WORDL Chronic Disease Prevention Control in the Americas

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					  Chronic Disease Prevention & Control in the Americas
                       Monthly Newsletter of the PAHO/WHO Chronic Disease Program
                       P a n A m e r i ca n He a lt h Or g a ni z a ti o n
                       Regional Office of the World Health Organization

                                                                   Vol. 3, No. 4, April 2009
Editor-in-Chief: James Hospedales ; Associate Editor: Silvana Luciani ; Editorial Staff: Pilar Fano, Enrique Pérez-Flores, Suzanna Stephens; Copy Editor: Donna Eberwine

                                                                                           aspects surrounding the introduction of the HPV
          We would like to thank the readers who
                                                                                           vaccine, such as:
          participated in the brief survey that
          accompanied last month’s issue and                                                   What would be the added value of
          encourage those of you who have not                                                   administering the HPV vaccine in
          done so, to provide us with your                                                      combination with specific health
          comments and suggestions. Your                                                        interventions for adolescents, including
          feedback will help us determine future                                                reproductive health services?
          directions and better meet your needs.
                                                                                               What would be the impact of administering
          We are in the process of evaluating the
                                                                                                the HPV vaccine in combination with a health
          results received and will compile the
       Spotlight: C ancer
          results in due course.
                                                                                                package for adolescents as part of an HPV
                                                                                                vaccination program?
       HP V Vaccine : Inte rvention in                                                         What would be the added value of including
                                                                                                the HPV vaccine in national programs to
       Adoles ce nts                                                                            control cervical cancer?
       Potential stakeholders meet to plan operational
       research study on prevention of cervical cancer                                     Mexico reported that it initiated HPV
       through human papillomavirus (HPV) vaccination                                      vaccination in November 2008 in girls
       and intervention in teenagers                                                       ages 12–16 in the poorest 125
                                                                                           municipalities. It concluded that it is
       This meeting in Mexico City on 25–27 February                                       indeed feasible to set up such a study,
       2009, brought together managers from cancer,                                        but Mexico’s interest would be to focus
       adolescent health, and immunization programs in                                     not only on adolescents but also on
       Mexico, Panama, Peru, and Colombia. WHO,                                            adult women (mothers), to evaluate detection and
       PAHO, and UNFPA convened the meeting to                                             follow-up from Pap tests.
       discuss a proposal for operations research on
       adolescent health and prevention of cervical cancer,
       including the HPV vaccine, with the goal of                                        Contents
       providing support to countries that have made, or                                   Spotlight: Cancer ......................................................... 1
       will soon make, policy decisions on introducing the
                                                                                              o HPV Vaccine: Intervention in Adolescents ........... 1
       HPV vaccine.
                                                                                              o IARC Study on HPV Testing in Low-Resource
       The overall                                                                                 Settings.............................................................................. 2
       objective of the                                                                       o WHO Position Paper on HPV Vaccines Just
                                                                                                   Released ............................................................................. 2
       research study
       would be to                                                                            o WHO/PAHO Cryotherapy Guidelines ........... 3
       generate                                                                               o Call for Abstracts: International Cancer Control
       information on the                                                                          Congress ........................................................................... 4
                                                                                           News Roundup .............................................................. 4

                       Chronic D isease Prevention & Control in the Americas, April 2009                        2

