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This study aimed to evaluate the awareness and practice of breast self-examination (BSE) and the awareness of screening and risk factors for breast cancer among patients from a mastology clinic and to associate such findings with sociodemographic factors of that population. A total of 202 randomly selected patients from the outpatient clinic of the Mastology Unit of São Paulo School of Medicine were interviewed. A structured questionnaire was used and included questions regarding sociodemographic variables, questions to assess the knowledge and practice of BSE, and knowledge of mammographic screening and risk factors for breast cancer. The vast majority of patients were aware of the existence of BSE (93.1%). BSE was performed by most patients (64.9%), although only 20.3% performed it adequately. Only 21.8% of respondents showed awareness of the best screening method for breast cancer. Furthermore, 17.3% of patients showed adequate awareness of risk factors for breast cancer. The analysis of sociodemographic variables showed that older, postmenopausal, and less-educated women showed better practice of BSE. Overall, the patients had no adequate awareness of BSE, mammographic screening, and risk factors for breast cancer, and the majority failed to practice BSE adequately, particularly the group of patients with the higher level of education. These data show that educational measures regarding the practice of BSE and, especially, mammograms should be emphasized, regardless of education level or family income of the patient.

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The number of oncological patients (OP) admitted to intensive care units (ICU) for sepsis/septic shock has dramatically increased in recent years. The definition of septic shock has been modified, adding hyperlactatemia as a severity biomarker for mortality. However, it remains poorly reported in septic OP. We performed a retrospective analysis from a prospective database of sepsis/septic shock patients admitted to our ICU between September 2017 and September 2019 and followed until day 90. We identified 251 patients and 31.9% had active oncological comorbidity, mainly solid tumor (81.3%). Septic shock criteria were met for 112 (44.6%). Hyperlactatemia was observed in 136 (54.2%) patients and this was associated with a lower survival rate. Overall 90-day mortality was 15.1%. In OP vs. non-OP, hyperlactatemia was more frequent (65% vs. 49.1%, p = 0.013) and associated with lower survival (65.4% vs. 85.7%, p = 0.046). In OP, poor performance status was also associated with lower survival (HR 7.029 [1.998-24.731], p = 0.002) In an adjusted analysis, cancer was associated with lower 90-day survival (HR 2.690 [1.402-5.160], p = 0.003). In conclusion, septic OP remains a high mortality risk group in whom lactate levels and performance status could help with better risk stratification.

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Patients in Brazil continue to present with late-stage breast cancer. Notwithstanding these figures, policies and programs to overcome this long-lasting scenario have had limited results. We enlist the main barriers for advancing breast cancer diagnosis in Brazil, based on the available evidence, and we propose feasible strategies that may serve as a platform to address this major public health challenge.

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OBJECTIVE: Colorectal cancer (CRC) is the most common cause of cancer death in Puerto Rico (PR). CRC screening rates among PR Hispanics aged ≥ 50 years (57.5%) are below the Healthy People 2020 recommendations (70.5%). Low screening rates can be attributed to lack of education, and beliefs and knowledge about CRC screening procedures. This study evaluated the effectiveness of the Caribe Colon inflatable colon model in two community events as an educational tool to increase CRC knowledge, awareness, and intention to undergo CRC screening. METHODS: Participants (aged ≥ 40 years and with no previous CRC history) completed a pre- and post- questionnaire, and took the tour of the Caribe Colon. RESULTS: After completing the tour, survey responses (n=154) revealed a significant increase in CRC knowledge and awareness (p<0.0001). Multivariable logistic regression models showed that fear of CRC screening procedures was the primary independent factor for not getting screened after adjusting for age, gender, education, regular visits to a primary care physician, insurance, and history of CRC screening (p=0.006). CONCLUSION: Future studies should focus on understanding and reducing barriers to CRC screening including fear. Patients more knowledgeable about CRC screening procedures may have less fear for CRC screening. Furthermore, educational strategies need to be reinforced to reduce fear; this may lead to an increase in CRC screening rates among Hispanics.

