Programa De Prevenção E Rastreio De Cancros

Objectives

The manual establishes an integrated national approach to cancer control in Cabo Verde, where cancer is identified as the second leading cause of death and incidence is increasing. Its purpose is to organise a differentiated response to principal cancer types within the principles of the National Health System, providing accessible guidance for health professionals in primary and hospital care, including those who are not oncology specialists.[1][2]

The strategic scope spans the cancer continuum: primary prevention, population screening, early recognition, diagnosis, referral, treatment, follow-up, rehabilitation, psycho-oncology and palliative care.[3][4]The approach is person-centred, considering patients alongside their families and communities and addressing physical, psychological, social and spiritual needs.[5][6]

• Reduce exposure to preventable cancer risks through healthier diets, physical activity, tobacco control, reduced harmful alcohol use, infection prevention, hepatitis B vaccination and public awareness of sun protection.[7][8][9][5]
• Deliver organised population-based cervical screening for eligible women, supported by universal free prophylactic human papillomavirus vaccination through the national vaccination plan, to reduce cervical-cancer incidence and mortality.[10][11]
• Achieve cervical-screening coverage above 70%, generally begin organised screening between ages 25 and 30, end it at 65, and use three- to five-year intervals appropriate to the screening method.[12]
• Promote breast-cancer awareness, clinical breast examination and, where logistical capacity permits, biennial mammography from age 50; use periodic mammography screening where feasible.[8][13]
• Target colorectal screening and surveillance according to risk, including screening average-risk people from age 50 and intensified follow-up for familial or hereditary risk groups.[14]
• Support timely diagnosis and treatment, with an intended maximum interval of four weeks between diagnosis and the first therapeutic approach, although exceptional intervals may reach 12 weeks.[15]
• Provide treatment selected according to histopathological diagnosis, tumour staging, grade, disease characteristics and individual circumstances, using surgery, radiotherapy, hormone therapy, immunotherapy, chemotherapy and palliative therapy alone or in combination.[15][16]
• Ensure access to comprehensive palliative care for people whose illness no longer responds to curative treatment, respecting autonomy and choice while relieving symptoms and supporting families during illness and bereavement.[6][17]

Implementation

Implementation centres on primary health care, which is responsible for prevention, screening-programme management and patient follow-up, working with hospital and specialist services. The manual was developed and validated through the Ministry of Health system, the National Directorate of Health, hospitals, a sanitary region, multidisciplinary health professionals and technical partners including the World Health Organization, Portugal’s Directorate-General of Health and the United Nations Population Fund.[5][18][2]

Primary-care teams deliver prevention, screening and continuing care close to communities, while specialist services provide complex staging, specialist treatment and detailed clinical protocols. Referral to another specialised facility, between islands or abroad, is envisaged when local technical capacity is exhausted, following consultation with the relevant specialist or receiving service.[7][5][19]

• Establish a focal point in every health centre to implement local programme guidance, coordinate multidisciplinary work, manage human resources and logistics, provide technical reference, support research and maintain local cancer registration.[20]
• Assign district health delegates overall responsibility for coordinating prevention and screening activities and collaborate with focal points to oversee programme performance, quality and efficiency.[20][19]
• Engage doctors to validate eligible populations, arrange screening, conduct consultations, record clinical information and communicate results.[20]
• Engage nurses to provide health education, prepare appointments, collect clinical and cytology information, manage materials, transfer samples and results, and actively follow up people who miss appointments.[20][19]
• Engage administrative staff to manage invitations, appointments, contact information, sample dispatch and necessary supplies, and involve social workers in socioeconomic assessment, information, follow-up, reintegration and rehabilitation support.[19]
• Use structured registration and referral records to capture institutional and patient details, diagnosis, screening status, tumour characteristics, staging, treatment, vital status, last contact and cause of death.[21][10][11]
• Apply multidisciplinary oncology committees before first treatment and when reassessment is required, involving relevant clinical, surgical, radiotherapy, pathology, radiology and gynaecology specialists; document and sign group decisions.[15]
• Deliver palliative care through multidisciplinary inpatient, ambulatory, hospital-support and community-support teams, with at least a doctor, nurse, psychologist, social worker and physiotherapist, and plan discharge and referral from admission.[6][17][22]
• Provide psycho-oncology support to patients, relatives, carers and professionals through early assessment, individual and group interventions, psycho-education, communication support and appropriately authorised family information-sharing.[23][24]
• Monitor clinical care through screening coverage and quality control, registration, documented referrals, scheduled follow-up, tumour staging and treatment-related assessment; the extracts do not specify a single comprehensive national indicator framework, reporting schedule, budget or financing plan.[12][20][15][4]

