cervical
Cancer
Initiative
D7
D8
Dominican Republic
Insituto Oncologico regional del Cibao
Cervical
Cancer
Initiative
D9
D10
Guatemala
Liga Nacional Contra el Cáncer
Cervical
Cancer
Initiative
D11
Honduras
Asociación Hondureña de lucha contra el cáncer
D12
Cervical
Cancer
Initiative
D13
D14
Mexico
Asociación Mexicana de Lucha contra el Cáncer (AMLCC)
Apoyamos el esfuerzo de movilización de la UICC a nivel mundial y local a favor de una
prevención integral del cáncer cervicouterino. Por medio de esta carta, queremos demostrar
nuestro compromiso en el esfuerzo para eliminar a nivel mundial el cáncer cervicouterino y dar
acceso a estrategias de prevención accesibles y efectivas a las mujeres que tienen la mayor
necesidad.
En países industrializados, la implementación de la detección temprana, programas de tamizaje y
tratamiento ha reducido dramáticamente las tasas de cáncer cervicouterino en los últimos 60 años.
Pero en los países en desarrollo, donde la gran mayoría de mujeres nunca se han hecho un
control, la incidencia y tasas de mortalidad de cáncer cervicouterino continúan creciendo.
cervicouterino, la Declaración Mundial del Cáncer reclama programas de vacunación de VPH en
países de bajos y medianos ingresos, donde la incidencia del cáncer cervicouterino es alta. La
Initiative
Para las mujeres en países en desarrollo el cáncer cervicouterino es la primera causa de
mortalidad por cáncer en mujeres y la segunda causa a nivel mundial. Prácticamente todos los
casos de cáncer cervicouterino se deben al virus de papiloma humano (VPH), la infección viral
más común del tracto reproductivo femenino.
Cancer
Cervical
Mayo 2008
vidas por décadas a venir. Más aún, una mejor adaptación de los métodos de tamizaje pueden
hacer realidad la detección eficaz, aún en los escenarios más remotos.
Firmado,
Mayra Galindo Leal
Directora General
Asociación Mexicana de Lucha Contra el Cáncer
México
D15
Instituto Nacional de Cancerología
D16
Uruguay
Cervical
Cancer
Initiative
D17
D18
E.
Middle East
Israel Cancer Association
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- E2
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- E3
Lebanon
Lebanese Cancer Society
Cervical
Israel
Cancer
Initiative
E1
Israel
E2
From: Miri Ziv
Sent: 01 July 2008 09:12
To: Victoria Kay
Subject: RE: Reminder: UICC dossier for improved cervical cancer prevention worldwide
June 30, 2008
Dear Isabel,
We definitely support the global effort led by the UICC to prevent cervical cancer. There
is no doubt that we must increase efforts particularly in areas with a high incidence rate
and see to a comprehensive program that may indeed be implemented.
In Israel it has been decided to include HPV vaccinations in the National Vaccination
Program by the year 2011-2012 the latest. Until then the Clalit healthcare services
(Israel's largest HMO) is providing the vaccination at a subsidized rate for insureds with
supplementary health insurance.
Israel has a very low incidence rate of cervical cancer as compared to the rest of the
world (about 160 new cases as opposed to 4,000 new cases of breast cancer). However,
means of detection which may completely prevent the disease are to be welcomed.
Likewise, it is important to educate the public and to clarify that the vaccination does not
prevent HIV infection, etc.
Sincerely,
Miri Ziv
Director General
Lebanon
Lebanese Cancer Society
Cervical
Cancer
Initiative
E3
E4
F.
North america
British Columbia Cancer Agency
- - - - - Cervical Cancer prevention Program, Cancer Care Nova Scotia
- - - - F2
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F3
Centre Hospitalier de l’Université de Montréal – CHUM / Department of Radiation Oncology
Fondation Québécoise du Cancer
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F6
Public Health Agency of Canada
- - - - - - - - - F8
United States of America
International Psycho-Oncology Society - IPOS
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Oncology Nursing Society (ONS)
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- -
- -
- - F9
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- - F10
- F12
Cancer
American Society of Clinical Oncology - ASCO
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F4
Cervical
Canada
Initiative
F1
Canada
British Columbia Cancer Agency
F2
Cervical Cancer prevention Program, Cancer Care Nova Scotia
Cervical
Cancer
Initiative
F3
Centre Hospitalier de l’Université de Montréal – CHUM /
Department of Radiation Oncology
F4
Cervical
Cancer
Initiative
F5
Fondation Québécoise du Cancer
F6
Cervical
Cancer
Initiative
F7
Public Health Agency of Canada
F8
International Psycho-Oncology Society - IPOS
via e-mail
To the International Union Against Cancer (UICC):
Cervical cancer is the second largest cause of death from cancer in women worldwide. For women
in developing countries, it is the biggest cancer killer. Virtually all cervical cancer is caused by
infection with human papilloma virus (HPV), the most common viral infection of the reproductive
tract.
Recognizing the potential of the new HPV vaccines to prevent cervical cancer, the World Cancer
Declaration calls for HPV vaccination programmes in low and middle-income countries where the
burden of cervical cancer is high and calls for specific actions to reduce costs and provide public
and professional education, public policy and research.
We recognize that vaccination programmes need to be based on what is affordable, feasible, and
culturally acceptable in our country and that vaccination is not a substitute for screening.
Cervical cancer is preventable and we are now in an unprecedented position where new technology
provides us with the means to make a difference. HPV vaccines given to young girls now can
prevent future infections and save numbers of lives for decades to come. Furthermore, improved
screening methods could make efficient screening a reality, even in the most remote settings.
Initiative
In industrialized countries, expanded screening and treatment have dramatically reduced cervical
cancer rates over the last 60 years. But in developing countries, where the vast majority of women
never have a pap smear, the incidence and death rates from cervical cancer continues to rise.
Cancer
We understand the UICC is gathering evidence for improved cervical cancer prevention. By means
of this letter, we would like to show our commitment to the global effort to eliminate cervical
cancer worldwide and provide those who need it most with affordable and effective prevention
strategies.
Cervical
27 June 2008
We share your commitment to work with governments and other sectors to make cervical cancer
prevention work.
Sincerely,
William Breitbart, MD
Chief of Psychiatry Services
Memorial Sloan Kettering Cancer Center
USA
2365 Hunters Way, Charlottesville, VA 22911 USA ! Telephone: +1 434.293.5350 ! Facsimile: +1 434.977.1856
Website: www.ipos-society.org ! E-mail: [email protected]
F9
American Society of Clinical Oncology - ASCO
F10
Cervical
Cancer
Initiative
F11
Oncology Nursing Society (ONS)
F12
June 24, 2008
International Union Against Cancer
To Our International Union Against Cancer (UICC) Colleagues:
On behalf of the Oncology Nursing Society (ONS) and its more than 37,000 oncology
nurses and other health professionals, who are dedicated to ensuring and advancing
access to quality cancer care, we are writing to express our support for efforts we
understand UICC has underway to improve global cervical cancer prevention. ONS
has consistently supported advocating for domestic and international policies and
programs that seek to enhance and expand prevention and early detection of cancer. To
that end, we commend you for recognizing the global public health imperative for
renewed and expanded efforts to reduce and prevent the second most common cause of
death from cancer in women worldwide.
As you know, since its inception in 1941, the Pap smear has reduced cervical cancer
deaths by 70% among American women. While the incidence of cervical cancer is
relatively low in the U.S., ONS has concerns that 85% of all cervical cancer cases occur
in developing countries, where it is the most common cause of death. Infection with the
human papillomavirus (HPV) is the most significant risk factor for developing cervical
cancer. As such, preventing HPV infection among women and girls can reduce cervical
cancer incidence and save hundreds of thousands of lives across the globe. Moreover,
when detected at an early stage through the Pap smear, cervical cancer can be treated
effectively. ONS believes that availability of the Pap smear and the recent development
of new screening and vaccination technologies – including the HPV vaccine – together
offer an unprecedented opportunity to reduce the incidence and mortality of this highly
preventable disease, particularly in developing countries.
ONS advocates – and stands ready to support – international efforts to increase access
to cervical cancer screening, while also ensuring that all women and girls who wish to
be immunized against HPV receive vaccination. ONS believes that such efforts must be
reflective and respectful of each country’s culture and that the provision of cervical
cancer screening and/or HPV immunization should be affordable and include informed
consent, education on safer sexual practices, and explanation that vaccination is not a