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The human papilloma virus (HPV) vaccine is an effective but underused cancer prevention tool. This study assessed knowledge of HPV and HPV vaccine initiation among Mexican-born farmworkers in North Carolina. Interviewer-administered questionnaires were conducted with 100 Latino farmworkers and 100 nonfarmworker Latino North Carolina residents in 2015 as part of an ongoing community-based participatory research project. Farmworkers had low levels of knowledge about HPV and the HPV vaccine. They had a similar amount of HPV and HPV vaccine knowledge compared to nonfarmworkers. Farmworkers and nonfarmworkers learned about the HPV vaccine from different sources. Adolescent children of farmworkers and nonfarmworkers had low HPV vaccine initiation. However, for children living in the United States with farmworker parents, vaccine initiation was high. To prevent HPV-related cancers and improve health equity, interventions are needed in order to increase HPV education and vaccine initiation among children of Mexican-born farmworkers and nonfarmworkers. Public health programs should look for partners outside the traditional health care setting to reach underserved populations. Other key strategies include promoting catch-up vaccines, improving patient-provider communication, and providing case management services.

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O programa de diagnóstico e prevenção de câncer de boca do Univag - Centro Universitário, elaborado pelos docentes da disciplina de Diagnóstico em Odontologia, visa ao incremento de ações preventivas e precoces das doenças bucais com ênfase no câncer bucal, buscando reduzir os índices de morbi-mortalidade através de palestras educativas, divulgação do auto-exame, realizadas pelos acadêmicos de odontologia do Univag desde o segundo semestre de 2005 até os dias atuais. Os acadêmicos de odontologia dos 1º, 2º, 3º e 4º semestres foram capacitados através de aulas teórico-práticas, para a realização de exames preventivos e diagnósticos, como o auto-exame, citologia esfoliativa e biópsia da mucosa bucal, e ainda para a apresentação de palestras educativas. Analisando-se os resultados preliminares foi constatado incremento no número de diagnósticos e encaminhamento de pacientes diagnosticados com câncer bucal para os serviços de referência. Concluiu-se que programa de diagnóstico e prevenção de câncer de boca possibilita o diagnóstico precoce e adoção de medidas de prevenção, e, consequentemente aumento da sobrevida e qualidade de vida da população acometida.

The program of diagnosis and prevention of oral cancer of Univag - University Center aims to increase preventive and early oral diseases with emphasis on oral cancer, aiming to reduce the morbidity and mortality through educative actions, spreading of the auto-examination, performed by dental students of UNIVAG since the second half of 2005 to the present day. The dental students of 1st, 2nd, 3rd and 4th semesters were trained using practice-theoretical classes, for realization the exams preventives and diagnostics, such as self-examination, exfoliative cytology and biopsy of oral mucosa, and even present educative actions. Analyzing the preliminary results were observed increase in the number of diagnoses and referral of diagnosed with oral cancer for treatment in referral services. It was concluded that the program of diagnosis and prevention of oral cancer can make possible early diagnosis and adoption of preventive measures, consequently improving survival rates and life quality in population.

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A recent study of the incidence of cervical cancer in the Cayman Islands found that there had been a dramatic increase in the rate from 19.2/100,000 women during the first year of the 6 years studied to 62.6/100,000 women during the last year of the study. Well over 50% of the cases (58.6%) were women under the age of 40 years. 75% of the cases (75.9%) did not have a Pap smear within 5 years of the diagnosis. The mean annual age-adjusted incidence of cervical cancer during the study period was 42.7/100,000 women over 20 years of age, which is the highest reported incidence in the Caribbean. Further details of the study can be obtained from Dr. P. Maoris, George Twon Hospital, PO Box 915, Grand Cayman, Cayman Islands; phone: 0135 949 0190; e-mail: maourisp@cand.ky

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PIP: Invasive cervical cancer is a leading cause of death in Jamaica despite the availability of Pap smear screening. 90% of women who die from cervical cancer have never been screened. The effectiveness of Pap smear screening depends on women's knowledge of and attitudes toward screening, the availability of this service, the adequacy of laboratory facilities to process the smears, staffing of clinics and laboratories, quality control, a system of recall of women with positive smears, and economic factors. This article reviews the impact of each of these factors in the Jamaican context. Most women have heard of the Pap smear but believe its purpose is to detect rather than prevent cervical cancer. Screening rates are low among poor, uneducated women. As a result of staff shortages in government laboratories, there is a long delay before Pap smear results are returned. The problem of cervical cancer is severe enough in Jamaica to justify the reallocation of funds from less critical areas.^ieng

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This is a transversal study, developed between women of the Anhanguera community, with the objectives of knowing the demographic, sociocultural, gynecological and obstetric profile and of assessing health preventive behaviors in order to elaborate a plan of obstetric nursing assistance. The research tool was a form applied at home during visits to 104 women. Our results showed that 23.08% did not know about cancer prevention, 50.00% never performed it, 77.88% presented gynecological complaints but, 62.96% of these never looked for health services. Based on nursing diagnoses a plan of nursing care and health education was elaborated for the women from this community.

