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The increasing burden of cancer represents a substantial problem for Latin America and the Caribbean. Two Lancet Oncology Commissions in 2013 and 2015 highlighted potential interventions that could advance cancer care in the region by overcoming existing challenges. Areas requiring improvement included insufficient investment in cancer control, non-universal health coverage, fragmented health systems, inequitable concentration of cancer services, inadequate registries, delays in diagnosis or treatment initiation, and insufficient palliative services. Progress has been made in key areas but remains uneven across the region. An unforeseen challenge, the COVID-19 pandemic, strained all resources, and its negative effect on cancer control is expected to continue for years. In this Series paper, we summarise progress in several aspects of cancer control since 2015, and identify persistent barriers requiring commitment of additional resources to reduce the cancer burden in Latin America and the Caribbean.

Este artigo busca refletir, cultural e eticamente, sobre os desafios atuais e futuros da incorporação de novas biotecnologias de diagnóstico e tratamento de câncer no Brasil, bem como seu impacto no acesso e no controle do câncer no país. Para tanto, esta pesquisa parte da problematização da literatura sobre o tema e dos resultados de um estudo, que realizou uma websurvey com especialistas médicos dos setores público e privado brasileiros, associados às dez sociedades oncológicas mais representativas do país, atuantes nas áreas da clínica, cirurgia, radioterapia, patologia e diagnóstico. A discussão do estudo desenvolve-se em torno de três eixos temáticos: conhecimento e expectativas sobre o advento das novas tecnologias para o diagnóstico e tratamento do câncer; considerações estruturais e éticas envolvidas no uso atual e futuro das novas tecnologias; e possíveis cenários associados ao uso e aplicação das novas tecnologias para o diagnóstico e tratamento do câncer. Foram suscitadas algumas questões: novos paradigmas tecnológicos beneficiarão todos os usuários do Sistema Único de Saúde (SUS) ou serão privilégios de poucos? Diminuirão as discrepâncias em termos de oferta de distribuição de serviços, de recursos tecnológicos e de acesso ao diagnóstico e tratamento do câncer? Como diversos segmentos da sociedade poderão participar e influir nesse processo? Que tipos de cenários poderão ainda compor esse quadro? Visando contribuir com o planejamento da atenção ao câncer no Brasil, o artigo finaliza propondo o desenvolvimento de futuras ações a partir de cinco dimensões estratégicas: dimensão econômica; dimensão científica, de inovação e tecnológica; dimensão estrutural; dimensão cultural; e dimensão reguladora. This study seeks to culturally and ethically reflect on the current and future challenges of incorporating new biotechnologies to diagnose and treat cancer in Brazil and assess their impact on cancer control. To this end, this study begins by problematizing the literature on the subject and the results of a study that conducted a web survey with medical specialists from the Brazilian public and private sectors; the latter associated with the ten most representative cancer societies in the country, working in clinical practice, surgery, radiotherapy, pathology, and diagnosis. We discussed this study around three thematic axes: knowledge and expectations on the advent of new technologies to diagnose and treat cancer; structural and ethical considerations in the current and future use of new technologies; and possible scenarios associated with the use and application of new technologies to diagnose and treat cancer. We have raised some questions: will new technological paradigms benefit all Brazilian Unified National Health System (SUS) users, or will they be the privileges of the few? Will they reduce discrepancies regarding the distribution of technological services and resources and cancer diagnosis and treatment? How can different segments of society participate and influence this process? What scenarios can still compose this picture? Aiming to contribute to planning the future of cancer care in Brazil, this study proposes the development of future actions from five strategic dimensions: economy; science, innovation and technology; structure; culture; and regulation. Este artículo busca reflexionar, cultural y éticamente, sobre los desafíos actuales y futuros de la incorporación de nuevas biotecnologías para el diagnóstico y tratamiento del cáncer en Brasil, así como su impacto en el acceso y control del cáncer en el país. Para ello, parte de la problematización de la literatura sobre el tema y de los resultados de un estudio que realizó una encuesta web con médicos especialistas de los sectores público y privado brasileños asociados a las diez sociedades oncológicas más representativas del país y actuantes en las áreas de clínica, cirugía, radioterapia, patología y diagnóstico. La discusión del estudio se desarrolla en torno a tres ejes temáticos: conocimiento y expectativas sobre el advenimiento de las nuevas tecnologías para el diagnóstico y tratamiento del cáncer; consideraciones estructurales y éticas involucradas en el uso actual y futuro de las nuevas tecnologías; posibles escenarios asociados al uso y aplicación de nuevas tecnologías para el diagnóstico y tratamiento del cáncer. Se han suscitado algunas cuestiones: ¿Los nuevos paradigmas tecnológicos beneficiarán a todos los usuarios del Sistema Único de Salud (SUS) o serán privilegios de unos pocos? ¿Reducirán las discrepancias en la oferta de distribución de servicios y recursos tecnológicos y en el acceso al diagnóstico y tratamiento del cáncer? ¿Cómo los diferentes segmentos de la sociedad podrán participar e influir en este proceso? ¿Qué clase de escenarios todavía podrán componer esta imagen? Con el objetivo de contribuir a la planificación futura de la atención del cáncer en Brasil, el artículo concluye con una propuesta para el desarrollo de acciones futuras desde cinco dimensiones estratégicas: económica; científica, de innovación y tecnología; estructural; cultural; y reguladora.

