Cervical Cancer and the Development of HPV Vaccines in Guanacaste Costa Rica推荐.pdfVIP

Chapter 9 Cervical Cancer and the Development of HPV Vaccines in Guanacaste, Costa Rica Nuria Homedes and Antonio Ugalde 9.1 Introduction Cervical cancer is the second most frequent cancer in women worldwide, and the second most frequent cause of cancer death for women between the ages of 14–45 years. Eighty-three percent of cervical cancer cases occur in residents of developing countries, and it is the primary cause of cancer deaths in women of Central America (WHO/ICO 2009). Unfortunately, cytology-based prevention programs (such as Pap smears) have been less effective in developing countries than in countries with adequate health systems (Robles and Roses Periago 2004), leading to continued efforts to develop better methods to prevent and treat the disease. Between 1985 and 1987, the United States National Cancer Institute (NCI) sponsored a multi-center study to identify risk factors for cancer of the uterine cervix. The study group was composed of women living in the United States, Costa Rica, Mexico, Panama, and Colombia. The study resulted in one of the major health discoveries in the past two decades: that cervical cancer resulted from infection with the Human Papilloma Virus (HPV) (Herrero et al. 1997). The presence of the virus triggers a series of events that over the years can result in cancer. Once the relationship between HPV infection and cancer had been recognized, hope arose that a vaccine to prevent infection and any resulting cancers could be developed. But not all women infected with HPV developed cancer, and it remained necessary to look for other contributors to the development of the disease. One such study, also sponsored by the NCI, took place in Guanacaste, Costa Rica, between 1993 and 2001. It is now known that the majority of HPV infections (more than 90 %) N. Homedes (*) School of Public Health, D