To Our International Union Against Cancer (UICC) Colleagues:
Asknow
you know,
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cancer.
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HPV infection among
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Manager,
Leslie
Greenberg
([email protected],
301/233-2203).
cancer incidence and save hundreds of thousands of lives across the globe. Moreover,
when detected at an early stage through the Pap smear, cervical cancer can be treated
Sincerely,
effectively. ONS believes that availability of the Pap smear and the recent development
of new screening and vaccination technologies – including the HPV vaccine – together
offer an unprecedented opportunity to reduce the incidence and mortality of this highly
preventable
particularly
countries.
Brenda
Nevidjon,disease,
RN, MSN,
FAAN in developing
Paula Rieger, RN, MSN, AOCN, FAAN
President
ONS advocates – and stands ready to support – international efforts to increase access
to cervical cancer screening, while also ensuring that all women and girls who wish to
be immunized against HPV receive vaccination. ONS believes that such efforts must be
reflective and respectful of each country’s culture and that the provision of cervical
cancer screening and/or HPV immunization should be affordable and include informed
consent, education on safer sexual practices, and explanation that vaccination is not a
Initiative
On behalf of the Oncology Nursing Society (ONS) and its more than 37,000 oncology
nurses and other health professionals, who are dedicated to ensuring and advancing
access to quality cancer care, we are writing to express our support for efforts we
understand UICC has underway to improve global cervical cancer prevention. ONS
has consistently supported advocating for domestic and international policies and
programs that seek to enhance and expand prevention and early detection of cancer. To
that end, we commend you for recognizing the global public health imperative for
renewed and expanded efforts to reduce and prevent the second most common cause of
Cancer
Cervical
June 24, 2008
F13
F14
Annex 1 .
Australia
Cancer Council
G2
Bangladesh
G4
Nigeria
G6
Oncology Nursing Society
G8
European Union
Uruguay
Procedimientos del Programa de Prevención del Cáncer de Cuello Uterino de Uruguay
Cancer
Cervical
EXAMPLE OF Country work on
cervical cancer BY MEMBERS
G10
Initiative
G1
Australia
Cancer Council
G2
Best practice in cervical cancer immunisation
Report of a roundtable discussion about the impact
of the human papillomavirus vaccine in Australia
Discussion and recommendations
March 2008
HPV vaccination in Australia – report/recommendations of a national policy roundtable
On 18 April 2007, The Cancer Council Australia convened a national roundtable
discussion on human papillomavirus (HPV) immunisation and its impact on the National
Cervical Screening Program. The aim was to bring leaders in immunisation and screening
together to share their expertise, examine the latest evidence and develop
recommendations for policy makers. The Australian Government (Commonwealth
Department of Health and Ageing) co-sponsored the event.
The event gathered together the nation’s leaders in cervical cancer policy and
implementation, with the key objectives to: identify what information is currently available
for health professionals and the community about the HPV vaccine; lead discussion
around the impact of HPV vaccination on the National Cervical Screening Program; and
generate outcomes and recommendations that can help inform policy and practice.
The roundtable also featured formal presentations from experts in a range of fields related
to cervical cancer control, which are summarised in Attachment 1.
Following lengthy discussion, roundtable participants agreed on five principles around
which a set of more detailed recommendations, and agencies with remit to explore them,
are documented:
Initiative
A key component of the roundtable was a workshop facilitated by Professor Terry Nolan,
Head of School, School of Population Health, University of Melbourne, which identified:
potential barriers to the successful rollout of the HPV vaccination program; potential
barriers to ensuring the National Cervical Screening Program delivers optimal results
following the introduction of HPV immunisation; and research questions that need to be
addressed in the short and long term. The workshop rated the significance of key
interventions under each of these headings, as documented in this report.
Cancer
The roundtable was convened in response to the emergence of a vaccine that prevents
two strains of HPV that cause approximately 70% of cervical cancer. While HPV
vaccination has the potential to significantly reduce the impact of cervical cancer, its
introduction in Australia must be managed in a way that ensures Australia’s successful
cervical cancer screening program continues to protect women who, for reasons
documented in this report, would not benefit from the vaccine.
Cervical
Executive summary
1. Review the National Cervical Screening Program;
2. ‘Central’ overseeing to monitor the HPV vaccine’s impact on the National Cervical
Screening Program;
3. Develop an Indigenous ‘package’ for screening and vaccination;
4. Undertake post-implementation evaluation of the National HPV Vaccination
Program; and
5. Address information systems issues.
This report lists these recommendations and summarises the discussion and presentations
from the roundtable. Publication was deferred to enable additional expert input and to
coincide with the subsequent development of the HPV immunisation chapter of The
Cancer Council Australia’s National Cancer Prevention Policy.
Full document:
http://www.cancer.org.au//File/PolicyPublications/NCPP/NCPP07-09cervicalca.pdf
2
G3
Bangladesh
G4
Cervical
Cancer
Initiative
For more information:
Prof.Latifa Shamsuddin - [email protected]
G5
Nigeria
G6
The First International Open Day to Raise
Awareness of Screening for the Prevention
of Cervical Cancer
Cervical Cancer Screening Open Day May 16th 2008
There are multiple reasons why cervical cancer is common in
Nigeria. There is no effective screening program and awareness of
cervical cancer, even among healthcare workers, is low. In addition,
HIV infection increases susceptibility to the disease. The majority
of women present late and as there is little opportunity for curative
treatment and no access to palliative care, most women die a
miserable death.
Initiative
Cervical cancer is the second commonest cancer in women world
wide, second only to breast. It accounts for half a million cases a
year and approximately 80% of these occur in the developing
world. 300,000 women die of cervical cancer per annum, more than
those who die of complications of childbirth.
Cancer
How the Free Cervical Screening Project Began
The idea of setting up a project for cervical screening in Nigeria
began when the newly formed Institute for Women’s Health, under
the directorship of Prof. Ian Jacobs, received a donation of
£500,000, which was to be spent on new projects in developing
countries. Adeola Olaitan, Consultant Gynaecologist at University
College London Hospital (UCLH) saw an opportunity to use her
skills and those of her colleagues to help prevent cervical cancer in
Lagos and in November 2005 the project was allocated £50,000. A
successful collaboration with Dr Rose Anorlu, Consultant
Gynaecologist at the Lagos University Teaching Hospital (LUTH)
and Dr Chiara Mezzalira, Medical Director of St Kizito’s Primary
Health Care Project saw the launch of a screening program for the
prevention of cervical cancer.
Cervical
BACKGROUND
Thus a small, inexpensive intervention such as cervical screening
could potentially save numerous lives. It is estimated that screening
in the United Kingdom saves 5000 lives per year.
For more information on CLASP:
Dr Christine Ekechi
[email protected]
G7
Oncology Nursing Society
June 24, 2008
OncOlOgy nursing sOciety POsitiOn
To Our International Union Against Cancer (U
The Human Papillomavirus Vaccine
and Prevention of Cervical Cancer
On behalf of the Oncology Nursing Society
nurses and other health professionals, who
access to quality cancer care, we are writin
understand UICC has underway to improve
has consistently supported advocating for
programs that seek to enhance and expand pr
that end, we commend you for recognizing
renewed and expanded efforts to reduce and
As you know, since its inception in 1941, th
deaths by 70% among American women.
relatively low in the U.S., ONS has concerns
in developing countries, where it is the most
human papillomavirus (HPV) is the most sig
cancer. As such, preventing HPV infection am
cancer incidence and save hundreds of thous
when detected at an early stage through the
effectively. ONS believes that availability of
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References
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#ANCERSTATISTICSCA: A Cancer Journal for Clinicians, 57
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53#ANCER3TATISTICS7ORKING'ROUPUnited States cancer
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G8
OncOlOgy nursing FOrum – vOl 35, nO 1, 2008
17
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 


