Evaluation and Recommendations to Modernize Cervical Cancer Detection and Prevention Programs in Brazil: Challenges...

Background: Cervical cancer remains a major public health problem particularly in low- and middle-income countries. Systematic screening of at-risk women, detection of oncogenic human papillomavirus (HPV) types, and vaccination against HPV are essential strategies for reducing the incidence and mortality of this malignancy.

This narrative review details publications related to the panorama of cervical cancer in Brazil and highlights major deficiencies as well as advances related to prevention, screening, diagnosis, and treatment of this disease.

Cervical cytology, specifically the Papanicolaou test, has been the main method of cervical cancer screening in Brazil. The subsequent implementation of HPV testing, alone or combined with cytology, has been shown to have increased efficacy in the detection and elimination of precancerous lesions. Currently, regional inequities in access to cervical cancer screening, prevention, and treatment actions, as well as in expertise in HPV detection protocols, have resulted in large regional differences in the quality of patient care. Vaccination against HPV is available free of charge by the Unified Health System. However, coverage remains suboptimal due to barriers such as misinformation, resistance from legal guardians, and failures in distribution logistics.

State-of-the-art molecular testing and effective screening of at-risk vulnerable populations for cervical lesions and for the presence of HPV still face regional, logistical, and infrastructure barriers. To improve cervical cancer prevention, detection, and treatment in Brazil, it is necessary to provide upgraded vaccination, screening, and treatment strategies, with a focus on an equitable country-wide access to comparable health services.