This study seeks to culturally and ethically reflect on the current and future challenges of incorporating new biotechnologies to diagnose and treat cancer in Brazil and assess their impact on cancer control. To this end, this study begins by problematizing the literature on the subject and the results of a study that conducted a web survey with medical specialists from the Brazilian public and private sectors; the latter associated with the ten most representative cancer societies in the country, working in clinical practice, surgery, radiotherapy, pathology, and diagnosis. We discussed this study around three thematic axes: knowledge and expectations on the advent of new technologies to diagnose and treat cancer; structural and ethical considerations in the current and future use of new technologies; and possible scenarios associated with the use and application of new technologies to diagnose and treat cancer. We have raised some questions: will new technological paradigms benefit all Brazilian Unified National Health System (SUS) users, or will they be the privileges of the few? Will they reduce discrepancies regarding the distribution of technological services and resources and cancer diagnosis and treatment? How can different segments of society participate and influence this process? What scenarios can still compose this picture? Aiming to contribute to planning the future of cancer care in Brazil, this study proposes the development of future actions from five strategic dimensions: economy; science, innovation and technology; structure; culture; and regulation.Este artigo busca refletir, cultural e eticamente, sobre os desafios atuais e futuros da incorporação de novas biotecnologias de diagnóstico e tratamento de câncer no Brasil, bem como seu impacto no acesso e no controle do câncer no país. Para tanto, esta pesquisa parte da problematização da literatura sobre o tema e dos resultados de um estudo, que realizou uma websurvey com especialistas médicos dos setores público e privado brasileiros, associados às dez sociedades oncológicas mais representativas do país, atuantes nas áreas da clínica, cirurgia, radioterapia, patologia e diagnóstico. A discussão do estudo desenvolve-se em torno de três eixos temáticos: conhecimento e expectativas sobre o advento das novas tecnologias para o diagnóstico e tratamento do câncer; considerações estruturais e éticas envolvidas no uso atual e futuro das novas tecnologias; e possíveis cenários associados ao uso e aplicação das novas tecnologias para o diagnóstico e tratamento do câncer. Foram suscitadas algumas questões: novos paradigmas tecnológicos beneficiarão todos os usuários do Sistema Único de Saúde (SUS) ou serão privilégios de poucos? Diminuirão as discrepâncias em termos de oferta de distribuição de serviços, de recursos tecnológicos e de acesso ao diagnóstico e tratamento do câncer? Como diversos segmentos da sociedade poderão participar e influir nesse processo? Que tipos de cenários poderão ainda compor esse quadro? Visando contribuir com o planejamento da atenção ao câncer no Brasil, o artigo finaliza propondo o desenvolvimento de futuras ações a partir de cinco dimensões estratégicas: dimensão econômica; dimensão científica, de inovação e tecnológica; dimensão estrutural; dimensão cultural; e dimensão reguladora.Este artículo busca reflexionar, cultural y éticamente, sobre los desafíos actuales y futuros de la incorporación de nuevas biotecnologías para el diagnóstico y tratamiento del cáncer en Brasil, así como su impacto en el acceso y control del cáncer en el país. Para ello, parte de la problematización de la literatura sobre el tema y de los resultados de un estudio que realizó una encuesta web con médicos especialistas de los sectores público y privado brasileños asociados a las diez sociedades oncológicas más representativas del país y actuantes en las áreas de clínica, cirugía, radioterapia, patología y diagnóstico. La discusión del estudio se desarrolla en torno a tres ejes temáticos: conocimiento y expectativas sobre el advenimiento de las nuevas tecnologías para el diagnóstico y tratamiento del cáncer; consideraciones estructurales y éticas involucradas en el uso actual y futuro de las nuevas tecnologías; posibles escenarios asociados al uso y aplicación de nuevas tecnologías para el diagnóstico y tratamiento del cáncer. Se han suscitado algunas cuestiones: ¿Los nuevos paradigmas tecnológicos beneficiarán a todos los usuarios del Sistema Único de Salud (SUS) o serán privilegios de unos pocos? ¿Reducirán las discrepancias en la oferta de distribución de servicios y recursos tecnológicos y en el acceso al diagnóstico y tratamiento del cáncer? ¿Cómo los diferentes segmentos de la sociedad podrán participar e influir en este proceso? ¿Qué clase de escenarios todavía podrán componer esta imagen? Con el objetivo de contribuir a la planificación futura de la atención del cáncer en Brasil, el artículo concluye con una propuesta para el desarrollo de acciones futuras desde cinco dimensiones estratégicas: económica; científica, de innovación y tecnología; estructural; cultural; y reguladora.