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
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
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


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
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
Cancer


Cervical
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          

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

To o b t ain a full copy please contact the press office:
[email protected] http://www.consilium.europa.eu/Newsroom
G9
Uruguay
Procedimientos del Programa de Prevención del Cáncer de Cuello Uterino de Uruguay
Programa Nacional de Control de Cáncer
Ministerio de Salud Pública
Programa de Prevención
de Cáncer de Cuello Uterino
en el Uruguay ”Dr. Enrique Pouey”
ESTRATEGIA
Y
MANUAL DE PROCEDIMIENTOS
Montevideo, 2008
G10
Cervical
Prefacio
Este documento pretende ubicar al actor, participante activo del Programa dentro del esquema organizativo, así como conocer todos los módulos que lo componen con la información mínima indispensable de cada uno de ellos.
Para su escritura se utilizó la información epidemiológica internacional y de Uruguay publicada por International Agency for Research on Cancer (IARC), y del Registro Nacional de
Cáncer de Uruguay. Se tomó en cuenta la información obtenida por el PPCCU que desde
hace trece años ha implementado la CHLCC en Montevideo y varias localidades del interior
del país.
Se realizaron reuniones con amplia participación de técnicos locales.
15
Initiative
• Seminario en Paysandú, Uruguay, sobre Organización, Control de Calidad y Evaluación de un programa de prevención del cáncer de cuello de útero, con la participación de las Dras. Hélène Sancho Garnier (Francia), Leticia Fernández Garrote (Cuba)
y Lisseth Ruiz de Campos (El Salvador), como profesoras y Maria Stella de Sabata,
jefa de Prevención y Detección Temprana de Cáncer, UICC (Unión Internacional
Contra el Cáncer) Noviembre, 2005.
• Primera Asesoría local de UICC en Mayo de 2006 con trabajo práctico y analítico
sobre la organización del Programa, el sistema de información, visitas a laboratorios
de citología, Unidades de toma de muestra de PAP y Unidades de colposcopía. Dras.
Leticia Fernández Garrote (Cuba) y Lisseth Ruiz de Campos (El Salvador).
• Segunda Asesoría local de UICC en Diciembre de 2006 para el desarrollo del sistema de información, control de calidad de los laboratorios y elaboración del Manual
del Programa. Visitas a Centros Asistenciales de segundo y tercer nivel. Dras. Leticia
Fernández Garrote (Cuba) y Lisseth Ruiz de Campos (El Salvador).
• Tercera Asesoría local de UICC 1º a 15 de Junio de 2007 «Aprobación de la primera
versión del manual del Programa, desarrollo del sistema de información y sistema
informático nacional, implementación de un plan de reclutamiento de la población
objetivo, instrumentación del sistema de control de calidad de la citología y de cursos
de formación de citotécnicos para el PPCCU.» Prof. Hélène Sancho Garnier (Francia), Dra. Leticia Fernández (Cuba) y Dra. Lisseth Ruiz De Campos (El Salvador).
Cancer
El Programa de Prevención del Cáncer de Cuello Uterino (PPCCU) surge en el Uruguay en
el año 1994 por iniciativa de la Comisión Honoraria de Lucha contra el Cáncer (CHLCC)
como una experiencia piloto en el área de influencia del Hospital Saint Bois en Montevideo,
la capital de Uruguay. Esta experiencia se extiende progresivamente a otros departamentos del interior del país, con complementación de recursos de los Hospitales del Ministerio
de Salud Pública (MSP). Posteriormente se coordinan actividades con algunas Intendencias Municipales adquiriendo la forma de una compleja organización con personas que
dependen de diversas instituciones, que componen áreas técnicas y administrativas con
diferentes niveles de acción.
A nivel de la CHLCC se plantea la extensión del PPCCU a todo el Uruguay, en coordinación
con el Programa Nacional de Control de Cáncer (PRONACCAN). Por este motivo se solicita el asesoramiento de la Unión Internacional contra el Cáncer (UICC), realizándose las
siguientes actividades:
Se elaboró un documento preliminar, que fue aprobado en su primera versión, luego continuó perfeccionándose hasta llegar a la versión actual, que contó con la contribución inestimable de un grupo de
expertos locales en las diferentes áreas temáticas del Programa (cuya lista se adjunta a continuación)
y la revisión exhaustiva de las consultoras internacionales.
Creemos que es importante destacar que la tarea de cada uno es indispensable y que la suma de las
acciones de todos en el fiel cumplimiento de los objetivos específicos planteados, determina el éxito
de esta tarea.
Dr. Guillermo Rodríguez
del a
Programa
F o r m o r e Coordinador
inform
t i o nde: Prevención
de Cáncer de Cuello Uterino
Dr. Guillermo Rodríguez www.urucan.org.uy
G11
G12
Dorothy Shaw
International Federation of
Gynecology and Obstetrics
MCH Director
Dr. Nguyen Duy Khe
Minister of Health
Hon. Dr. R. Nduhuura
Annex 2. Evidence of
Comm. S. Kassim-Momodu
Ministry of Women’s Affairs
Prof. A.L. Ashmaig, Obstetrical
and Gynecological Society
Catherine Hankins, UNAIDS
About the dossier
Cervical Cancer Action is an advocacy coalition with the goal of expediting global availability,
affordability and accessibility of new cervical cancer prevention tools; strategic advocacy for
expanded political will and financial commitment and civil society mobilization and support.
Sign the Global Call to Stop Cervical Cancer at www.CervicalCancerAction.org.
PATH, a founding member of Cervical Cancer Action, is an international nonprofit organization that
creates sustainable, culturally relevant solutions, enabling communities worldwide to break
longstanding cycles of poor health. For more information, please visit www.path.org.
Initiative
For more information about cervical cancer, please visit RHO Cervical Cancer at www.rho.org.
Cancer
This dossier was compiled by Cervical Cancer Action and PATH. It may be freely shared for
educational and non-commercial purposes.
Cervical
Country Support for Improved
Cervical
Cancer Sudan:
Prevention
Nigeria: Letter from
Letter from
Global: Letter from
The dossier will be available at www.rho.org/CCAdossier
G13
Annex 3. ECCA
European Cervical Cancer Association.
STOP Cervical Cancer in Europe
