Rethinking Cervical Cancer Screening in Brazil Post COVID-19: A Global Opportunity to Adopt Higher Impact Strategies

Area of Science:

• Public Health
• Oncology
• Molecular Diagnostics

Background:

• Cervical cancer elimination efforts require effective screening programs.
• Brazil's Unified Health System (SUS) offers free screening but faces challenges due to unequal resources, leading to disparities in incidence and mortality.
• Existing screening programs need adaptable strategies for varied community realities to improve coverage and adherence.

Purpose of the Study:

• To evaluate the potential of human papillomavirus (HPV)-DNA testing with self-collection and molecular triage for cervical cancer screening in Brazil.
• To assess if these strategies can improve coverage, identify high-risk individuals, and overcome infrastructure limitations within the SUS.
• To inform the development of a nationwide, organized cervical cancer screening program adaptable to Brazil's diverse settings.

Main Methods:

• Investigating the performance of highly sensitive HPV-DNA testing compared to cytology.
• Exploring the feasibility and benefits of self-collection methods for improved access, especially in remote areas.
• Examining molecular triage strategies, such as HPV genotyping, for risk stratification using self-collected samples.

Main Results:

• HPV-DNA testing demonstrates higher sensitivity than cytology for cervical cancer detection.
• Self-collection improves access to screening, particularly for populations in remote regions.
• Molecular triage can effectively identify individuals at highest risk from self-collected samples, enabling targeted follow-up.

Conclusions:

• Implementing HPV-DNA testing with self-collection and molecular triage offers a promising strategy to enhance cervical cancer screening coverage and effectiveness in Brazil.
• These approaches can reduce the need for speculum exams and decrease follow-up visits, potentially improving efficiency and patient experience.
• A nationwide organized program utilizing these advanced strategies could address existing disparities and serve as a model for global cervical cancer elimination efforts.