A participatory assessment to identify strategies for improved cervical cancer prevention and treatment in Bolivia

Cervical cancer remains a leading cause of death for women in many countries of the world.In Latin America and the Caribbean, cervical cancer has become the primary cause of cancer-related deaths among women despite the introduction of screening programs more than 30 years ago.Each year in Latin America and the Caribbean 52 000 new cases are diagnosed, and 25 000 women die of the disease (1).Bolivia has one of the highest cervical cancer incidence rates in the Americas (58.1/100 000 women) (2).An estimated 661 deaths per year in Bolivia are attributed to cervical cancer, equivalent to an agestandardized mortality rate of 22.2/100 000.This compares with 7.6/100 000 in Argentina and 12/ 100 000 for all of South America.These statistics are particularly noteworthy given that cervical cancer can be prevented by the timely identification and treatment of precancerous lesions (3,4).Bolivia is one of the poorest countries in South America.Some 70% of Bolivians live in poverty, with limited access to adequate housing, sanitation, education, and health care.Surveys indicate that the public sector in Bolivia provides health care for 40%-60% of the population, and performs 70% of all the Pap smears done in the country for cervical cancer screening (5, 6).Various efforts related to cervical cancer prevention in Bolivia have yet to result in an appreciable decrease in morbidity and mortality from the disease.These efforts have included Pap smear screening, creating the Component for the Detection and Control of Women's Cancer (Componente de Detección y Control del Cáncer de la Mujer) (the "Women's Cancer Component") as a unit within the Ministry of Health and Social Welfare (MHSW) (Ministerio de Salud y Previsión Social), and developing national clinical norms for the prevention of cervical cancer.To identify the obstacles that have impeded the effectiveness of cervical cancer prevention, three organizations joined together in 2001 to coordinate an assessment of the existing cervical cancer prevention and treatment services and the development of appropriate intervention strategies.The three groups were the Women's Cancer Component, EngenderHealth (an international reproductive health organization based in New York City), and the Pan American Health Organization.