Among women in Latin American and Caribbean countries, where cervical carcinoma is the most common type of cancer, efforts to detect and treat the disease have been largely unsuccessful due to the practice of screening young women at low risk who attend family planning clinics and prenatal care visits. All women, regardless of age or socioeconomic status, must have access to screening and treatment. Those with abnormal Pap test readings should undergo additional diagnostic procedures to rule out or confirm the presence of a malignant tumor or high-grade lesion. Given the serious consequences of both false-positive and false-negative results, screening tests should be subject to strict quality control procedures. It is essential that women's and nongovernmental organizations, health service administrators, and professional associations participate in determining the most appropriate preventive strategies for each country as well as for the various socioeconomic strata and cultural contexts.

This article presents an assessment of cervical cancer mortality trends in the Americas based on PAHO data. Trends were estimated for countries where data were available for at least 10 consecutive years, the number of cervical cancer deaths was considerable, and at least 75% of the deaths from all causes were registered. In contrast to Canada and the United States, whose general populations had been screened for many years and where cervical cancer mortality has declined steadily (to about 1.4 and 1.7 deaths per 100,000 women, respectively, as of 1990), most Latin American and Caribbean countries with available data have experienced fairly constant levels of cervical cancer mortality (typically in the range of 5-6 deaths per 100,000 women). In addition, several other countries (Chile, Costa Rica, and Mexico) have exhibited higher cervical cancer mortality as well as a number of noteworthy changes in this mortality over time. Overall, while actual declining trends could be masked by special circumstances in some countries, cervical cancer mortality has not declined in Latin America as it has in developed countries. Correlations between declining mortality and the intensity of screening in developed countries suggest that a lack of screening or screening program shortcomings in Latin America could account for this. Among other things, where large-scale cervical cancer screening efforts have been instituted in Latin America and Caribbean, these efforts have generally been linked to family planning and prenatal care programs serving women who are typically under 30; while the real need is for screening of older women who are at substantially higher risk.