Panama, which introduced the HPV vaccine in                  April 2 2009 issue of the New England Journal of
October 2008 to all 10-year-old girls, is interested in      Medicine: abstract | free full text.
participating in the study. The main questions
Panama would wish to evaluate are whether the                Although Pap-smear testing
coverage and demand can be increased, primarily              for cervical cancer screening
by reducing obstacles to accessing adolescent and            has substantially reduced
immunization programs and cervical cancer                    cervical cancer deaths in
prevention services, and whether the vaccine could           developed countries, its
be delivered as part of a health package for                 impact in low- and medium-
adolescents.                                                 resource countries has been
                                                             limited. Therefore, this
Peru implemented a pilot HPV vaccine project in              study—led by Dr
three demonstration sites, for girls ages 9–14. Peru         Rengaswamy
concluded that it is feasible to set up a study to           Sankaranarayanan, head of the Screening Group at
evaluate the added value of administering the HPV            IARC—shows promise through this new approach
vaccine as part of an adolescent health service              to preventing cervical cancer. The reduction of
package.                                                     incidence of advanced cancers and deaths
                                                             associated with HPV testing reflects its higher
Colombia did an HPV prevalence study that                    sensitivity in detecting precancerous lesions that
showed that HPV types 16 and 18 account for 63%              could potentially progress to invasive cancer.
of all cervical cancer cases in that study. The
country has not yet introduced HPV vaccine but               Obstacles to widespread use of HPV testing in
could potentially do so in various areas of the              low-resource settings include the high price of the
country. There are indications that it would be              currently available HPV tests and the
feasible to carry out the proposed study in a few            requirements for sophisticated laboratory
sites in Medellín.                                           infrastructure. A simple, affordable HPV test
                                                             named careHPV, which provides same-day results,
Pending questions about the study include how to             is currently under investigation and is showing
increase vaccination coverage in populations with            performance similar to that of the current HPV
the greatest burden of disease and how to improve            test, named Hybrid Capture II.
adolescent health services through the introduction
of HPV vaccine.                                              While HPV vaccines have been launched recently
                                                             to prevent infection by the two major types of
                                                             HPV that cause cervical cancer, screening for
                                                             cervical cancer precursors will need to continue,
HPV Testing in L ow-Resource Settings                        and HPV testing would be an effective new tool
New Study on HPV Testing in Low-Resource                     for widespread use in screening programs.
Settings from the International Agency for
Research on Cancer (IARC)
                                                             WHO Position Paper on HPV Vaccines
Cervical cancer
screening using a test                                       Just Released
that directly detects
human papillomavirus                                         The first World Health Organization
(HPV) can                                                    (WHO) position paper on HPV
significantly reduce                                         vaccines in the context of cervical cancer
advanced cervical                                            prevention has just been published in the Weekly
cancers and deaths,                                          Epidemiological Record. This position paper
according to an IARC                                         summarizes essential background data on HPV-
study conducted in India and just published in the           induced disease and presents the WHO

                         Chronic D isease Prevention & Control in the Americas, April 2009                        3

recommendations for
programmatic use of the HPV
                                                               WHO/PAHO Cryotherapy
vaccines.                                                      Guidelines
WHO recommends that
                                                               Cervical Precancer Treatment Using Cryotherapy
HPV vaccination should be
introduced into national                                       in Low-Resource Settings
immunization programs
where prevention of cervical                                   Cryotherapy is
cancer is a public health                                      currently being
priority, where the                                            promoted as the
introduction is                                                most cost-effective,
programmatically feasible and economically                     feasible approach
sustainable, and where cost-effectiveness aspects              to treating
have been considered.                                          precancerous
                                                               cervical lesions in
The following documents may be accessed at the                 low-resource settings. However, there is a scarcity
WHO Vaccines Papers website:                                   of guidelines and recommendations on the clinical
                                                               use, effectiveness, safety and acceptability of
   A brief summary of the WHO position
                                                               cryotherapy treatment. In addition, several
                                                               technical problems have been experienced with the
   A detailed background paper that                           commercially available devices and techniques,
      summarizes the scientific evidence on HPV                prompting the need for improvements in
      vaccines                                                 equipment and design.
   A list of key references, including abstracts
   A PowerPoint presentation of the key points                With a view to making cryotherapy techniques
      of the WHO position paper.                               and effective equipment more available to
                                                               practitioners worldwide, WHO, the United
Links t o doc uments:                                          Nations Population Fund (UNFPA), and the
                                                               Program for Appropriate Technology in Health
                                                               (called simply PATH) have partnered to review
 Position paper (April 2009). Original English
                                                               evidence on cryotherapy treatment, to discuss with
  and French versions
                                                               industry partners possible device modifications to
 Grading of scientific evidence (Adolescent                   overcome technical challenges, and to develop
  Girls)                                                       WHO guidelines for cryotherapy use in low-
        Grading of scientific evidence (Booster)              resource settings.
        Grading of scientific evidence (HIV)
                                                               At the end of March 2009, over 50 clinicians, public
        Grading of scientific evidence (Males)                health professionals, researchers and cryotherapy
     Grading of scientific evidence (Anogenital               manufacturers from around the world gathered to
         Warts)                                                discuss these issues. Participants reviewed the
                                                               literature on cryotherapy treatment effectiveness,
 Introductory letter on WHO position paper on                 safety and acceptability, and the expert group began
  HPV                                                          to identify the evidence that will be used to
    Key references, with abstracts, to the HPV                substantiate the WHO guidelines to be developed
        position paper                                         before the end of the year. Participants also
    HPV vaccine background paper                              discussed the technical problems experienced with
                                                               the devices and techniques and agreed with industry
    Presentation: Summary of key points -                     partners on some critical next steps that can be
        WHO position paper on HPV vaccine                      taken to modify devices with a view to enhancing
                                                               their functionality.

