Reduction in Vaccine HPV Type Infections in a Young Women Group (18-25 Years) Five Years after HPV Vaccine Introduction in Colombia.

In Colombia, the human papillomavirus (HPV) vaccine was launched in 2012 in the context of a school-based national vaccination program targeting girls ages 9 to 14 and offering catch-up vaccination for girls ages 14 to 17. In this study, we evaluated the program's impact on type-specific HPV infection by comparing HPV cervical prevalence among vaccinated and nonvaccinated women. This is a comparative cross-sectional study conducted 5 years after the quadrivalent HPV vaccination implementation in a sentinel Colombian City. This study included young women (18-25 years old) who had been vaccinated in the catch-up group and were attending universities and technical institutions, and women who attended primary health care facilities for Pap smear screening. The HPV prevalence of 1,287 unvaccinated women was compared with the prevalence of 1,986 vaccinated women. The prevalence of HPV16/18 infections was significantly lower in vaccinated compared with unvaccinated women (6.5% vs. 15.4%; P < 0.001), whereas for HPV6/11 infections, a decrease of 63.7% in vaccinated women (1.02% vs. 2.81%) was observed. The adjusted effectiveness to HPV16/18 was 61.4%; 95% CI, 54.3%-67.6%. However, the effectiveness against HPV16/18 was significantly higher among women vaccinated before their sexual debut 91.5%; 95% CI, 86.8-94.5, compared with effectiveness for vaccination after their sexual debut, 36.2%; 95% CI, 23.6-46.7. Five years after the introduction of HPV vaccines in Colombia, high effectiveness of HPV to prevent HPV16/18 infections is observed in the catch-up cohorts including virgin and sexually active women. PREVENTION RELEVANCE: Monitoring HPV vaccines post-licensure plays an important role in assessing the progress of immunization programs, demonstrating the impact of vaccines on the population, and providing data for policy needs. In Colombia, HPV vaccines showed effectiveness when administered before start of sexual activity, and two doses are sufficient to achieve good protection.

Políticas basadas en la evidencia científica: El caso del control del cáncer de mama en Colombia / Evidence-based policies: The case of breast cancer control in Colombia

Resumen Colombia tiene un riesgo intermedio a desarrollar cáncer de mama con una tasa de incidencia estandarizada por edad en de 44,1 por 100.000 mujeres. A pesar de que en el país se recomienda la tamización mediante mamografía, en mujeres de 50 a 69 años y examen clínico de mama anual, así como detección temprana para mujeres sintomáticas independientemente de la edad; en Colombia no se ha podido reducir la mortalidad por esta causa. Múltiples causas parecen explicar este problema: baja participación en las actividades de tamización con mamografía por parte de la población objeto; baja calidad de la mamografía, y barreras de acceso para el diagnóstico oportuno y el tratamiento integral. Frente a esta problemática el 3 de octubre fue aprobado en primer debate el proyecto de ley 259 de 2019 Cámara Proyecto de Ley "Por medio de la cual se establecen medidas para la prevención, diagnóstico, tratamiento oportuno, rehabilitación, y cuidados paliativos del cáncer de mama y se dictan otras disposiciones". A fin de revisar el soporte científico del contenido del proyecto de ley y aportar a su adecuada discusión, el Instituto Nacional de Cancerologia (INC) realizó un foro el 9 de diciembre de 2019. El propósito de este artículo es presentar el análisis de los puntos de mayor controversia desde una perspectiva científica, como base para la adecuada toma de decisiones en materia de políticas de salud pública.

Abstract Colombia ranks at an intermediate risk level regarding the development of breast cancer, with an age-standardized incidence rate of 44.1 per 100,000 women. Although mammography screening and annual Clinical Breast Examination for women aged 50 to 69 are recommended in Colombia, as well as early detection for symptomatic women regardless of age, mortality from this cause has not been reduced in Colombia. Multiple causes seem to explain this problem: low participation of the target population in mammography screening activities, poor quality of mammography, and access barriers for timely diagnosis and comprehensive treatment. In view of this problem, the House of Representatives approved in first debate last October 3 Bill No. 259 of 2019 "by means of which measures and other provisions for prevention, diagnosis, timely treatment, rehabilitation, and palliative care of breast cancer are set up". The Colombian National Cancer Institute INC, held a forum on December 9, 2019, aimed at reviewing the scientific support of the content of the bill and contribute to its proper discussion. The purpose of this paper is to present the analysis of the most controversial points from a scientific perspective, as a basis for appropriate decision-making in public health policy.