Every year in Europe, 50,000 women develop and 25,000 women die from cervical cancer.
Effective, organised cervical cancer screening can prevent up to 80% of cervical cancers. New
technologies, if properly implemented within organised programmes, have the potential to reduce
cervical cancer rates even further and prevent almost every case of this disease in Europe.
We, the undersigned, call upon the European Parliament, the European Commission and all
national governments of Europe to:
1. Work together to implement effective cervical cancer prevention programmes in compliance
with the recommendations of the Council of the European Union and the European Guidelines
for Quality Assurance in Cervical Cancer Screening.
2. Support the establishment of public health education programmes to ensure that all women
are aware of the importance of cervical cancer prevention and take full advantage of the
services that are available to them.
. Facilitate the exchange of best practice between the countries of Europe so that all can benefit
from the world-class expertise that exists within Europe.
4. Support independent research to establish the most appropriate means to implement new
screening methods and vaccination against the Human Papillomavirus (HPV) to ensure the
greatest reductions in cervical cancer across Europe.
5. Recognise and support the essential role played by charities, non-governmental organisations,
patient support groups and volunteers in the ongoing reduction of cervical cancer in Europe.
For more information:
http://www.ecca.info/webECCA/en/
http://www.cervicalcancerpetition.eu/
G14
• Cervical cancer develops in the cervix, the part
of the uterus that opens into the vagina. It occurs
when cells of the cervix become abnormal and start
to grow in an uncontrolled fashion.
The ECCA supports the reduction of cervical cancer in
Europe by promoting awareness of cervical cancer and
the means by which it can be prevented. Drawing upon
the expertise of researchers, clinicians and public health
organisations from across Europe, the ECCA has prepared:
• Cervical screening is designed to find abnormal
cervical cells in the early stages when they can be
easily removed so they do not develop into cervical
cancer. Cervical screening is currently done using
the cervical smear test.
The booklets
• Everything you need to know to help you avoid cervical
cancer
• Everything you need to know if you have an abnormal
cervical smear
Photos : Getty Image / Stockbyte
For additional information
:
Visit our website: www.ecca.info
+
Send your questions to: [email protected]
L1_EN_UK_C
The leaflets
• Cervical cancer screening
• Human Papilloma Virus (HPV) and cervical cancer
• Follow-up and treatment of an abnormal cervical smear
• Vaccination against HPV and cervical cancer
• All women from 25 to 65 years of age should be
screened. Women who are 25 to 49 years of age
should be screened once every 3 years, while those
from 50 to 64 years of age should be screened
every 5 years.
• Vaccination is now available to reduce the risk of
cervical cancer, but it will not eliminate need for
screening. Together, screening and vaccination will
offer the most effective protection against cervical
cancer.
British Association for
Sexual Health & HIV
• How does screening work?
• Normal cervical smear result?
• Abnormal cervical smear result?
• Is screening reliable?
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The leaflets
• Cervical cancer screening
• Human Papilloma Virus (HPV) and cervical cancer
• Follow-up and treatment of an abnormal cervical smear
• Vaccination against HPV and cervical cancer
• Vaccination prevents HPV infection occurring in the first
place. Therefore it provides the greatest protection if
given before the start of sexual activities.
L4_EN_UK_A
• Vaccination has not been shown to offer protection
against disease if you have HPV 16 or 18 when you are
vaccinated. Therefore, the benefits of vaccination may be
less in women who are already sexually active as some
will be infected with one or both of these types.
• The current vaccine appears to be safe with the clinical trials
showing only minor reactions typical of any vaccination.
Photos : Getty Image / Stockbyte
• Vaccination against HPV reduces the risk of cervical
cancer but does not eliminate it. Even if you have
been vaccinated, it is important to continue with
regular cervical screening.
tion
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Initiative
2 most common types of HPV, HPV 16 & 18, that are
responsible for about 2/3 of cervical cancers and many
abnormal Pap smears, but does not protect against all the
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Cancer
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e
edur
d.
ical sm
e
they e
of th
will te oid using
a proc
ely.
middl last perio
that
r cerv
pointm
pl
av
, they
ch is ore clos
ur
ed so only a sim y
anothe
book u should re your ap
, whi
m
•
ov
py
to
ix
of yo
ll
m
rv
co
yo
fo
re
ca
ires
ecolog
lpos
ur ce
neral, 2 days be .
ld be
n you
requ
• a co amine yo
l gyna x life or
Whe are. In ge
r
s shou usually
spita
before
na fo
to ex
rmalitiencer. This in the ho s your se
to prep your vagi the night
no
?
ca
ne
e
in ab
fect
g sex
work
insid
Certa velop into n be do rarely af
vin
al
g
ic
ha
t
in
ca
cerv
avoid
not de ure that Treatmen
the
reen
x
.
ed
Cervi
using ur GP
s sc
proc ient clinic ildren.
yo
done
a
doe
at
Vagin
g is taken at This is a
outp to have ch
How
.
reenin
y
st may
abilit
clinic
al sc
out
ch is
ear te
Cervic test whi planning takes ab e
ble?
to be
a
al sm
li
r
ily
re
only
cervic you need
mor
smea e or fam
issed
d the
e that lves little the
ning
tic
why
en m
ct an
edur
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prac
vo
perfe e. This is at has be re it has
cree
is
s
e proc and in ion. Durin ill be
pl
st
fo
as
th
Is
sim
w
g te
es
se
be
inat
minut nal exam e of cells small
reenin ses of di at anything the next,
sc
n
al
o
te
ca
N
th
rvic
g a
vagi
mpl
p at
ry
t
al ce so
some
rly, so picked-u
an a ion, a sa rvix usin
ns
rm
la
e ve
th
?
iss
ai
ar
no
gu
m
d
ed
ce
ab
inat
ms
en ag ch
ed re
ay be
s
ene
find
remov
exam from your
ogra
t wom
screen screen m
, whi
s.
h.
g pr
scre designed to ey can be e cancer ha
e
protec s 16 & 18 many
.
taken or brus
reenin ical cancer
th
get
d less
Onc
on on progress
a
d
pe
ble to
d sc
rv
ing is
when
t