PIP: In the community of Anhanguera, a poor neighborhood of the state of Mato Grosso do Sul, Brazil, a cross-sectional study was carried out in May 1995 dealing with the prevention of cervical cancer. 104 out of 142 women living in the community were enrolled, and semistructured questionnaires containing questions concerning demographic, sociocultural, obstetrical, gynecological information and diagnosis were administered. Second-year nursing school students made the home visits and collected the data. A 1995 analysis showed that in the previous 10 years there had been a steady increase of deaths due to cervical cancer in this state, especially among women aged 50 years and older owing to difficulty of access to prevention programs or the lack thereof in basic health units and nonutilization of such services by women at risk. Most women studied were in reproductive age, with little or no education, and a steady partner. There was a high percentage of multiparas (38.46%), 79.25% of deliveries were normal, and 20.75% were by cesarean section. 94.66% of newborn infants were breast-fed and 73.39% were breast-fed for 6 months or more. 23.08% of the women did not know about cervical cancer prevention programs and only 50% reported that they had made a visit for preventive examination at least once. 77.88% of the women had gynecological complaints (amount of menstrual flow, vaginal discharge, dysmenorrhea, lower abdominal pain, menstrual irregularity, and vulvar itching), but only 37.04% obtained medical help.

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The etiologic role of the oncogenic types of human papillomavirus (HPV) in the development of cervical cancer has been widely proven. Since this cancer occurs more frequently in immunosuppressed individuals, we sought to evaluate the prevalence of HPV infection among human immunodeficiency virus (HIV)-infected and HIV-noninfected prostitutes in Tegucigalpa, Honduras. Cervical scrapes were collected from 23 HIV-seropositive and 28 HIV-seronegative prostitutes for HPV DNA detection by the polymerase chain reaction. Fifty-six percent of the HIV-seropositive women and only 18% of the seronegative women were HPV DNA positive (odds ratio = 6.0). In addition, there was a significant association between seropositivity for HIV with a history of sexually transmitted diseases (P < 0.01). Our data confirm the association between infections with HIV and HPV.

PIP: Numerous studies have revealed a higher prevalence of human papillomavirus (HPV)--etiologically linked to the development of cervical cancer--in women infected with HIV. This study investigated the association of HPV and HIV among 51 prostitutes in Tegucigalpa, Honduras. 23 were HIV-positive. All participants were in their early thirties, had had at least one pregnancy, and experienced their first pregnancy at a mean age of 16 years. Polymerase chain reaction identified HPV DNA in cervical scrapes from 13 (56.5%) HIV-positive women compared with only 5 (18%) HIV-negative prostitutes (odds ratio, 6.0; 95% confidence interval, 1.5-26.7). In addition, there was a significant association between HIV and a history of other sexually transmitted diseases (p 0.01). Since the progression to invasive cervical disease is more aggressive in HIV-infected women, prostitutes and other women at risk of both these infections should receive frequent cytologic screening and counseling.

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The study reported here sought to assess Pap test coverage of a group of asymptomatic Argentine women from the poor urban district of La Matanza in the Buenos Aires metropolitan area Initially, all 2495 women who voluntarily enrolled in a program for early detection of breast cancer between January 1991 and June 1993 were included. After removing those who did not meet various study criteria, there remained 779 study subjects with no gynecologic or mammary symptomatology. Two subgroups of these 779 were established-women who had received a Pap test at any time and those who had received such a test within the previous three years. Using these subgroups, the influence of certain sociodemographic and other variables upon the likelihood of Pap testing was assessed. The results indicated significant associations between past Pap testing and age, formal education, parity, and a family history of cancer Likewise, significant associations were found between Pap testing within the preceding three years and age, formal education, and parity. The study findings affirm the idea that it would be advisable to seek Pap testing for all study population women once every three years instead of every year. Since the study population was not necessarily representative of Buenos Aires population, however, and the findings could have been affected by self-selection and other biases, additional studies are needed to determine actual Pap test coverage among women of the metropolitan area.