                      Chronic D isease Prevention & Control in the Americas, April 2009                          4

International Cancer Control Congress:                      News Roundup
Call for Abstracts
                                                            This Month’s News Links in English (from most recent)

The organizers of the                                        Study Rates Breast Cancer Risks
3rd International Cancer                                      Among Races
Control Congress (ICCC),                                     Melanoma Detection: Waiting Is
to be held 8–11 November                                      Risky for Men
2009 in Como, Italy, are
calling for the submission                                   Breastfeeding 'protects mother'
of abstracts. This congress                                  A question of health
promotes international
collaboration and brings together the world’s best           Britannia to remove trans fats from its biscuits
minds in cancer control to share knowledge and               Stretch legs on long flights
learn together what works and what doesn’t in
                                                             Cleaner air equals longer lives: Study
different resource settings. The congress promotes
information and knowledge on the implementation              Alcohol abuse… Valencia project to provide
of effective and sustainable population-based                 answers
national cancer control strategies.
                                                             Gym class no solution for obesity: study
Scientific abstracts are called for in the following         UN marks World Autism Awareness Day
subject areas:                                               GlaxoSmithKline seeks new approval for
    1. Planning and monitoring population-based               breast drug
    2. Establishing effective primary prevention
        and population-based screening programs.            Vínculos de este mes a noticias en español
                                                            (del más reciente)
    3. Research and development: What do we
        need to know and how best should we                  Más calidad de vida: programa de
        apply it?                                             lucha contra el cáncer
    4 . Organization of population-based                     El tabaco causará 6 millones de muertes en 2010
                                                             La vacuna contra el VPH no hizo enfermar a
    5. Critical factors influencing the                       las niñas valencianas
        establishment, maintenance, and
        sustainability of population-based                   Preocupan suicidios en Cartagena
        programs.                                            Cáncer: más del 50% de las mujeres lo tienen en
    6. International collaborative interest group             las mamas
        workshop.                                            Los cánceres gastroenterológicos matan cerca
                                                              de 7.000 chilenos
Abstracts are now being accepted via the
conference website’s abstract page.                          Unos siete millones de niños sufren riesgo
                                                              ambiental en Argentina
                  Deadline: 5 June                           Se brindarán talleres sobre factores de riesgo y
                                                              hábitos saludables
                                                             Podrían multar a las tabacaleras por no advertir
                                                              en los paquetes ...
                                                             Cuide sus ojos de situaciones peligrosas en

                      Chronic D isease Prevention & Control in the Americas, April 2009                                  5

 Lucha contra el cáncer tendrá éxito trabajando               Profamilia presenta programa contra el cáncer
  sociedad e ...                                                de cuello uterino
 Dormir mal despierta ideas suicidas                          En Colombia cada tres horas muere una mujer
                                                                por cáncer de cuello ...
 La OMS pide más recursos para tratar el
  autismo en los países pobres                                 Es importante modificar la dieta y mantener el
                                                                peso adecuado
 Prevén incremento de cáncer en América
  Latina                                                       Presentan campaña de información sobre lupus
                                                                en EU
 Sodio: se consume el doble recomendado
 Festejarán este sábado Día Mundial de la
  Actividad Física                                            Source: Selected from daily lists compiled by Sonia Mey-
                                                              Schmidt, PAHO Public Information Office.
 Entendamos y atendamos las enfermedades
  relacionadas con diabetes ...

             Chronic Disease Prevention and Control in the Americas

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contributions of 1–3 paragraphs on activities related to chronic disease in the Americas by sending them to Dr.
James Hospedales ( with copies to Suzanna Stephens ( and Pilar Fano
( Letters to the Editor should be addressed to Silvana Luciani (
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