cult an
ncer.
spatul
Why
availa of HPV, ty ncers an
e to
ganise ent all ce
mos
screen stages rvical ca more diffi
w
or
tim
be
ca
al
no
s
,
ev
d
will
n is
type cervical
Cervic the early lop into ce es much
quality
not pr
ines
18, an
inatio common
l
in
m
High- , but will
of al rrent vacc PV 16 or types.
Vacc
t
t deve ent beco
cells
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mos
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m
cu
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PV
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ld
the 2 about 2/
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they ped, treat
all H
ve ha
lo
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u shou n
tests.
ncer
deve sful.
caus
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t
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al Ca
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protec vaccinat d vaccin
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tion
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irus
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s of H
ma V
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e tim
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n at
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fectio
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PV in on its ow r, it can
or
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daH
are m use cerv
ea
ears
ve ha
sapp
sapp
can ca
will ha ually di es not di ping.
ts
ul
us
lo
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Mos
es, bu the HPV cancer de
eir liv
rvical
in th oblem. If
of ce
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e risk
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• Vaccination provides very effective protection against the
The ECCA supports the reduction of cervical cancer in
Europe by promoting awareness of cervical cancer and
the means by which it can be prevented. Drawing upon
the expertise of researchers, clinicians and public health
organisations from across Europe, the ECCA has prepared:
© ECCA 2007
• What do you need to do?
Vaccination against HPV and
cerVical cancer
ecca
For additional information
:
Visit our website: www.ecca.info
+
Send your questions to: [email protected]
• Who should be screened?
BRITISH SOCIETY FOR
COLPOSCOPY AND
CERVICAL PATHOLOGY
© ECCA 2006
The booklets
• Everything you need to know to help you avoid cervical
cancer
• Everything you need to know if you have an abnormal
cervical smear
• What is cervical cancer?
• Why get screened?
Cervical
CerviCal CanCer sCreening
eCCa
six
over
ions
od
d
inject
rs go
three
n offe sease
long
n as
inatio
• What is cervical cancer?
d di
How
is give that vacc
the
ine an
ccine
ow
vacc
ch is
va
e
kn
hi
th
e
nt
w
in
• Why get vaccinated?
ical
t, w
e
curre
years,
types
e clin
esen
5
for us
The
th
pr
PV
t
H
d
in
At
as
le
s.
up
in
t the
ense
longer
• Who should be vaccinated?
and
for at
month n agains
en lic
llowed w much
s be
en fo
types
years,
int
otectio
ese
ve be
see ho
e Jo
ine ha 9 to 15
pr
th
th
ha
to
cc
by
• Does vaccination provide complete
va
ay
en
tion,
ed
ee
ed
e wom are underw
caus
e HPV cents ag s. In addi
mmitt
tim
on
protection against cervical cancer?
co
?
of
(a
12
ies
year
e UK,
adoles
ation
ated
length far. Stud
aged
In th
to 26
and
munis
last.
so
ccin
at girls , official
• How long does vaccination protect?
ildren
ed 16 n and Im
n will
trials
ed th
er
e va
in ch males ag
ssotectio
inatio ) has advis
owev
fe
en b
can pa
S. H
Vacc
the pr
07.
m
H
lth
• Should boys or men be vaccinated?
ey
adult
20
N
on
r
ea
th
e
in
er,
so
t of H ed on th
mittee
later
canc
tmen
until
Com
boy
in
rvical
r?
ccinat
cted
• Is vaccination safe?
Depar
ould
expe
males t
get ce
nce
be va
t
h
the
r
of the
a
ot
ld
S
no
fo
of
c
nn
d
en
rt
are
shou
te
en ca
ende
ical
tions
ly prev e
to 13
the pa cells of
rtner.
gh m
comm
ctive
rvix,
cerv
n
mple
menda
d th
Althou to their pa
not re it will effe
e ce
d an
t is
and
recom
rs whe
e co ncer?
in th
if
PV
ion is
studie
occu
rmal
men
Wha
on H
rovidical ca
and
abno
velops
ccinat t yet know w being
na. It
p
e
gi
va
de
ys
m
,
va
n
bo
no
is no
ncer
ever
the
of
beco
atio
cerv
use in
How
al ca
we do ales. This
ent
HPV,
s into
d for
ccin gainst
K as
Cervic at open
with
ion.
m
velopm ccine.
ende
th
the U
s va
a
d fash
ion in
va
e de
fected
comm
infect
uterus ix are in
ntrolle
Doe ction
ts th pes in the
ho
be re
HPV
unco
rv
even
us
en w
ty
may
Uter
ly pr the HPV
wom
,
the ce grow in an
ines
prote
vacc
.
. Also
otect
fective
to
to
re
ef
pr
e
ed
t
tu
at
ar
du
to
n
fu
st
only
n
lls
ccin
HPV
inatio
in the
al ce
show
show
?
are va e other
Vacc
cervic
trials
hing,
th
t been time they
safe
rmal
inical
g, itc
s no
all of
e
abno
tion
it ha
The cl n (swellin
ea,
ainst
at th
e
safe.
ever,
cina
r, naus
atio
or 18 protect ag er.
c
be
ovid
ve
in
How
a
fe
pr
to
16
cc
v
t
tly
t
nc
ars
Is
HPV
any va
quen
es no
appe
es no er. Even
ical ca
of
fre
n
l
do
have
rv
do
io
ss
ca
n
ce
n
e
inat
d le
nc
en.
typi
inatio
Vacc
inatio
wom
al ca
site an
tions
n caus
ix
vacc
cc
n
ic
nt
ac
ca
io
rv
va
Cerv
na
re
ct
ce
that
s,
preg
minor at the inje
nst
a
ason
types
d for
agai
s
Vagin
it is
e re
ende
tion
ed,
rednes iness).
thes
comm
r
For
protec vaccinat
zz
but
not re
gula
and di
en
plete
time,
ion is
ith re
y
be
at
w
y
an
in
com
an
ve
xual
r at
vacc
ntinue
u ha
that
occu
HPV
t of se
d
if yo
to co
so
d can
e star -off their
foun
rtant reening
on an
n be
ter th
ht
m
af
ca
impo
fig
m
be
sc
lls
n
on
):
ill
using
ry co
ical
s (HPV
PV so
ical ce n they ca
em w ithout ca
is ve
d?
er
cerv
a Viru ncer
cerv
uce
get H ost of th
act. It
canc
whe
sw
t:
pillom rvical ca
rmal
inate
cont
n prod e
le will
onth
age
an Pa
ce
ent a
ly, m
abno
preven
acc
peop
Hum use of
rly st
24 m HPV, it ca
most
prev
thes
nate
ively
most
et v
two
an ea oved to
s
the ca
r, but
Fortu
within
effect
g
e
.
r
ha
at
ea
to
th
es
y
ea
n
m
an
,
iti
cl
al sm
Wh
show
er
.
activ
d 18
sily re
c
it will hile a wom r cervic
ne
an
en
n
ea
.
d
by
a
go
be
ng
16
an
eir
ed
,
W
lC
lopi
on he
s has
n has
HPV
ear th
types
lems.
und
of HPV cells caus
deve
rvica
inatio
e viru
not cl
er
HPV
lls fo
prob
a
types
al
Vacc
ce th
& Ce
any
al ce
with
en do lls may, ov
sing
pillom
cervic
ear on
irus
norm
ction
ce
e wom
ing
er-cau
an Pa these
rmal
cted
sapp
ma V
the ab
• infe
need
canc
Hum