PIP: The incidence of Pap test coverage was assessed in 779 asymptomatic women from a low-income district (La Matanza) of Buenos Aires, Argentina, who had enrolled voluntarily in a breast cancer screening program. Overall, 66% of respondents were 30-49 years old, 71% had no secondary education, and 67% lacked social security coverage. A total of 262 women (33.6%) had undergone Pap testing during the year preceding the survey, 279 (35.8%) had received such testing during the preceding 2 years, and 135 (17.4%) had had the test 3 or more years earlier, the remaining 103 (13.2%) had never been tested. Univariate analysis indicated that age, education, parity, and a family history of cancer other than breast cancer were significantly associated with having had a Pap test. Pap testing in the preceding 3 years was significantly associated with age, education, and parity. In the multivariate analysis, age, education, parity, and family history of cancer retained significance for testing at any time. Although the likelihood of testing increased with age, women in the oldest age group (50-69 years) were less likely to have been tested within the past 3 years than women 30-49 years. Parous women were 3-4 times more likely to have been tested than nulliparous women. These findings provide support for the recommendation that Pap testing should be scheduled every 3 years rather than every year to maximize coverage and make effective use of the health system's limited resources. The relatively high coverage rate identified in this study may not be representative of the Buenos Aires population, however, given the possibility of a self-selection bias of women concerned enough with their health to enroll in a cancer prevention program.

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From August 1994 to June 1995, laboratories in 28 Mexican states and the Federal District submitted a total of 10098 diagnosed Pap test slides to Mexico's National Institute of Epidemiologic Diagnosis and Reference (INDRE) for reexamination by conventional methods and also by the automated PAPNET system in Suffern, New York, U.S.A. The aim was to determine the degree of agreement obtained by these various methods. Most of the slides examined (at least 78%) yielded negative results or merely indicated an inflammatory process; 8% to 14% indicated mild or moderate cervical dysplasia; and 2% to 3% indicated conditions ranging from severe dysplasia to invasive cervical cancer. Comparison of the state laboratory and INDRE diagnoses yielded a Kappa correlation coefficient of 0.62, near the lower limit of agreement, the agreement being poorest in cases where it was necessary to distinguish between degrees of abnormality. Although state laboratory underestimation appeared lowest with respect to cases of atypia and of mild, moderate, and severe dysplasia (between 12% and 20%), these percentages are alarming because it is at these stages that the patient may be treated to prevent evolution to carcinoma. While the Kappa correlation coefficient was better (0.80) when the INDRE and PAPNET diagnoses were compared, PAPNET showed only limited ability to distinguish between various pathologic alterations, and the percentages of underestimates (false negatives) obtained with PAPNET were also high. Overall, the results indicate a need to improve the quality of cervical cytology diagnoses at state public health laboratories in Mexico through stepped-up training and supervision. They also indicate that the use of PAPNET involves greater difficulty than does manual microscopic examination of cervical smears, and that a way still needs to be found to detect and review the false negative results generated by PAPNET before approving use of this technology.

PIP: Comparison of cervical smear analyses conducted in Mexican laboratories through conventional microscopy with the results of quality control studies conducted by the National Institute of Epidemiologic Diagnosis and Reference (INDRE) using both conventional and automated (PAPNET) methods revealed an alarming lack of agreement. A total of 10,098 slides prepared by technicians working at state public health laboratories in 28 Mexican states and the federal district were reviewed. Most slides (about 78%) yielded negative results or an inflammatory process; 8-14% indicated mild or moderate cervical dysplasia, and 2-3% revealed severe dysplasia or cervical cancer. The Kappa correlation coefficient for agreement between positive and negative diagnoses made by the states and INDRE was 0.62, near the lower limit, while comparison of diagnoses made by INDRE and PAPNET produced a coefficient of 0.80, near the upper limit. Diagnostic agreement between state laboratories and INDRE was greatest (93%) with slides classified as normal or exhibiting inflammatory changes. Agreement rates were lowest when it was necessary to differentiate degrees of abnormality: unspecified carcinoma (13.3%), invasive carcinoma (51.4%), and moderate dysplasia (63.1%). PAPNET generated substantially more false-negative results than traditional microscopy performed either by INDRE or the states and underestimated the presence of human papillomavirus virus, Candida infection, and trichomoniasis. Inadequate fixing, staining, and mounting of the slides compromised PAPNET analysis. Overall, these findings indicate a need to improve the quality of cervical cytology diagnoses at state laboratories through increased training and supervision.

