driven by persistently higher levels of cervical cancer
mortality in the poorer states. The women living in these
states, the poorest in the country, continue to face a double
cancer burden. Yet, deaths from cervical cancer are
beginning to decline even in the poorer regions and the gap
between rich and poor states for cervical and breast cancer
mortality in Mexico will likely narrow further in the future.
Over time, and especially with the recent introduction of
national coverage of HPV vaccination to prevent cervical
cancer, breast cancer will dominate both in incidence and
mortality.
38
Conclusions and policy recommendations
The global cross-sections, historical data and within-country
trends clearly illustrate the transition in women´s cancers.
Low- and middle-income countries, and especially poorer
women, face a double burden of cervical and breast cancer
and strategies are required to meet the challenge of both
diseases in the context of programmes that promote the
health of women.
Health systems must offer prevention, treatment and
palliation responses that are appropriate to each disease. In
the absence of efforts in vaccination, screening and
treatment of precancer lesions, cervical cancer mortality will
become a persistent burden restricted increasingly to the
poorest countries and the poorest women. It is a moral and
equity imperative to prevent cervical cancer through HPV
vaccination and screening for precancerous lesions, while
offering treatment to those women affected by cervical
cancer.
There is reason to hope that with increased community
health measures for detecting and managing precancerous
lesions of the cervix, and expanded coverage of the HPV
vaccine, that cervical cancer mortality will continue to decline
globally.39 The remaining challenge is one of equity, and the
imperative will be to ensure that cervical cancer does not
become another neglected "tropical" disease of the poor.
At the same time, breast cancer is likely to increase and
CANCER MANAGEMENT
CANCER CONTROL 2014 55
The challenge of the transition in
women's cancers is further
illustrated by analysing trends in
mortality rates separately for
cervical and breast cancers within
Mexico at the sub-regional level
Health systems must offer prevention,
treatment and palliation responses
that are appropriate to each disease.
In the absence of efforts in
vaccination, screening and treatment
of precancer lesions, cervical cancer
mortality will become a persistent
burden restricted increasingly to the
poorest countries and the poorest
women
mortality rates between cervical and breast cancer increase
steadily with marginalization. The states in the highest
marginalization category had the greatest difference in C-V
rates.
The challenge of the transition in women's cancers is
further illustrated by analysing trends in mortality rates
separately for cervical and breast cancers within Mexico at
the sub-regional level. There is a clear progression in the
cervical-breast cancer transition by category of state
marginalization. In poorer states, cervical cancer continues to
be the primary cause of cancer-related mortality for women,
although the gap has narrowed significantly. In wealthier
parts of the country, breast cancer is the dominant cause of
death from cancer in women. In some states, this has been the
case since the late 1980s (Figure 3). In states with the highest
levels of marginalization (represented by Oaxaca), cervical
cancer mortality rates continue to be almost double those of
breast cancer, although the gap has closed substantially from
the fourfold difference of the early 1990s. Indeed, in Oaxaca
in the early 1990s, the difference between the cervical and
breast cancer mortality rate reached up to fivefold with a
high of close to 20 deaths per 100,000 women from cervical
cancer compared to rates of breast cancer mortality of less
than 5.
The smallest C-V (cervical-breast or C-V) differences
occurred in the wealthiest states where the rates were close
to inverting. In these states, the twofold gap that was evident
in the early 1980s had closed by the early to mid-1990s. By
2008, the inverse was true: breast cancer mortality was
approximately double that of cervical cancer with rates of
over 13 per 100,000 for breast cancer compared to below 7
per 100,000 for cervical cancer. In the case of Nuevo León,
one of the wealthiest states of Mexico, the crossover in
mortality rates occurred prior to 1985.
In the two decades spanning 1990 to 2010, the relative
levels of mortality for women's cancers in Mexico were