abno
n som al cervical not dete
lly di
lo
of
of
of
il
on
of
he
e
ua
k
s
p
m
t
w
m
us
ce
a
en
rs
way
rm
to
e ris
are
type
com
. So
also
occu the abno
an P
is no
ress
ce th
ld redu
they
rent
tract
velopm
e
m
if
l
m
og
ou
du
ffe
er
le
u
de
ta
re
er
pr
di
sh
s,
H
ob
nc
ost
ly, th
d it
• the
n will
e geni that can
t forty
The pr these case rvical ca . Current
the m g
t.
types.
lls an
inatio
fect th
abou
lls
ong
al ce
In
ed
vacc
these
will no
to ce
use
al ce
usin
e are
can in
e am
HPV.
this,
cervic
at ca
lop in and remov and who
Ther
) that
cervic
18 ar cancer, ca
rmal
se of
11 th
deve
rs.
s
(HPV
rmal
16 &
ening their viru
time,
Becau t for abno ncer.
smea
6 and
pes
Virus use abno
rvical
h scre
Pap
ca
en
t HPV
ear
PV ty
pes
ith ce
rmal
throug ho will cl
treatm of cervical
ay ca
er. H
agains
PV ty
ed w
no
m
H
nc
ts
at
ab
.
t
ci
ec
ca
k
y
ll w
ot
al
ts bu
warts
.
s asso and man
to te
the ris
so pr
cervic
l war
nital
type
warts
ine al
e ge
ses
genita
nital
mon
vacc
caus
com 2/3 of ca
One
?
ses of
s of ge
can
al
t
of ca
case
HPV
ated
sexu
ority
abou
ncer.
most
s of
ccin
e first
type
e maj
rm of
ical ca
in th
y fo
e va
use th with cerv
Other
ng
b
en
an
ca
rri
11
cu
by
wom
uld
6 and associated
read
ion oc d many
sho
ities.
t
infect
an
be sp
activ
HPV
Who
can
are no
mmon sexual
tion
ents
ry co
of
l HPV
protec ss
n prev PV is ve
start
best
Genita
H
inatio
be le
the
e the
Vacc
ever,
after
d may
provid
How
an
ill
,
on
e.
w
plac
ed so ccination al activities .
infect
va
xu
omen
are
this,
of se
se of
s or w
start
e teen
Becau
re the
n befo xually activ
if give
in se
ive
ct
effe
Vaccination against
HPV and cerVical
cancer
G15
Annex 4. useful links
G16
Alliance for Cervical Cancer Prevention
American Cancer Society: AIDS-related cancers
American Cancer Society: guideline for detection
American Cancer Society: HPV vaccine recommendations
Centres for Disease Control and Prevention, USA
Cervical Cancer Action
ECCA
European Commission
Genital HPV infection
HPV Vaccine: Q&A for the public
Human papilloma viruses and cancer
International Agency for Research on Cancer
JHPIEGO
Pan-American Health Organization
PATH
RHO Cervical Cancer
What is the HPV virus?
World Health Organization
http://www.who.int/hpvcentre/en/
International Agency for Research on Cancer (IARC)
http://screening.iarc.fr/digitallearningserie.php
For more information on the signatories:
Burundi
Dr Rosa Paula Manariyo
[email protected]
Taiwan
http://ecancer.org.tw
Viet Nam
[email protected]
Europe
Niger
Dr Hadiza Nathalie Djermakoye
[email protected]
Belgium
http://www.cancer.be/index.cfm?fuseaction=ho
me&Lang=NL
Nigeria
http://www.copebc.com/
www.socron.net/socron/ (Society of oncology
and cancer research of Nigeria)
Denmark
http://www.cancer.dk/Cancer/forside+cancerdk.
htm
Tunisia
www.atcc.org.tn
Uganda
Dr Gertrude Nakigudde
[email protected]
Australia
Cancer council
http://www.cancer.org.au/Home.htm
Queensland
www.qldcancer.com.au
South Australia
www.cancersa.org.au
Victoria
www.cancervic.org.au
Bangladesh
Prof.Latifa Shamsuddin
[email protected]
India
WIA Dr Rajkumar Thangarajan
[email protected]
Gujarat
www.cancerindia.org
TATA
http://tmc.gov.in/
Indonesia
www.kankerindo.org
Malaysia
www.radiologymalaysia.org/breasthealth/
bcwaindex.htm
Pakistan
http://www.shaukatkhanum.org.pk/
France
http://www.ligue-cancer.net/
http://www.cjp.fr/
Germany
http://www.dkfz.de/index.html
Italy
AIOM
http://www.aiom.it/
AIMaC
http://www.aimac.it/
Nothern Ireland
http://www.ulstercancer.org/
Norway
http://www.kreftforeningen.no/
Portugal
http://www.ligacontracancro.pt/
Initiative
Australasia/Asia
Estonia
http://www.cancer.ee/?op=&id=&cid=
Cancer
Ethiopia
www.mathycancersoc.org
Cervical
Africa
Slovakia
Dr Eva Siracka
[email protected]
Spain
AEEC .
http://www.todocancer.org/
FECEC
http://www.fecec.org/contents/home.php
ICO
http://www.iconcologia.net/
Switzerland
http://www.swisscancer.ch/index.php?id=314
Turkey
www.turkcancer.org
G17
G18
UK
CRUK
http://www.cancerresearchuk.org/
CLASP
Dr Christine Ekechi
[email protected]
Latin America
Argentina
Henry moore
www.hmoore.com.ar
SLACOM
http://www.slacom.org/
LALCEC
http://www.lalcec.org.ar/
Bolivia
[email protected]
Dominican Republic
[email protected]
Guatemala
[email protected]
Honduras
http://www.ccancer.hn/
Mexico
AMLCC
http://www.amlcc.org/
Instituto Nacional
http://www.incan.edu.mx/
Uruguay
http://www.urucan.org.uy/
Middle eAst
Israel
http://www.cancer.org.il/
Lebanon
http://www.cancer.org.lb/
North America
Canada
BCCA
http://www.bccancer.bc.ca/default.htm
Nova Scotia
http://www.cancercare.ns.ca/
CHUM
http://www.chumontreal.qc.ca/
Québeque
http://www.fqc.qc.ca/
PHA Canada
http://www.phac-aspc.gc.ca/index-eng.php
USA
ASCO
http://www.asco.org/
IPOS
http://www.ipos-society.org/about/org/mission.
htm
ONS
http://www.ons.org/
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G19
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Partridge, J.M. et al. J. Infect. Dis. 196(8):1117-9, 2007
42.
Garland, S.M. et al. N. Engl. J. Med. 356: 1928-43, 2007
4.
Barnabas, R.V. et al. PLOS Med. 3: e138, 2006
44.
Sanders, G.D. and Taira, A.V. Emerg. Infect. Dis. 9: 37-48, 2003
45.
Wheeler, C.M. et al. Atypical Squamous Cells of Undetermined Significance/Low-Grade Squamous Intraepithelial Lesions Triage Study Group. J. Infect. Dis. 194: 1291-1299, 2006
46.
Schiffman, M. et al. Lancet 370, 890-907, 2007
47.
Shankar, R et al. Lancet 370(9585):365-6, 2007
Annex 6
Model letters
Si vous désirez apporter votre soutien a l’effort mondial pour une prévention
organisée contre le cancer du col de l’utérus dans le monde, faites nous parvenir
une lettre signée sur papier en-tête par courrier, fax ou e-mail.
Initiative
International Union Against Cancer UICC
62 rte de Frontenex
1207 Geneva
Switzerland
Fax: +41 (0)22 809 18 10
E-mail: [email protected]
Cancer
Si usted desea apoyar el esfuerzo de movilización de la UICC a favor de una
prevención integral del cáncer cervicouterino, envíenos una carta membreteada
y firmada por correo, fax o e-mail
Cervical
If you would like to add your voice to the global effort for improved
cervical cancer prevention worldwide, please send us a signed letter on your
organization’s letterhead by mail, fax or email.
G21
English
G22
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             
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         