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The work reported here, which was performed in Santiago, Chile, in 1993, explored factors relating to low Pap test coverage. A survey instrument was prepared and interviews were obtained with 299 women 25-54 years of age who were attending three primary health care clinics in Santiago. Most (at least 87%) of these women had not had a Pap test in three years. Only 28% knew the test's purpose was to detect cervical neoplasia; most (58%) knew the test was related to reproductive health but did not have a clear idea of its purpose; 14% knew nothing of the test or gave completely incorrect answers. Health personnel and the mass media were cited as principal sources of information about the test. Regarding anxieties relating to the test, 60% of the women said they were afraid of being reproached by a health practitioner for failing to come in sooner; 39% said they feared pain resulting from the test; 20% said they feared bleeding; and 14% were afraid they might lose part of the uterus. Also, of the 231 women with intrauterine devices, over 25% said they feared removal of the device. These results suggest a need to improve communication between health care workers and their patients, and to ensure that health personnel respect the rights of women, especially their right to sufficient information enabling them to make their own decisions.

PIP: This exploratory study was conducted among a sample of 299 women out of a total sample of 861 who had attended three primary health care clinics (La Feria, San Jose, and Maipu) in southern and western portions of Santiago, Chile. The interviews were conducted during June, August, and November 1993. The women were aged 25-54 years. Most were overdue for a Pap smear. The women had been seen at these clinics during January 1987 and January 1989. 248 refused to be interviewed, and 314 were lost to follow-up. One question about the purpose of the Pap test was answered only by 199 women. 34% of the 299 women interviewed reported a failure to have a Pap test due to forgetfulness. 27% did not think it was necessary to have the test every 3 years. 8% reported fear of the procedure. This proportion of fearful women remained the same regardless of educational level. The most educated women were the most likely to be up to date with Pap smear testing. 30% of women aged over 45 years were up to date with their Pap tests. 28% had knowledgeable answers about the purpose of the Pap test; 58% gave fair answers and 10% gave incorrect answers. 30% trusted that health care personnel had good quality information. 36% believed that mass media had good quality information, but 12% thought the media also gave incorrect information. 43% of better educated women, 25% of less educated women, and 23% of least educated women had good quality information. The proportion of good quality information was 19% among women aged over 45 years, 30% among women aged 36-45 years, and 27% among women aged under 36 years. 60% of the common fears were blamed on the criticism given by health workers for delaying a Pap test. 39% feared pain. Over 25% feared loss of their IUD during the Pap test.

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PIP: This article describes the objectives and content of a workshop held in Managua, Nicaragua, during November 1995, on screening for cervical cancer. The aims were to discuss cost-effective models of screening in countries with a high incidence of cervical cancer and to reach a consensus on principles for screening that is balanced with a country's resources. The workshop aimed to develop a planning framework and to identify program strengths and weaknesses by country. In 1990 there were 25,000 deaths due to cervical cancer in Central America; even so, most countries attach a low priority to cervical cancer screening. Workshop plenary sessions were devoted to discussions about the natural history of cancer of the cervix and the implications for screening, the high costs of human papillomavirus (HPV) tests, approaches to national registries of cervical cancer, screening issues in Central America, downstaging, laboratory quality control issues, treatment of abnormalities, recruitment of women, and IEC. This report includes individual country program reports for Nicaragua, Panama, Haiti, the Dominican Republic, Guatemala, Honduras, and St. Vincent and the Grenadines. Participants concluded that priority should be placed on education about cancer and cancer of the cervix and education of primary health care professionals. It was agreed that all participating countries should begin pilot programs adapted to resource availability, with the idea of a later nationwide expansion. Health care professionals who treat women during the prime reproductive years should use the opportunity to identify women at high risk of invasive cancer. There is overcoverage of women aged under 35 years and insufficient coverage of women aged 35-64 years. Health programs need to enlist the help of women's groups in creating a need and demand in communities. Cytology laboratories need to provide quality services.^ieng

