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The need to build on recent progress

Screening and early detection show mixed

results. Argentina, Brazil, Chile, Colombia and

Uruguay show the strongest performance,

while Mexico, Paraguay and Peru perform

below average. WHO data from 2017 show

that national screening programmes for

cervical and breast cancers are available in

all countries. Comparable figures of actual

coverage are unavailable at present, but

there is evidence that there is still a long road

ahead, for example in addressing geographical

disparities. “Using data for 2013-15, the

proportion of breast cancer identified at

early stages in the south of Brazil is 68%, but

it is only 50% in the poorest regions in the

north of the country, due to limited access

to diagnosis,” explains Mr Medici. PAHO

estimates that by 2019 coverage of cervical

screening had not reached 70% of women

between 30 to 49 years.^64

However, some progress has been observed.

Dr Ubillos highlights the publication of national

early detection guidelines for breast and

colon cancer in Uruguay, adding to previously

existing guidelines for cervical cancer. As he

notes, “these will have an impact across all

the medical bodies”. In Argentina, Dr Ismael

describes a successful expansion of cervical-

cancer screening, from initially one province

to now 11 laboratories “aiming to reach 50%

province coverage in 2022 with pap smear

and HPV test”, says Dr Ismael. In developing

efficient screening programmes, the local

epidemiology should be understood. “Not all

countries are the same for the purposes of

cancer screening. Also, cervical cancer is not

the same in the Amazon as in Bogotá. A good

understanding is needed for targeting these

initiatives,” says Dr Murillo.

Based on information from the WHO in

2014, mammography at the public primary

healthcare level is generally available in six

of the countries (Argentina, Brazil, Chile,

Colombia, Mexico, Uruguay), while five

countries have availability of clinical breast

exams (Bolivia, Costa Rica, Ecuador, Panama

and Paraguay). No availability of either service

was reported in Peru by 2014.

Faecal occult blood test or faecal

immunological tests were reported as

generally available at the primary healthcare

level in all countries but Mexico, Paraguay

and Peru. Bowel cancer screening by exam

or colonoscopy was available in only half of

the countries, with Bolivia, Ecuador, Mexico,

Panama, Paraguay and Peru still to implement

such programmes. In Brazil, “hidden-blood

screening covered only 5% of the targeted

SUS population in 2011, and colonoscopy was

available for only 20%,” says Mr Medici.

Lack of resources may often hinder the

scaling-up of these programmes. A pilot

screening programme for colorectal cancer

in Paraguay targeting 600 people required

the samples being sent to Chile for the occult

blood analysis to take place.^65 Dr Mitsui’s

team at the Instituto Nacional del Cancer has

approached the Ministry of Health so that the

necessary equipment can be acquired. Users

may also face limitations in transportation

to health centres or in time required to seek

care. To address this in some way, Ecuador has

expanded time allowances for public-sector

workers to seek medical care.^66 “This helps

making access more feasible,” says Mr Merino.

The voices of the experts are clear in a call

for strengthening promotion and prevention

(^64) PAHO, “El cáncer cervicouterino es el tercero más frecuente entre las mujeres de América Latina y Caribe, pero se puede prevenir”, 2019.
(^65) Ministerio de Salud Pública y Bienestar Social. “Lanzan PRENEC, Programa Para La Prevención Y Detección Temprana Del Cáncer Colorrectal”, 2018.
(^66) Redacción Médica, “Asamblea amplía el tiempo de permiso para atención médica de los servidores públicos”, 2019.