Cancer Reduction in Guatemala

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Cervical cancer is still one of the most common cancers affecting women in Guatemala and remains a leading cause of cancer morbidity and mortality across Latin America.[6][8] Epidemiological studies demonstrate a strikingly high prevalence of high-risk HPV (hrHPV) in Guatemala. In a cross-sectional study, hrHPV DNA was detected in 38% of women from the general population and in 67% of sex workers, with HPV16 being the most prevalent genotype.[1] More recent data from over 1,700 cancer-free Guatemalan women found an overall hrHPV prevalence of 13%, peaking at 22% in women under 30 years of age.[3] These rates are among the highest globally and underscore the urgent need for effective primary prevention. 

The quadrivalent and nonavalent Gardasil vaccines, both produced by Merck, are well-studied in Latin American populations. A single dose provides protection against persistent HPV16/18 infection, with efficacy rates up to 97.5% through 18 months of follow-up.[2][4][5] Longitudinal data also suggests that people who get these vaccines are protected for at least 8–10 years after a single dose.[4][2]

Guatemala faces significant barriers to HPV vaccine uptake, including vaccine hesitancy, limited public awareness, cost, and logistical challenges in delivering multi-dose regimens.[6] Single-dose vaccines are recognized by The World Health Organization as a viable, evidence-based strategy to expand coverage in resource-limited settings.[6][10][8]. This approach offers a pragmatic solution by reducing costs, simplifying logistics, and improving adherence which are critical factors for success in low-resource environments.[4][6][11] School-based and community outreach models have also been proven effective in similar contexts.[6] 

The HPV-FASTER is an innovative public health strategy designed to accelerate the elimination of cervical cancer. It has been modeled in other countries and has show early promise. The program's name, FASTER, reflects its goal of a "Fast Assessment and Screening to Eliminate" cervical cancer. The core of this strategy is the integration of two key interventions in a single visit:

• GuatemalaHPV Vaccination for Adult Women: Unlike many traditional programs that focus solely on adolescent girls, HPV-FASTER offers the HPV vaccine to a broader age range of women (25-45 years old) who are already participating in cervical cancer screening. The rationale is that the vaccine can still provide protection against new infections in women who are not currently infected, even if they are sexually active. This broadens the direct benefits of vaccination and can also contribute to herd immunity.
• High-Risk HPV (hrHPV) Screening: The program uses hrHPV DNA testing as the primary screening method. This is a more sensitive test for detecting the viruses that cause cervical cancer than traditional cytology (Pap smears). By combining vaccination and screening, the program aims to provide more comprehensive protection.

A key benefit of this combined approach is the potential to extend the interval between screenings. For women who test negative for hrHPV and receive the vaccine, the time between subsequent screenings could be extended from the current 5 years to 10 years. This not only reduces the demand on healthcare services but also makes the program more cost-effective

A single-dose HPV vaccination campaign in Guatemala represents a high-impact, evidence-based intervention to reduce the burden of cervical cancer and other HPV-related diseases. This project will serve as a model for scalable, sustainable cancer prevention in high-need settings.