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PIP: This article presents the findings and recommendations of the evaluation of a project that aimed to decrease mortality from cervical cancer in the Caribbean. The Cervical Cancer Control Project was initiated in 1990 in 10 countries in the Caribbean with a total population of 850,000. The project was directed at women aged 25-69 years and sought to increase cervical screening. The production of education materials was based on a KAP survey conducted in Barbados and Grenada. Findings indicate that Pap smears were more popular among young, better educated women. Men contributed to decision making on reproductive health issues, but women would follow the advice of health professionals. The following informative materials were produced: brochures on prevention, public service announcements, and posters. A follow-up survey indicated little impact of the IEC campaign to increase screenings. Training materials were produced that aimed to assure the quality in performance of Pap smear procedures among health workers. Laboratory-based cervical cytology registries were established that were compatible with PAHO/WHO systems. Quality control in laboratories was reinforced by meetings with pathologists and by exploration of the use of semi-automated cytology screening systems. Meetings were conducted in 1996 to assess whether project goals had been met. It was recommended that cost-benefit studies be conducted in order to prove to policy makers that there was a need to invest in screening programs. It was recommended that community and women's groups be encouraged to participate in awareness creation. Recruitment of the target population should be more flexible and involve possible use of mobile clinics in the workplace and communities. Simple, accurate information needs to be communicated through all available channels, including social marketing. Clinicians need to learn to manage their time and to prioritize their work load.^ieng

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PIP: This brief article presents a profile of cervical cancer prevention in Peru. Limited information is available on the extent of cervical cancer due to lack of a national cancer registry. The only statistics on cervical cancer pertain to Lima. During 1952-91, 44.6% of cases treated were due to cervical cancer, according to the National Institute of Neoplastic Diseases in Lima. The Anti-Cancer League reports that 95.9% of the 1403 cancers of the genital organs among 500,445 women examined during 1953-94 were cervical cancers. 80%-86% of these cancers were advanced-stage cervical neoplasms. The Maes-Heller Center for Research on Cancer reports that the incidence of cervical cancer declined during 1970-80. Reproductive health care provided through the Ministry of Health focuses on reducing maternal mortality and promoting family planning. PAHO/WHO funding has been limited to reducing maternal mortality and to promoting family planning. The focus is on obstetric care rather than gynecologic care. Funding deficits are a constraint to the development of a centralized national program for the control of cervical cancer. In the year 2000, the Ministry of Health should have established the new Reproductive Health and Family Planning Program. One of the program goals is to provide at least 30% of Peruvian women with an annual Pap smear.^ieng

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BACKGROUND AND OBJECTIVES: Human papillomavirus is the major etiologic agent of cervical cancer. Although the incidence of cancer of the cervix is high in Jamaica, the prevalence of human papillomavirus among Jamaican women has not been defined. GOAL OF THE STUDY: To estimate the prevalence of human papillomavirus infection and associated risk factors in women attending an STD clinic in Kingston, Jamaica. STUDY DESIGN: A cross-sectional survey was done of 202 women attending an STD clinic in Kingston in 1990. Cervical and vaginal cells were collected by lavage, and human papillomavirus genomes were detected in extracted DNA using low-stringency Southern blot hybridization. RESULTS: Fifty-eight (28.7%) women were identified as HPV positive. Prevalence of HPV by age group was 39% in women 15-19 years old, 33% of women 20-24 years old, 31% in women 25-29 years old, and 17% in those 30 years or older. Increasing age was significantly associated with a lower prevalence of human papillomavirus infection (test for trend, P = 0.025). The effect of age was independent of years of sexual activity. Women reporting more than one sexual partner per month on average were found to have a significantly higher HPV prevalence (odds ratio 2.87, 95% confidence Interval 1.29-6.38), as were women who reported more frequent sex (test for trend, P = 0.006). CONCLUSIONS: Sexual behavior is associated with risk of human papillomavirus infection. The decrease of human papillomavirus prevalence in older women agrees with other studies that argue in favor of a biological effect, such as increased immunity to human papillomavirus with age. A better understanding of why immunity to human papillomavirus may develop in older women may provide the basis for developing an effective vaccine to prevent cancer of the cervix.