           
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             

           
        
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              
          

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             
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            
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                 
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              
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             
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


We understand the UICC is gathering evidence for improved cervical cancer prevention. By means
of this letter, we would like to show our commitment to the global effort to eliminate cervical
cancer worldwide and provide those who need it most with affordable and effective prevention
strategies.
In industrialized countries, expanded screening and treatment have dramatically reduced cervical
cancer rates over the last 60 years. But in developing countries, where the vast majority of women
never have a pap smear, the incidence and death rates from cervical cancer continues to rise.
We recognize that vaccination programmes need to be based on what is affordable, feasible, and
culturally acceptable in our country and that vaccination is not a substitute for screening.
Cervical cancer is preventable and we are now in an unprecedented position where new
technology provides us with the means to make a difference. HPV vaccines given to young girls
now can prevent future infections and save numbers of lives for decades to come. Furthermore,
improved screening methods could make efficient screening a reality, even in the most remote
settings.
We share your commitment to work with governments and other sectors to make cervical cancer
prevention work.
Name:
Position:
Organization:
Country:
E-mail:
Initiative
Recognizing the potential of the new HPV vaccines to prevent cervical cancer, The World Cancer
Declaration calls for HPV vaccination programmes in low and middle-income countries where the
burden of cervical cancer is high and calls for specific actions to reduce costs and provide public
and professional education, public policy and research.
Cancer
Cervical cancer is the second largest cause of death from cancer in women worldwide. For women
in developing countries, it is the biggest cancer killer. Virtually all cervical cancer is caused by
infection with human papilloma virus (HPV), the most common viral infection of the reproductive
tract.
Cervical
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           
             