Since December 2019, the world has been mired in an infectious pandemic that has displaced other health priorities for 21st century populations. Concerned about this situation, Latin American experts on cancer decided to evaluate the impact of the pandemic on cancer control in the region. The analysis was based on information obtained from public sources and scientific publications and included the characteristics of the health care and cancer control prior to the pandemic, the COVID-19 pandemic and measures implemented by the governments of the region, and the regional impact of the pandemic on cancer control together with the costs of cancer care and possible impact of the pandemic on cancer expense. We compared 2019 and 2020 data corresponding to the period March 16-June 30 and found a significant reduction in the number of first-time visits to oncology services (variable depending on the country between –28% and –38%) and a corresponding reduction in pathology (between –6% and –50%), cancer surgery (between –28% and –70%), and chemotherapy (between –2% and –54%). Furthermore, a significant reduction in cancer screening tests was found (PAP smear test studies: between –46% and –100%, mammography: between –32% and –100%, and fecal occult blood test: –73%). If this situation becomes a trend, the health and economic impact will be compounded in the postpandemic period, with an overload of demand on health services to ensure diagnostic tests and consequent treatments. On the basis of this information, a set of prevention and mitigation measures to be immediately implemented and also actions to progressively strengthen health systems are proposed.

According to the Pan American Health Organization, noncommunicable diseases, including cancer, are the leading causes of preventable and premature death in the Americas. Governments and health care systems in Latin America face numerous challenges as a result of increasing morbidity and mortality from cancer. Multiple international organizations have recognized the need for collaborative action on and technical support for cancer research and control in Latin America. The Center for Global Health at the US National Cancer Institute (NCI-CGH) is one entity among many that are working in the region and has sought to develop a strategy for working in Latin America that draws on and expands the collaborative potential of engaged, skilled, and diverse partners. NCI-CGH has worked toward developing and implementing initiatives in collaboration with global partners that share the common objectives of building a global cancer research community and translating research results into evidence-informed policy and practice. Both objectives are complementary and synergistic and are additionally supported by an overarching strategic framework that is focused on partnerships and science diplomacy. This work highlights the overall strategy for NCI-CGH engagement in Latin America through partnerships and diplomacy, and highlights selected collaborative efforts that are aimed at improving cancer outcomes in the region.