PIP: During November 1990-January 1991, DNA was extracted from cervicovaginal cells from 202 women attending the Comprehensive Health Centre, a sexually transmitted disease (STD) clinic, in Kingston, Jamaica, to determine the prevalence of human papilloma virus (HPV). Health workers interviewed these women so researchers could identify risk factors for HPV. 58 women (28.7%) tested positive for HPV. 62% had uncharacterized HPV DNA types. 16% had more than one type of HPV. HPV prevalence fell with age (39% for 15-19 year olds, 33% for 20-24 year olds, 31% for 25-29 year olds and 17% for 30+ year olds; odds ratio [OR] for oldest group = 0.34; p = 0.025), suggesting that older women have developed an immunity to HPV infection. The higher the number of years of sexual activity, the lower the HPV prevalence (40% for 1-4 years, 32% for 5-9 years, and 23% for 10+ years; OR for 10+ years was 0.44; p = 0.03). Women with at least two sexual partners over the last 12 months had a higher HPV prevalence than those with fewer sexual partners (OR = 2.87; p = 0.01). The greater the average number of times women claimed to have had vaginal intercourse per month in the last year, the greater the HPV prevalence (OR for 3-4 times = 2.07, OR for 5+ times = 3.22; p = 0.006). A multiple logistic regression analysis revealed that age confounded the inverse association between HPV prevalence and years of sexual activity. 3% of Pap smears exhibited cervical dysplasia. Further studies are needed to obtain a better understanding of why immunity to HPV may occur in older women. This information could form the basis for developing an effective vaccine against cervical cancer.

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PIP: In Brazil, cervical cancer is the second most common cancer in women (20.1% of all cancers in women) after skin cancer (24.3%). It is responsible for about 5% of all cancer deaths among women in the State of Sao Paulo. The cervical cancer mortality rate does not differ among regions in Brazil, even though most health services are in metropolitan areas. In 1968, the Cervical Cancer Control Program began in Campinas. Its first phase (1968-1972) was characterized by a low number of Papanicolaou tests and a very high frequency of altered cervical cytologies. The second phase (1972-1978) was characterized by a higher number of repeat Pap tests, a high number of treatments of cervical benign lesions, and a lower frequency of altered cytologies. Geographical expansion of the program to 84 cities in the region (population of 3.5 million) characterizes the current phase, which corresponds with another increase in the frequency of altered cytologies. 85% of patients were in stages II, III, and IV before 1968 compared to only 3% after 1984. Before 1968, no one had cervical intraepithelial neoplasia while most cases (86%) had it after 1984. Therefore, the program achieved its goal of reversing the diagnosis of cervical cancer in the incurability phase to the treatable phase in the region of Campinas. In 1986, the State Health Secretariat of Sao Paulo began implementing a similar cervical cancer control program which was organized into the primary, secondary, and tertiary care levels. It increased its coverage of Pap tests from 8.38% in 1986 to about 40% in 1990. 82% of women who had undergone a consultation at Perola Byington Hospital had a Pap test during the last 2 years and almost all of these women (99%) knew that the Pap test should be repeated. Obstacles faced by the 2 programs included an increased demand in initial stages for specialized care (i.e., surgery), great exit of technicians and professionals from programs to the private sector, and inadequate follow-up of detected cases.^ieng

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This Venezuela Resolution requires the performance of a cytological study in all medical offices providing family planning, pre- and postnatal care, adult hygiene, treatment for sexually transmitted diseases, and gynecological services and, in general, all medical offices in the public sector that treat women between the ages of 25 and 64. It also requires all patients treated in these offices who for any reason have to be admitted for hospitalization to undergo a cytological exam. The purpose of these activities is the prevention of uterine cancer.

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Cuba still has a double burden of health risks. It must contend with some risks to health that persist in underdeveloped rural areas, and it must also deal with the risk factors associated with modern, urban living conditions. The economic and social changes fostered in the postrevolutionary period have reduced the relative importance of the first set of factors, but the changes have also introduced or intensified a myriad of factors derived from their own successes. In this article, the risk factors of greatest concern in contemporary Cuba are described, and the strategies adopted to combat these risk factors, together with the ways in which such strategies are shaped by Cuba's social and economic development are discussed.

PIP: Cuba still has adouble burden of health risks. It must contend with some risks to health that persist in underdeveloped rural areas, and it must also deal with the risk factors associated with modern, urban living conditions. The economic and social changes fostered in the postrevolutionary period have reduced the relative importance of the 1st set of factors, derived from their own successees. Cuba's preventive attention is increasingly concentrated on heart disease, cancer, and stroke. Risk factors related to diet, smoking, obesity, sedentarianism, and occupational accidents are also receiving much attention. 2 types of preventive strategies have been employed to avoid health risks, namely, changing behavior that exposes people to risk and eliminating the risk itself. It is too early to tell how successful Cuba will be in its present campaign to reduce risk factors. The decisive factors for Cuba's current health programs very likely will be the roles of the local governments and of the mass organizations operating at the level of the community and workplace.

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