Trends in Cervical Cancer Mortality in the Americas

This arficle presents an assessment of cervical cancer mortality trends in the Americas based on PAHO data, Trends were esfimafed for countries where data were available for at least 10 consecutive years, the number of cervical cancer deaths was considerable, and at least 75 % of the deathsfiom all causes were registered. In contrast to Canada and the United States, whose general populations had been screened for many years and where cervical cancer mortality has declined steadily (to about 1.4 and 1.7 deaths per 100 000 women, respectively, as of 1990), most Latin American and Caribbean countries with available data have experienced fairly con-stant levels of cervical cancer morfality (typically in the range of 5-6 deaths per 100 000 women). In addifion, several other countries (Chile, Costa Rica, and Mexico) have exhibited higher cervical cancer mortality as well as a number of noteworthy changes in this mortality over time. Overall, while actual declining trends could be masked by special circumstances in some countries, cervical cancer morfality has not declined in Latin America as it has in developed countries. Correlations between declining mortality and the in fensity of screening in devel-oped countries suggest that a lack of screening or screening program shortcomings in Latin America could account for this. Among other things, where large-scale cervical cancer screen-ing efforts have been instituted in Latin America and Caribbean, these efforts have generally been linked to family planning and prenatal care programs serving women who are typically under 30; while the real need is for screening of older women who are at substantially higher risk. The uterine cervix is the most common 1 cancer site for females in Latin America and the Caribbean, where approximately 52 000 new cases occur annually. Overall in the Americas, where it is estimated that nearly 68 000 new cases occur annually (I), North America exhibits the lowest morbid-ity and mortality. Elsewhere in the Ameri-cas there is considerable variation, with cancer registry morbidity data showing relatively high incidences of cervical can