2021-11-16-世界卫生组织-Cervical_cancer_Uruguay_2021_country_profile_1页_64kb

Cervical Cancer Summary

Core Content

The document provides an overview of cervical cancer epidemiology, prevention strategies, treatment availability, and the goals of the WHO Cervical Cancer Elimination Strategy for 2030.

Incidence and Mortality

• Crude cervical cancer incidence per 100,000 women (2020): 15.2
• Age-standardized cervical cancer incidence per 100,000 women (2020): 11.7
• Cumulative risk of cervical cancer (ages 0-74, 2020): 1.1%
• Cervical cancer deaths (2019): 170
• Cervical cancer mortality-to-incidence ratio (2020): 0.58

These figures indicate that cervical cancer remains a significant public health issue, with a notable incidence rate and mortality burden. The mortality-to-incidence ratio suggests that a substantial proportion of cervical cancer cases result in death, highlighting the need for improved prevention and treatment measures.

Primary Prevention

• HPV vaccination programme coverage among girls (2020): 40% of girls turning 15 years old received their final HPV vaccination dose
• HPV included in national vaccination programme: Yes
• Scale of vaccination programme: National
• Year of introduction: 2013
• Primary target cohort: 11 years

The HPV vaccination programme is a key component of primary prevention. While it is implemented nationally and targets girls at 11 years of age, the coverage is still below optimal levels, with only 40% of girls receiving the final dose by 2020. This suggests that there is room for improvement in vaccine uptake and completion rates.

Secondary Prevention

• National screening programme for cervical cancer exists (2021): Yes
• Primary screening test used (2021): Cytology
• Target age range of programme (2021): 21-69 years
• Programme/guidelines exist to strengthen early detection at primary health care level (2021): Yes
• Clearly defined referral system exists from primary care to secondary and tertiary care (2021): Yes
• Screening for cervical cancer (2019): 70% of women have been screened in the last 5 years

The country has a well-established national cervical cancer screening programme that uses cytology as the primary test. It targets women aged 21-69 years and includes mechanisms for early detection and referral to higher levels of care. However, only 70% of women have been screened in the last 5 years, indicating that screening coverage could be expanded to meet WHO targets.

Treatment and Supportive Care

• National guidelines on cervical cancer management exist (2021): Yes
• Radiotherapy units per 10,000 cancer patients (2021): 9
• Brachytherapy units per 10,000 cancer patients (2021): 9
• Cancer diagnosis and treatment services available:
  • Cancer centre or department at tertiary level: Yes
  • Pathology services: Yes
  • Cancer surgery: Yes
  • Chemotherapy: Yes
  • Radiotherapy: Yes
• Medical staff per 10,000 cancer patients (2019):
  • Radiation oncologists: ND
  • Medical physicists: ND
  • Surgeons: 265
  • Radiologists: 103
  • Nuclear medicine physicians: 21

The country has access to a range of cancer diagnosis and treatment services, including surgery, chemotherapy, and radiotherapy. However, the availability of radiation oncologists and medical physicists is not specified, which may affect the quality and capacity of radiotherapy services. The number of surgeons, radiologists, and nuclear medicine physicians is provided, indicating a moderate level of medical staffing for cancer care.

Palliative Care and Opioid Availability

• Palliative care for patients with NCDs in the public health system:
  • Available in primary health care facilities: Yes
  • Available in community or home-based care: Yes
• Reported annual opioid consumption (excluding methadone) in oral morphine equivalence per capita (2017): 11mg

Palliative care services are available at both primary health care and community levels, which is crucial for managing symptoms and improving quality of life for patients with advanced cervical cancer. The opioid consumption data suggests that there is some availability of pain management resources, although it may not be sufficient for all patients.

WHO Cervical Cancer Elimination Strategy Targets for 2030

• 90% of girls fully vaccinated with the HPV vaccine by the age of 15
• 70% of women are screened with a high-performance test by 35 years of age and again by 45 years of age
• 90% of women identified with cervical disease receive treatment

These targets emphasize the importance of increasing HPV vaccination coverage, expanding cervical cancer screening, and ensuring that all women with cervical disease receive timely and effective treatment. Achieving these goals would significantly reduce the incidence and mortality of cervical cancer.