Surgery is essential for global cancer care in all resource settings. Of the 15.2 million new cases of cancer in 2015, over 80% of cases will need surgery, some several times. By 2030, we estimate that annually 45 million surgical procedures will be needed worldwide. Yet, less than 25% of patients with cancer worldwide actually get safe, affordable, or timely surgery. This Commission on global cancer surgery, building on Global Surgery 2030, has examined the state of global cancer surgery through an analysis of the burden of surgical disease and breadth of cancer surgery, economics and financing, factors for strengthening surgical systems for cancer with multiple-country studies, the research agenda, and the political factors that frame policy making in this area. We found wide equity and economic gaps in global cancer surgery. Many patients throughout the world do not have access to cancer surgery, and the failure to train more cancer surgeons and strengthen systems could result in as much as US $6.2 trillion in lost cumulative gross domestic product by 2030. Many of the key adjunct treatment modalities for cancer surgery--e.g., pathology and imaging--are also inadequate. Our analysis identified substantial issues, but also highlights solutions and innovations. Issues of access, a paucity of investment in public surgical systems, low investment in research, and training and education gaps are remarkably widespread. Solutions include better regulated public systems, international partnerships, super-centralisation of surgical services, novel surgical clinical trials, and new approaches to improve quality and scale up cancer surgical systems through education and training. Our key messages are directed at many global stakeholders, but the central message is that to deliver safe, affordable, and timely cancer surgery to all, surgery must be at the heart of global and national cancer control planning.

OBJETIVO: Avaliar a eficácia do colírio bimatoprosta 0,03% (Glamigan, Germed, Brasil) na redução da pressão intraocular (PIO) em pacientes com glaucoma primário de ângulo aberto (GPAA) ou hipertensão ocular (HO), bem como avaliar os efeitos colaterais decorrentes do uso da droga no desenho epidemiológico randomizado, controlado. MÉTODOS: Foram avaliados pacientes portadores de GPAA ou HO, acima de 18 anos de idade. Todos os pacientes receberam o colírio Glamigan® como primeira droga a ser introduzida no tratamento, tendo sido utilizada uma gota uma vez ao dia (à noite), e 30 dias após foram submetidos à tonometria de aplanação (Goldmann) para mensuração da PIO. RESULTADOS: A amostra do estudo foi composta por 35 (66 olhos) pacientes portadores de GPAA e HO, sendo 16 do sexo masculino (45,7%) e 19, do feminino (54,3%). A média de idade foi de 66,7 anos, sendo a idade máxima 84 anos. A média de redução da PIO após 30 dias de uso do Glamigan® foi de 6,5mmHg. Em relação aos efeitos colaterais, 17 (26,6%) pacientes referiram hiperemia conjuntival, 10 (15,6%) a dor, 8 (12,5%) o ardor, 5 (7,8%) o prurido ocular e 2 (3,1%) o embaçamento visual. CONCLUSÃO: A medicação Glamigan® foi eficiente na redução da PIO após 30 dias de uso contínuo, na dose de 1x/dia. Acerca dos efeitos colaterais, os mais observados foram hiperemia ocular (26,6%) e dor (15,6%), porém estudos com maior tempo de seguimento dos pacientes se fazem necessários a fim de investigar a importância daqueles na terapia com o Glamigan®. OBJECTIVE: To evaluate how much decreases intraocular pressure (IOP) with bimatoprost 0,03% (Glamigan, Germed, Brazil) in patiens with primary open angle glaucoma (POAG) and ocular hypertension (OH) and possible side effects. Study: Controlled and randomized study. METHODS: There were evaluated 66 eyes of 35 patients with age of 18 years old or more diagnosed with POAG and OH. All the patients had Glamigan® as first drop for treatment used once daily (at night) and 30 days later they had IOP measured by Goldmann tonometry. RESULTS: The study population had 35 (66 eyes) patients with primary open angle glaucoma (POAG) and ocular hypertension (OH), 16 male patients (45,7%) and 19 female (54,3%). The mean age was 66,7 years old and the maximum was 84 years old. The mean decrease in IOP was 6,5 mmhg after 30 days using the drops. Seventeen patients had conjunctival redness (26,6%), 10 (15,6%) had pain, 8 (12,5%) had burning, 5 (7,8%) had itch and 2 (3,1%) had blurring vision. CONCLUSION: Glamigan® was efficient when evaluating IOP decrease. The most correlated side effects were conjunctival redness (26,6%) and pain (15,6%). We still need more studies to observe the real importance of those with Glamigan® therapy.