Educación en Colombia para la detección temprana del cáncer de mama / Education for the early detection of breast cancer in Colombia

Introducción. El cáncer de mama representa un problema de salud pública cada vez mayor en Colombia. La mayoría de los estudiantes de medicina y de los profesionales de la salud no reciben capacitación para la detección temprana del cáncer de mama. Objetivo. Describir el proceso llevado a cabo por el Instituto Nacional de Cancerología de Colombia, para capacitar a los profesionales de la salud (médicos generales, ginecólogos, médicos familiares y enfermeras) en la detección temprana del cáncer de mama, mediante cursos presenciales y virtuales. Resultados. Con las dos modalidades de cursos, 1.875 profesionales de la salud han sido capacitados, la mayoría de ellos mediante el curso virtual (n=1.294; 73,0 %). Asimismo, los médicos generales han sido los profesionales que más se han certificado mediante alguna de las dos modalidades del curso (n=919; 49,0 %). Los dos cursos generan gran satisfacción en los participantes, con una tasa de certificación del 100 % en la modalidad presencial y del 73,0 % en la virtual. Conclusiones. Es difícil medir el impacto de la capacitación profesional en el diagnóstico precoz del cáncer de mama, porque la mayoría de las regiones de Colombia no tienen registros de cáncer. Es probable que, con un tiempo mayor de seguimiento, se logre medir el impacto real de los cursos en la detección temprana del cáncer de mama y, por ende, en la mortalidad debida a la enfermedad (AU)

Introduction: Breast cancer represents an increasing public health issue in Colombia. Most undergraduate medical students and health professionals do not receive training in early detection of breast cancer. Material and methods: This article describes the process and achievements developed by the National Cancer Institute of Colombia (NCIC) to train health professionals (general practitioners [GP], gynecologists, family doctors and chief nurses) in early detection of breast cancer through two modalities courses: physical presence and virtual. Results: With these two course modalities 1,875 health professionals have been trained, most of them were certified through the virtual course (n=1.294; 73,.0 %). Most of the trained health professionals were GP (n=919; 49,0 %). Both modalities had a high level of satisfaction of the participants, a certification rate of 100 % in the face-to-face modality and 73.0 % in the virtual one. Conclusions: It is difficult to measure the impact of professional training in the clinical staging of breast cancer mainly because most regions in Colombia do not have cancer records. We should have a longer follow-up time to be able to measure the real impact in achieving lower clinical staging and, therefore, to reduce mortality due to the disease (AU)

Detection and Genotyping of HPV DNA in a Group of Unvaccinated Young Women from Colombia: Baseline Measures Prior to Future Monitoring Program.

In 2012, Colombia launched human papillomavirus (HPV) vaccination program for girls ages 9 to 12, and in 2013, the target age was expanded to 9 to 17 years. Monitoring the changes of HPV infection prevalence among young women has been proposed as an endpoint for early assessment of HPV vaccination programs. However, the data on HPV prevalence in young ages are very limited. The purpose of this study was to determine the prevalence of HPV infection and the distribution of genotypes in a group of nonvaccinated women ages 18 to 25 years old in three Colombian cities as baseline for the monitoring of the HPV national vaccination program. A total of 1,782 sexually active women were included. Cervical smear samples were collected to perform the Pap smear and HPV DNA detection using a Linear Array HPV assay. Of the 1,782 specimens analyzed, 60.3% were positive for any HPV type; 42.2% were positive for high-risk HPV (HR-HVP) types, and 44.4% for low-risk HPV (LR-HPV) types. Multiple and single infections were identified in 37.1% and 23.2% of samples, respectively. HR-HPV types -16, -52, and -51 were the most predominant with proportions of 11.3%, 7.92%, and 7.9%, correspondingly. The prevalence for HR-HPV 16/18 was 14.4%. HR-HPV prevalence in women with abnormal cytology (75.16%) was higher than in women with normal cytology (38.6%). In conclusion, a high prevalence of HR-HPV was observed among younger women. This HPV type-specific prevalence baseline may be used to monitor postvaccination longitudinal changes and to determine its impact on HPV-related disease incidence in Colombia population. Cancer Prev Res; 11(9); 581-92. ©2018 AACR.

Creencias y percepciones de pacientes y familiares o cuidadores sobre el cáncer / Beliefs and perceptions about cancer patients and carers / Crenças e percepções perante o câncer em pacientes e parentes cuidadores

