EIn Portugal, the vaccine against human papillomavirus (HPV) was introduced in 2008, then only targeted at girls aged 10 years. In 2020 it was extended to boys, also at the age of 10, in a prevention and screening strategy, and the results are, after 16 years, very encouraging. However, the fight against this very common, sexually transmitted infection, which continues to leave its mark and cause many cases of cancer, is not won. It is necessary to continue to refine combat strategies.
The ambition to eliminate HPV extends across Europe, as demonstrated at the conference that brought together several experts in Lisbon at an event organized by MSD, which included Expresso as a media partner. In this fight, countries such as Italy, Ireland, Sweden, Malta and the United Kingdom have already presented plans to eliminate cancers caused by the human papilloma virus to be achieved by May 2025.
HPV continues, however, to be a European public health concern, as it is associated with several types of cancer, especially cervical cancer. The situation varies from country to country, but there is consensus on the idea of creating effective prevention and control programs. Vaccination coverage, tracking and early diagnosis, education and awareness (with training campaigns or training of health professionals) and research are considered fundamental.
In the Portuguese case, it is believed that compliance with the recommendations of the European Cancer Organization (ECO) and the European Commission, which argue that vaccination should reach other populations, including men between 15 and 26 years old, groups at increased risk (such as homosexual men), people with human immunodeficiency virus (HIV), women with a previous injury or immunocompromised people.
Ana Povo, Secretary of State for Health, recognizes that the disease “has an impact not only on people’s lives, but also on the sustainability of the entire system, not only health but also ©Social Security, with absenteeism from work, the need for care and early retirement”, and that “prevention is fundamental”, but emphasizes that Portugal “is on the right path” € and that it is “a global example†. Why? “We have an accessible screening program, free for all women, and in addition we have a vaccination plan that includes the HPV vaccine. All Portuguese people should be proud,” he highlighted.
Fulfilling the ambitions of the National Strategy to Fight Cancer, Horizon 2030, is another recommendation. For example, achieving a geographic coverage rate (per Functional Primary Health Care Unit) of 100% for the cervical cancer screening program by 2030 or a proportion of population coverage greater than 95%. Other equally essential advice: adherence of more than 65% to the cervical cancer screening program by 2030, among eligible users; reduction in access times to therapeutic innovation (which are currently estimated at 713 days, a number much higher than the 210 defined by law); increased investment in literacy and access to information.
“DGS is preparing a proposalâ€
Rita Sá Machado, general director of Health, despite being satisfied, also recognizes that there is still a way to go in Portugal towards eradication: “The DGS is preparing a proposal in order to define how and when we can estimate that we will be able to achieve this objective. Portugal is well placed in several areas – vaccination against HPV, for example – and in others we still have challenging room for improvement, particularly in the area of screening population-based assessment of cervical cancer and the timely diagnosis and treatment of injuries. In the very short term, DGS will make this presentation, ensuring that our proposal is feasible, credible and that it will allow Portugal to be an example country in this matter,” she added.
Luís Mendão, from GAT, Group of Activists in Treatments, a non-governmental organization, with areas of advocacy, health policies and external relations, highlighted needs, defending the free vaccine for people up to at age 26, with HIV or immunosuppression until age 45. “Portugal, for now, does not offer the vaccine to people with HIV, nor to sex workers, nor to young men who have sex with men . Injury screenings are insufficient and migrant women, in irregular or poorer and marginalized situations, do not have access (or very poor access) to cervical cancer screenings†, reported. “GAT has worked politically to increase access to the vaccine for groups that can benefit from it. It has sought to increase literacy about HPV in the most vulnerable groups (women at the head). We vaccinate those who can afford the vaccine, which is inaccessible to the overwhelming majority of people. GAT also offers
cases of cancer registered per year in Portugal and whose responsibility is the HPV. There are also close to 800 deaths per year
is the percentage of sexually active people who have had contact with the human papillomavirus at some point in their lives without knowing it
of cervical cancers are caused by HPV, which is also responsible for 90% of cancers of the anus, 75% of those of the vagina, 63% of those of the penis, 69% of those of the vulva and 70% of those in the oropharynx
Pedro Vieira Baptista, from Centro Universitário Hospitalar de São João, spoke about the innovative protocol implemented at HSJ, in which vaccination is seen as a complement to treatment in women even after being diagnosed a high-grade lesion caused by the Human Papilloma Virus
José Dinis, director of the National Oncological Diseases Program of the Directorate-General for Health, placed Portugal “at the top of public health in the world†when he made his presentation on “Screening of cervical cancerâ€
Carmen Lisboa, from the Centro Universitário Hospitalar de São João, recalled that HPV does not only affect women and that it also has a significant impact on men. This is a topic that is normally less discussed and requires greater attention and investigation.
