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Epidemiología y prevención del virus del papiloma humano y cáncer cervical en África sub‐Sahariana: revisión sistemática
Author(s) -
Louie Karly S.,
De Sanjose Silvia,
Mayaud Philippe
Publication year - 2009
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/j.1365-3156.2009.02372.x
Subject(s) - medicine , cervical cancer , epidemiology , public health , tanzania , population , incidence (geometry) , gynecology , developing country , vaccination , environmental health , cancer , immunology , pathology , geography , economic growth , physics , environmental planning , optics , economics
Summary Objectives To identify the gaps of knowledge and highlight the challenges and opportunities for controlling cervical cancer in sub‐Saharan Africa (SSA). Methods A comprehensive review of peer‐reviewed literature to summarize the epidemiological data on human papillomavirus (HPV) and invasive cervical cancer (ICC) by HIV status, to review feasible and effective cervical screening strategies, and to identify barriers in the introduction of HPV vaccination in SSA. Results ICC incidence in SSA is one of the highest in the world with an age‐standardized incidence rate of 31.0 per 100 000 women. The prevalence of HPV16/18, the two vaccine preventable‐types, among women with ICC, does not appear to differ by HIV status on a small case series. However, there are limited data on the role of HIV in the natural history of HPV infection in SSA. Cervical screening coverage ranges from 2.0% to 20.2% in urban areas and 0.4% to 14.0% in rural areas. There are few large scale initiatives to introduce population‐based screening using cytology, visual inspection or HPV testing. Only one vaccine safety and immunogenicity study is being conducted in Senegal and Tanzania. Few data are available on vaccine acceptability, health systems preparedness and vaccine cost‐effectiveness and long‐term impact. Conclusions Additional data are needed to strengthen ICC as a public health priority to introduce, implement and sustain effective cervical cancer control in Africa.