Cancer research in Africa will have a pivotal role in cancer control planning in this continent. However, environments (such as those in academic or clinical settings) with limited research infrastructure (laboratories, biorespositories, databases) coupled with inadequate funding and other resources have hampered African scientists from carrying out rigorous research. In September 2012, over 100 scientists with expertise in cancer research in Africa met in London to discuss the challenges in performing high-quality research, and to formulate the next steps for building sustainable, comprehensive and multi-disciplinary programmes relevant to Africa. This was the first meeting among five major organizations: the African Organisation for Research and Training in Africa (AORTIC), the Africa Oxford Cancer Foundation (AfrOx), and the National Cancer Institutes (NCI) of Brazil, France and the USA. This article summarizes the discussions and recommendations of this meeting, including the next steps required to create sustainable and impactful research programmes that will enable evidenced-based cancer control approaches and planning at the local, regional and national levels.

Esta edição temática da Revista Brasileira de Cancerologia, dedicada a promover e disseminar a produção do conhecimento sobre o câncer de mama, representa mais uma contribuição dos diversos autores e do INCA para o controle do câncer de mama no país.

This thematic edition of the Brazilian Journal of Cancerology, dedicated to promoting and disseminating the production of knowledge on cervical cancer, represents one more contribution of the several authors and INCA for the success of this Plan. Esta edición temática de la Revista Brasileña de Cancerología, dedicada a promocionar y diseminar la producción del conocimiento acerca del cáncer del cuello del útero, representa más una contribución de los diversos autores y del INCA para el éxito del Plan. Esta edição temática da Revista Brasileira de Cancerologia, dedicada a promover e disseminar a produção do conhecimento sobre o câncer do colo do útero, representa mais uma contribuição dos diversos autores e do INCA para o sucesso desse Plano.

Ao longo dos últimos 25 anos, o controle do tabagismo no Brasil tem sido calcado centralmente em medidas educativas e legislativas. E o marco inaugural desse movimento foi a instituição do Dia Nacional de Combate ao Fumo, a primeira contribuição do Congresso Nacional para o controle do tabagismo no Brasil, por meio da Lei Federal nº 7.488, de junho de 1986. Em 2011, ano do 25º aniversário da Lei, nada mais apropriado do que apresentar o tema com uma edição especial da Revista Brasileira de Cancerologia (RBC), exclusivamente voltada ao tabagismo. Aqui, o leitor encontrará 11 artigos originais, sendo dois deles de conteúdo histórico; um de opinião; três de revisão e uma resenha. Revista essa que também será produzida em inglês e distribuída na 15th World Conference on Tobacco or Health, de 20 a 24 de março de 2012, em Cingapura.

In middle resource countries (MRCs), cancer control programs are becoming a priority as the pattern of disease shifts from infectious diseases to non-communicable diseases such as breast cancer, the most common cancer among women in MRCs. The Middle Resource Scenarios Working Group of the BHGI 2010 Global Summit met to identify common issues and obstacles to breast cancer detection, diagnosis and treatment in MRCs. They concluded that breast cancer early detection programs continue to be important, should include clinical breast examination (CBE) with or without mammography, and should be coupled with active awareness programs. Mammographic screening is usually opportunistic and early detection programs are often hampered by logistical and financial problems, as well as socio-cultural barriers, despite improved public educational efforts. Although multidisciplinary services for treatment are available, geographical and economic limitations to these services can lead to an inequity in health care access. Without adequate health insurance coverage, limited personal finances can be a significant barrier to care for many patients. Despite the improved availability of services (surgery, pathology, radiology and radiotherapy), quality assurance programs remain a challenge. Better access to anticancer drugs is needed to improve outcomes, as are rehabilitation programs for survivors. Focused and sustained government health care financing in MRCs is needed to improve early detection and treatment of breast cancer.

