<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1688-0390</journal-id>
<journal-title><![CDATA[Revista Médica del Uruguay]]></journal-title>
<abbrev-journal-title><![CDATA[Rev. Méd. Urug.]]></abbrev-journal-title>
<issn>1688-0390</issn>
<publisher>
<publisher-name><![CDATA[Sindicato Médico del Uruguay]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1688-03902017000100142</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Cáncer de cuello uterino en Uruguay. Controversias en la prevención]]></article-title>
<article-title xml:lang="en"><![CDATA[Cervical cancer in Uruguay. Controversies in prevention]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Nozar]]></surname>
<given-names><![CDATA[María Fernanda]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Briozzo]]></surname>
<given-names><![CDATA[Leonel]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad de la República Facultad de Medicina Clínica Ginecotocológica A]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Uruguay</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Universidad de la República Facultad de Medicina Clínica Ginecotocológica A]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Uruguay</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>03</month>
<year>2017</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>03</month>
<year>2017</year>
</pub-date>
<volume>33</volume>
<numero>1</numero>
<fpage>142</fpage>
<lpage>165</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_arttext&amp;pid=S1688-03902017000100142&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_abstract&amp;pid=S1688-03902017000100142&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_pdf&amp;pid=S1688-03902017000100142&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen: En esta revisión se analizan de manera crítica las diferentes estrategias de prevención del cáncer de cuello uterino (CCU) con hincapié en la vacunación, las modalidades de implementación, así como en las estrategias sanitarias y regulaciones nacionales. El objetivo no es tomar postura a favor o en contra de la obligatoriedad de medidas sanitarias, sino realizar una discusión crítica de la estrategia. Se discute que la argumentación de una política de obligatoriedad u otra de recomendación está definida por dos ejes fundamentales: primero, la definición de si se está ante un riesgo sanitario poblacional, y, segundo, si es necesario promover decisiones informadas para lograr mayor impacto. En este sentido, lo fundamental es definir si se considera abordar la infección por el virus del papiloma humano (VPH) dentro de una estrategia integral de prevención como enfermedad de transmisión sexual. De esa forma se debería discutir firmemente la obligatoriedad para todos los involucrados en la cadena de transmisión. La vacunación contra el VPH se recomienda dentro de programas integrales de educación, prevención secundaria, terciaria y aun cuaternaria. Se deben ofrecer iguales condiciones de protección poblacional contra el CCU, y en este sentido es sustancial que el Estado se responsabilice de estas acciones y del acceso a todas ellas, es decir que la equidad se debería alcanzar en el acceso a la vacuna, pero también en las otras medidas de prevención recomendadas. Lo discutible es que, como respuesta a nuestra imposibilidad de evitar muertes evitables con medidas que ya conocemos, se tenga la necesidad de recurrir a acciones compulsivas, con lo que se intenta subsanar lo que no se ha podido alcanzar sobre el resto de las medidas preventivas que sí han demostrado disminuir la incidencia y mortalidad por CCU.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract: This review provides a critical analysis of the different cervical cancer prevention strategies, with an emphasis on immunization, implementation modalities, health strategies and national regulations. Rather than favoring or opposing the obligation to observe health policies, the study aims to offer a critical discussion on the strategy. It is often said that arguments in favor of the obligatory nature of a policy or recommendation are defined by two main axes: the first one refers to defining whether the population is facing a health risk in the population and the second one, whether informed decisions need to be promoted to achieve a larger impact. Thus, defining if addressing HPV infection within a comprehensive prevention strategy, as a sexually transmitted disease, is of paramount importance. To that end, the obligatory nature for all individuals involved in the epidemiological chain should be extensively discussed. HPV vaccination is recommended in the framework of comprehensive educational programs, as in secondary, tertiary and quaternary prevention. Equality in terms of population protection against cervical cancer needs to be achieved, and in this respect the government needs to take responsibility for these actions and universal access to all strategies. In other words, equal access to vaccination is essential, as well as to other recommended prevention measures. However, the need to refer to compulsory measures to stop avoidable deaths with measures we already know may be arguable, as this is a way to make up for failure to achieve other preventive measures, which have been demonstrated to reduce cervical cancer incidence and mortality.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo: Nesta revisão faz-se uma análise crítica das diferentes estratégias de prevenção do Câncer de Colo do Útero (CCU), enfatizando a vacinação, as formas de implementação, bem como as estratégias sanitárias e regulações nacionais. O objetivo não é tomar uma posição a favor ou contra a obrigatoriedade de medidas sanitárias, mas discutir criticamente a estratégia. Discute-se a argumentação de uma política de obrigatoriedade ou de recomendação, que está definida por dois eixos fundamentais: primeiro definir se existe um risco sanitário populacional e, segundo, se é necessário promover decisões informadas para conseguir um impacto maior. Para isso é fundamental definir se se considera abordar a infecção por VPH dentro de uma estratégia integral de prevenção como doença de transmissão sexual. Dessa forma deveria discutir-se firmemente a obrigatoriedade para todos os integrantes da cadeia de transmissão. A vacinação contra o VPH está recomendada como parte de programas integrais de educação, prevenção secundária, terciária e até quaternária. Deve-se oferecer condições iguais de proteção populacional contra o CCU, e nesse caso é substancial que o Estado se responsabilize por estas ações e pelo acesso a todas elas, isto é que estabelecer equidade no acesso à vacina, mas também a outras medidas de prevenção recomendadas. É discutível que, como resposta a nossa impossibilidade de prevenir mortes evitáveis com medidas conhecidas, seja necessário recorrer a ações compulsivas, tentando corrigir o que não foi possível alcançar com o resto das medidas preventivas que demonstraram diminuir a incidência e a mortalidade por CCU.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Neoplasias del cuello uterino]]></kwd>
<kwd lng="es"><![CDATA[Vacunas contra papiloma virus]]></kwd>
<kwd lng="es"><![CDATA[Promoción de la salud]]></kwd>
<kwd lng="es"><![CDATA[Uruguay.]]></kwd>
<kwd lng="en"><![CDATA[Uterine cervical neoplasms]]></kwd>
<kwd lng="en"><![CDATA[Papillomavirus vaccines]]></kwd>
<kwd lng="en"><![CDATA[Health promotion]]></kwd>
<kwd lng="en"><![CDATA[Uruguay.]]></kwd>
<kwd lng="pt"><![CDATA[Neoplasias do colo do útero]]></kwd>
<kwd lng="pt"><![CDATA[Vacinas contra papillomavirus]]></kwd>
<kwd lng="pt"><![CDATA[Promoção da saúde]]></kwd>
<kwd lng="pt"><![CDATA[Uruguai.]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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