Cervical cancer screening updates across Paraguay: Evaluation of the national cancer control program (PRONAC) initiative using HPV testing during 2024.

Abstract

e17505 Background: Cervical cancer is one of the most prevalent and deadly neoplasms in Paraguay. Globocan 2022 reported 1,115 new cases, accounting for 8.1% of all cancers. As of 2021, Paraguay's population was 7,353,038 inhabitants. The urban population (62.9%) is larger than the rural population (37.1%). The Paraguayan National Cancer Program (PRONAC) has developed strategies to introduce the HPV Test as a primary screening method in the country. This project presents the primary results of HPV screenings conducted in Paraguay during its first year of implementation. Methods: The project is a cross-sectional, descriptive study centered on anonymous information from the database of PRONAC. Results: A total of 53,789 subjects out of approximately 1,400,000 of the target were tested for HPV nationwide by PRONAC, either through PCR or Hybrid Capture methods. HPV was positive in 6,451 (11.9%). HPV testing was distributed in 13 out of the 18 health regions. The HPV+ proportion ranged from 8-14% across tested regions. The five not covered regions were rural areas. Among those with positive HPV, 4,188 (64.7%) were tested using PCR. Genotyping showed a predominance of oncogenic type HPV non-16/18 in 74.5% of the samples. Following National Guidelines all subjects received counseling and referral for follow-up with colposcopy, 26 patients (0.4%) of the HPV+ population were diagnosed with cervical cancer and underwent oncological treatment. Conclusions: The introduction of HPV testing as a primary screening tool is a significant advance towards eradicating a major public health concern in Paraguay, cervical cancer. While the initial results are encouraging, critical challenges persist such as the need to have homogeneous and well-distributed coverage across all regions, more rigorous follow-up and to potentially reach the majority of the target population within the next couple of years. Interventions like patient navigation may improve this process. The insights gained from this program can serve as a model for other countries in South America.