As national health systems seek to apply breast cancer screening recommendations to an entire population of women (within target age ranges for which there is evidence that screening reduces mortality), the volume of screening tests and resulting diagnostic investigations arising from abnormal test results-and the cost associated with them-will grow dramatically. Population-based early detection (screening) programs will need information systems and management tools to help these programs. This report describes Brazil's highly decentralized health care system and then describes in greater detail how the development and implementation of an information system for Brazil's nationwide breast cancer early detection program was carried out with input from various stakeholders. Challenges encountered in the implementation are shared. Preliminary findings from the first 1.5 million mammograms are presented to demonstrate the kind of provocative management information such a system can yield in a relatively short period of time. The potential of such information systems for improving efficiency, efficacy and cost-effectiveness of early detection programs is emphasized.

Resumo: O autor discute a Avaliação Tecnológica em Saúde (ATS) buscando contextualizá-la no processo de decisão médica e em suas interfaces com a formação médica e a prática profissional. Discute a instúiciência do paradigma biomédico quer seja como poder explicativo para o processo saúde-doença, quer seja para responder com eqüidade e integralidade às necessidades humanas e sociais de saúde. Reconhece finalidade e intencionalidade na escolha e no uso de tecnologias em saúde. Conclui pela necessidade de que a ATS se constitua em um Programa integranteda política científica do setor saúde, nos marcos dos direitos e necessidades individuais e sociais e dos princípios éticos da sociedade. Summary: The autl1or discusses Health Technology Assessment in the context of the decision-making process and its interfaces with medical training and professional practice. He maintains that the biomedical paradigm is incapable of either explaining the health/disease process or responding fully and equitably to human and social health needs. He acknowledges both the intent and intentionality in the choice and use of health technologies. The article concludes that there is a need for Health Technology Assessment to become an integral program in scientific policy for the health sector, within a framework of individual and social rights and needs as well as ethical principles pertaining to society.

Over the past few decades, there has been growing support for the idea that cancer needs an interdiscipli- nary approach. Therefore, the international cancer community has developed several strategies as outlined in the WHO non-communicable diseases Action Plan (which includes cancer control) as the World Health As- sembly and the UICC World Cancer Declaration, which both include primary prevention, early diagnosis, treat- ment, and palliative care. This paper highlights experi- ences/ideas in cancer control for international collabo- rations between low, middle, and high income coun- tries, including collaborations between the European Union (EU) and African Union (AU) Member States, the Latin-American and Caribbean countries, and the East- ern Mediterranean countries. These proposals are pre- sented within the context of the global vision on cancer control set forth by WHO in partnership with the Inter- national Union Against Cancer (UICC), in addition to is- sues that should be considered for collaborations at theglobal level: cancer survival (similar to the project CON- CORD), cancer control for youth and adaptation of Clinical Practice Guidelines. Since cancer control is giv- en lower priority on the health agenda of low and mid- dle income countries and is less represented in global health efforts in those countries, EU and AU cancer stakeholders are working to put cancer control on the agenda of the EU-AU treaty for collaborations, and are proposing to consider palliative care, population-based cancer registration, and training and education focus- ing on primary prevention as core tools. A Community of Practice, such as the Third International Cancer Con- trol Congress (ICCC-3), is an ideal place to share new proposals, learn from other experiences, and formulate new ideas. The aim of the ICCC-3 is to foster new inter- national collaborations to promote cancer control ac- tions in low and middle income countries. The develop- ment of supranational collaborations has been hin- dered by the fact that cancer control is not part of the objectives of the Millennium Development Goals (MG- Gs). As a consequence, less resources of development aids are allocated to control NCDs including cancer.