Objetivo. El cáncer es un fenómeno complejo, se requiere reconocer las creencias y percepciones de pacientes y familiares o cuidadores, que in-fluyen sobre las formas de pensar, decidir y actuar frente a sí mismos y al entorno. Este trabajo tiene la finalidad de ser insumo para el diseño e implementación de programas para el control del cáncer que permitan fomentar la participación y cumplimiento del tratamiento.Materiales y métodos. Se llevó a cabo un estudio cualitativo en el que participaron pacientes con cáncer y familiares o cuidadores, atendidos en el Centro de Educación del Instituto Nacional de Cancerología. Se con-formaron nueve grupos focales. Los datos se sometieron a un análisis del discurso y se utilizó el Atlas.ti, versión 7.0.Resultados. Participaron 88 personas, 39 pacientes y 49 familiares o cui-dadores, de las cuales, el 71,5 % era del sexo femenino y el 85 % era de estrato socioeconómico bajo. Se identificaron creencias y percepciones en torno a la propensión y la gravedad de la enfermedad, así como los beneficios y las barreras frente a su manejo, además de elementos clave para actuar frente a la enfermedad. Entre estos hallazgos surgen, por un lado, aspectos relacionados con la percepción de factores de riesgo y la concepción inicial del cáncer como sinónimo de muerte, y, por otro, se evidencia la existencia de distintos tipos de barreras para la obtención de un diagnóstico temprano.Conclusión. Los programas de prevención y detección temprana del cán-cer deben incluir en sus estrategias las creencias y percepciones de los individuos frente al cáncer, mejorando las estrategias de información, educación y comunicación dirigidas a la comunidad, a fin de que sean reconocidas y legitimadas para lograr mejores resultados en salud pública.

Objective: Cancer is a complex phenomenon in which beliefs and perceptions of patients and carers are key in understanding ways of thinking and acting. This study aims at providing a star-ting point for further devising and implementing programs gea-red towards increasing patient participation and compliance to cancer-related treatments.Tools and methods: A qualitative study was conducted with the participation of cancer patients and carers seeking care at the education center of a Colombian institution providing health care to cancer patients (Instituto Nacional de Cancerología). Nine focus groups were carried out; Atlas Ti version 7.0 was used for data analysis. Further analysis was implemented with the use of discourse analysisResults: This study was carried out with 88 participants; 39 pa-tients and 49 carers. 71.5% of the sample accounted for women. Sociodemographic data indicated that 85% of the participants of this study were classified as having low or medium income. Throughout the present study, beliefs and perceptions about cancer-related susceptibility, benefits and perceived barriers we-re identified. The findings of this study highlight risk factor per-ceptions and various barriers related to early diagnosis access. Conclusion: Cancer ­ related prevention and early detection programs ought to include beliefs and perceptions within their scope, when devising information, education and communica-tion strategies targeting communities, thus allowing for better outcomes in public health.

Objetivo: O câncer é um fenômeno complexo que requer con-hecimento das crenças e percepções dos próprios pacientes e seus parentes cuidadores, para entender melhor suas formas de pensar, decidir e atuar. Este artigo busca se tornar um insumo na criação e implementação de programas para o controle de câncer que facilitem a participação e aderência ao tratamento. Materiais e métodos: Estudo qualitativo com participação de pacientes com câncer e seus parentes cuidadores do Centro de Educação do Instituto Nacional de Cancerología. Foram reali-zados 9 grupos focais, sua análise foi feita com Atlas Ti versão 7.0 e a análise de dados foi feito com análise de discurso.Resultados: Participaram 88 pessoas, 39 pacientes e 49 paren-tes cuidadores, dentre eles 71,5% mulheres e 85% de baixa renda. Foram identificadas crenças e percepções em torno da susceptibilidade e gravidade da doença, mesmo como proble-mas no tratamento e diagnóstico e outros elementos chave para agir perante a doença. Conclusão: Os programas de prevenção e detecção precoce do câncer devem incluir estratégias que aprofundem as crenças e percepções dos sujeitos perante o câncer, para melhorar as es-tratégias de informação, educação e comunicação e conseguir maior legitimidade do tratamento e melhora nos impactos da saúde pública.

Comparison between Urine and Cervical Samples for HPV DNA Detection and Typing in Young Women in Colombia.

Urine sampling for HPV DNA detection has been proposed as an effective method for monitoring the impact of HPV vaccination programs; however, conflicting results have been reported. The goal of this study was to evaluate the performance of optimized urine HPV DNA testing in women aged 19 to 25 years. Optimization process included the use of first void urine, immediate mixing of urine with DNA preservative, and the concentration of all HPV DNA, including cell-free DNA fragments. Urine and cervical samples were collected from 535 young women attending cervical screening at health centers from two Colombian cities. HPV DNA detection and genotyping was performed using an HPV type-specific multiplex genotyping assay, which combines multiplex polymerase chain reaction with bead-based Luminex technology. Concordance between HPV DNA detection in urine and cervical samples was determined using kappa statistics and McNemar tests. The accuracy of HPV DNA testing in urine samples was evaluated measuring sensitivity and specificity using as reference the results obtained from cervical samples. Statistical analysis was performed using STATA11.2 software. The findings revealed an overall HPV prevalence of 60.00% in cervical samples and 64.72% in urine samples, HPV-16 being the most frequent HPV type detected in both specimens. Moreover, our results indicate that detection of HPV DNA in first void urine provides similar results to those obtained with cervical samples and can be used to monitor HPV vaccination trials and programs as evidenced by the substantial concordance found for the detection of the four vaccine types. Cancer Prev Res; 9(9); 766-71. ©2016 AACR.