Monitoring & Evaluation

Monitoring arrangements combine cancer registration, screening-process tracking, clinical follow-up and documented multidisciplinary decisions. However, the supplied material does not set out a unified national monitoring and evaluation framework with standard indicators, reporting schedules, audit processes or independent accountability arrangements.[4][15][21]

• Strengthen cancer information systems, as the health-sector assessment identified no national cancer registry and found morbidity data unreliable and not centralised.[4]
• Maintain cancer registration within health centres and use structured registration forms to capture patient identification, diagnosis, diagnostic examinations, tumour site and morphology, laterality, staging, treatment, referral institutions, vital status, cause of death and status at last contact.[20][21][10]
• Assign health-centre focal points and district health delegates responsibility for monitoring programme performance, quality and efficiency, while coordinating local prevention and screening activity.[20][19]
• Track eligible populations, appointments, consultation and clinical records, screening results, further procedures, sample movement and missed attendances; actively follow up people who do not attend appointments.[20][19]
• Report all internally or externally evacuated cases to the PPRC at the end of each quarter.[25]
• Apply population-based cervical screening at intervals of three to five years, assess effectiveness partly through coverage above 70%, and use standardised quality control.[11][12]
• Use operational screening parameters, including cervical-screening eligibility for women aged 25 to 64, while adapting intervals to the sensitivity of the selected testing method.[8][12]
• Record and monitor clinical diagnostic findings, including cytology adequacy and abnormality classification, histopathological diagnosis, tumour stage, tumour-node-metastasis classification and tumour grade.[26][27][15][16]
• Document and sign multidisciplinary treatment decisions before the first therapeutic intervention and when reassessment is justified.[15]
• Monitor treatment and follow-up through condition-specific clinical schedules, including post-treatment surveillance for cervical intraepithelial neoplasia, breast, prostate, colorectal and Barrett’s oesophagus care.[28][29][30][31][32]
• Use selected clinical measures for follow-up, such as carcinoembryonic antigen in colorectal cancer, pain and Edmonton scales in palliative care, and blood-count testing between chemotherapy cycles.[32][6][33]
• Reassess palliative-care outcomes and revise care plans when the patient’s condition changes, with referral documentation supporting continuity between hospital and health-centre care.[34][35]

Costing & Financing

No consolidated budget, expenditure plan, funding source, quantified financing gap, resource-mobilisation strategy or economic assumptions are specified in the supplied material.[18][4][6][12]

• Recognise financing difficulties as a major constraint on cancer control, alongside shortages of diagnostic and treatment resources, qualified professionals, multidisciplinary teams and facilities for chemotherapy-waste treatment.[4]
• Plan for human resources, logistics, medical and administrative supplies, transport of laboratory samples and access to specialised referral services, although no associated costs or allocations are quantified.[20][19]
• Provide prophylactic human papillomavirus vaccination universally and free of charge through the national vaccination plan; the material does not state the funding source or programme cost.[11]
• Recognise that population-based cervical screening is described as more economical than opportunistic screening, without providing comparative cost values or methodological assumptions.[11]
• Note that combining liquid-based cytology with human papillomavirus testing has a high cost, while the source does not quantify this cost or establish a budgetary implication.[12]
• Require logistical capacity before introducing mammography, but do not quantify equipment, workforce, infrastructure or recurrent financing needs.[8]
• Recognise that vacuum-assisted biopsy using a mamotome costs more than core biopsy, without stating a monetary amount, currency or date.[36]
• Identify workforce requirements for palliative care, including at least a doctor, nurse, psychologist, social worker and physiotherapist per team, but provide no costed staffing model.[6][17]
• Require laminar-airflow chambers for chemotherapy preparation to reduce contamination and occupational risks, without specifying capital or operating costs.[37]