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Muñoz N et al / Colombia Médica - Vol. 43 Nº 4, 2012 (Octubre-Diciembre)

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Colombia Médica

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Epidemiology of cervical cancer in Colombia
Muñoz, Nubiaa; Bravo, Luis Eduardob
a

National Cancer Institute, Bogota, Colombia.Director Cancer Registry of Cali, Universidad del Valle, Cali, Colombia.

b

Article info
Article history: Received 5 January 2012 Received in revised form 5 April 2012 Accepted 12 September 2012

Keywords:

Cervix uteri cancer, HPV, HPV vaccines, cancer epidemiology, Cali, Colombia.

ABSTRACT Worldwide, cervical cancer is the third most common cancer in women, and the first or secondmost common in developing countries. Cervical cancer remains in Colombia the first cause of cancer mortality and the second cause of cancer incidence among women, despite the existence of screening programs during the last 3 decades. Bucaramanga, Manizales and Cali reported rates around 20 per 100,000 and Pasto 27 per 100,000. The Cali cancer registry has reported a progressive decrease in the agestandardized incidence and mortality rates of cervical cancer over the past 40 years. Reasons for the decline in incidence and mortality of cervical cancer are multiple and probably include: improvement in socio-economic conditions, decrease in parity rates and some effect of screening programs. Human papilloma Virus is the main cause of cervical cancer, HPV natural history studies have nowrevealed that HPVs are the commonest of the sexually transmitted infec¬tions in most populations. Most HPV exposures result in sponta¬neous clearance without clinical manifestations and only a small fraction of the infected persons, known as chronic or persistent carriers, will retain the virus and progress to precancerous and cancer. HPV 16 and 18 account for 70% of cervical cancer and the 8 most commontypes. (HPV 16, 18, 45, 33, 31, 52, 58 and 35) account for about 90% of cervical cancer. Case-control studies also allowed the identification of the following cofactors that acting together with HPV increase the risk of progression from HPV persistent infection to cervical cancer: tobacco, high parity, long term use of oral contraceptives and past infections with herpes simplex type 2 andChlamydia trachomatis. The demonstration that infection with certain types of human papillomavirus (HPV) is not only the main cause but also a necessary cause of cervical cancer has led to great advances in the prevention of this disease on two fronts: (i) Primary prevention by the use of prophylactic HPV vaccines; and (ii) secondary prevention by increasing the accuracy of cervical cancer screening.INTRODUCTION Worldwide, cervical cancer is the third most common cancer in women, and the first or second most common in developing countries. From a total of 530,232 new cases that were estimated to have occurred in the world in 2008, 453,531 cases (86%) were diagnosed in less developed countries1. Its main public health importance in these countries lies in the fact that it affects relativelyyoung and poor women, devastating not only the women themselves, but also their families. In Latin America cervical cancer is the second most common cancer among women (after breast cancer) and it is the most important cause of years of life lost, despite the fact that it is a highly preventable disease. It is estimated that if the prevention programs are not improved in the region, the annualnumber of cases diagnosed will increase from 68,000 cases in 2008 to 126,000 in 20252.

Cervical cancer remains in Colombia the first cause of cancer mortality and the second cause of cancer incidence among women, 3 despite the existence of screening programs during the last 3 decades. The reasons for this lack of impact have been recently analyzed and include: poor quality of cytology, low...