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            

   
            
         
          
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            

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              
            

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          
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 
           
            
          

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




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           
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G24
Nous soutenons l’effort de mobilisation de l’UICC au niveau mondial et local en faveur d’une
prévention organisée contre le cancer du col de l’utérus. Cette lettre témoigne de notre
engagement dans l’effort pour éliminer le cancer du col dans le monde et donner accès à des
stratégies de prévention efficaces et abordables aux femmes qui en ont le plus besoin.
précancéreuses a contribué à une baisse spectaculaire des taux de cancer du col de l’utérus
durant les soixante dernières années. Cela contraste avec la situation des pays en voie de
développement qui sont lourdement touchés par 85% des cas de cancer du col et où les
taux continuent d’augmenter, alors que la majeure partie des femmes de ces régions ne sont
jamais ni dépistées ni traitées.
Néanmoins, il est clair que les programmes de vaccination doivent être développés en
fonction de ce qui est abordable, réalisable et culturellement acceptable dans chaque pays, de
plus, la vaccination ne se substitue pas au dépistage.
Le cancer du col de l’utérus n’est pas une fatalité et les nouvelles technologies fournissent
désormais les moyens nécessaires pour modifier le cours de ces cancers. Aujourd’hui, la
vaccination des jeunes filles contre le HPV permet d’éviter les conséquences d’infections futures et
de sauver bon nombre de vies durant les décennies à venir. De plus, une adaptation des méthodes
de dépistage peut faire du dépistage une réalité, même dans les pays les plus défavorisés.
Nous soutenons votre engagement auprès des gouvernements et des autres institutions pour
faire de la prévention contre le cancer du col de l’utérus une réalité.
Nom:
Titre/position:
Organisation:
Pays:
E-mail:
Initiative
Après évaluation du potentiel préventif des nouveaux vaccins contre le cancer du col, la
Déclaration Mondiale Contre le Cancer réclame des programmes de vaccination contre
le HPV pour les pays à faibles et moyens revenus. Elle réclame également des mesures
spécifiques pour réduire les coûts, former les professionnels de la santé, et informer la
population.
Cancer
Le cancer du col est la deuxième cause de mortalité par cancer pour les femmes du monde
entier. Pour les femmes des pays en voie de développement, c’est le cancer le plus meurtrier.
Pratiquement tous les cas de cancer du col sont dus à une infection par le virus Papilloma
humain (HPV), l’infection des organes génitaux la plus fréquente
Cervical
À l’attention de l’Union Internationale Contre le Cancer – UICC
Spanish
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               
          
            
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            
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             
           
           
            
             
           
              
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G26
Apoyamos el esfuerzo de movilización de la UICC a nivel mudial y local a favor de una prevención
integral del cáncer cervicouterino. Por medio de esta carta, queremos demostrar nuestro
compromiso en el esfuerzo para eliminar a nivel mundial el cáncer cervicouterino y dar acceso a
estrategias de prevención accesibles y efectivas a las mujeres que tienen la mayor necesidad.
En países industrializados, la implementación de la detección temprana, programas de tamizaje
y tratamiento ha reducido dramáticamente las tasas de cáncer cervicouterino en los últimos 60
años. Pero en los países en desarrollo, donde la gran mayoría de mujeres nunca se han hecho un
control, la incidencia y tasas de mortalidad de cáncer cervicouterino continúan creciendo.
vidas por décadas a venir. Más aún, una mejor adaptación de los métodos de tamizaje pueden
hacer realidad la detección eficaz, aún en los escenarios más remotos.
Nombre:
Título/posición:
Organización:
País:
E-mail:
Initiative
cervicouterino, la Declaración Mundial del Cáncer reclama programas de vacunación de VPH
en países de bajos y medianos ingresos, donde la incidencia del cáncer cervicouterino es alta. La
Cancer
Para las mujeres en países en desarrollo el cáncer cervicouterino es la primera causa de mortalidad
por cáncer en mujeres y la segunda causa a nivel mundial. Prácticamente todos los casos de
cáncer cervicouterino se deben al virus de papiloma humano (VPH), la infección viral más común
del tracto reproductivo femenino.
Cervical
THANK YOU
Supporting improved cervical
cancer prevention worldwide
About UICC
Founded in 1933, the International Union Against Cancer (UICC) is the leading international nongovernmental
organization dedicated exclusively to the global control of cancer. Its vision is of a world where cancer is eliminated as a
major life-threatening disease for future generations.
UICC is a non-profit organization. Its objective is to advance scientific and medical knowledge in research, diagnosis,
treatment and prevention of cancer and to promote all other aspects of the campaign against cancer throughout the
world. Members are voluntary cancer leagues and societies, cancer research and treatment centres and, in some countries,
ministries of health.
UICC focuses on cancer prevention and control, tobacco control, knowledge transfer, capacity building, and patient
advocacy and support. It organizes the World Cancer Congress held every two years, and annual symposia, workshops and
training courses with extensive expert networks.
It launched a World Cancer Campaign in 2005 and coordinates World Cancer Day on 4 February each year.
UICC fellowships help train researchers, clinicians, health professionals and cancer workers across the world. Between
them, GLOBALink (the online tobacco control community) and the Global Cancer Control Community service over 7,000
researchers and professionals.
UICC publishes the International Journal of Cancer, books in the TNM and prognostic factors series, a calendar of
international cancer conferences, and technical reports, newsletters and manuals.
UICC is governed by its members through a general assembly, which meets every two years, and an elected board of
directors. With over 300 members in more than 100 countries, UICC is a resource for action and a voice for change.
D O S S I E R O F S U P P O RT
August 2008

U IC CC e rv ic al C ancer In itia tiv e

Transcripción

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