Programa De Prevenção E Rastreio De Cancros

Objectives

Cabo Verde’s cancer-control manual establishes an integrated national framework for prevention, screening, diagnosis, treatment, follow-up, rehabilitation and palliative care, aligned with National Health System principles. It responds to cancer being the country’s second leading cause of death and to increasing incidence, while providing practical guidance for non-specialist health professionals.[1][2][3]

• Strengthen primary prevention through healthy diets, weight control, physical activity, reduced tobacco and harmful alcohol use, infection prevention, vaccination and protection from excessive sun exposure.[4][5][6]
• Implement organised population-based cervical cancer screening and prevention, including free universal human papillomavirus vaccination through the National Vaccination Plan, screening coverage above 70%, screening from approximately ages 25 to 30 until age 65, and repeat screening every three to five years.[7][8]
• Prioritise cytology for organised cervical screening, while allowing liquid-based cytology, visual inspection with acetic acid and high-risk human papillomavirus testing according to the chosen strategy and test performance.[8]
• Develop breast-cancer awareness, monthly self-examination and annual clinical breast examination, with biennial mammography from age 50 where logistics permit.[5]
• Establish colorectal-cancer screening from age 50 through faecal occult blood testing, proctological examination and colonoscopy after positive findings, with intensified surveillance for people with familial or hereditary risk.[9]
• Avoid population-based screening for endometrial, prostate, oesophageal, stomach and liver cancers, while applying risk-based or symptom-led assessment where clinically indicated.[5][6]
• Provide timely multidisciplinary diagnosis and treatment, aiming for no more than four weeks between diagnosis and first therapeutic intervention, except in exceptional circumstances where this may extend to 12 weeks.[10]
• Deliver treatment through surgery, radiotherapy, hormone therapy, immunotherapy, chemotherapy and palliative therapy according to tumour type, stage and therapeutic intent.[11][12][13]
• Improve quality of life for people with incurable or end-of-life illness and their families through comprehensive palliative care addressing physical, psychological, social and spiritual suffering, autonomy and preferred place of care.[14][15]

The framework also seeks to address recognised system weaknesses, including financial difficulty, limited diagnostic and treatment equipment, shortages of qualified staff and multidisciplinary teams, insufficient chemotherapy-waste facilities, and the absence of a reliable centralised cancer morbidity registry.[3]

Implementation

Implementation is centred on primary health care, with coordinated referral to hospitals and specialised services where local capacity is exhausted. National leadership sits with the National Directorate of Health and its Cancer Prevention and Screening Programme, supported by the World Health Organization, the Directorate-General of Health of Portugal, the United Nations Population Fund, national hospitals and health regions.[16][2][6][17]

• Organise prevention, screening management, patient follow-up and local cancer registration through primary health care, delivering care close to individuals, families and communities.[18][6][17]
• Appoint a focal point in each health centre to support the Health Delegate, coordinate local programme guidance and staff communication, organise human and logistical resources, contribute to research, maintain the local cancer registry, and monitor performance, quality and efficiency.[17]
• Define multidisciplinary health-centre teams according to available staff, involving doctors, nurses, administrative personnel and social workers in information, invitations, appointment scheduling, examination preparation, sample logistics, non-attender follow-up, rehabilitation information and social reintegration.[19][20]
• Inform eligible people about screening, validate annual eligible populations, arrange examinations, record clinical and screening information, communicate results and coordinate subsequent care.[19]
• Refer patients to specialised facilities after contacting the relevant specialist or service manager when local technical capacity, telephone support or telemedicine has been exhausted; standardise evacuation criteria, referral reception, oncology appointment prioritisation, and referral and counter-referral documentation.[20]
• Submit internally and externally evacuated cases to the Cancer Prevention and Screening Programme at the end of each quarter, and limit the interval between diagnosis in primary care and specialist care to four weeks.[20]
• Establish oncology commissions comprising clinical oncologists, oncology surgeons, radiotherapists, pathologists, radiologists and other relevant specialists; convene multidisciplinary meetings before first treatment and when reassessment is needed.[10]
• Base treatment decisions on histopathological confirmation and tumour-node-metastasis staging, record multidisciplinary decisions formally, and obtain signatures from participating team members.[10]
• Apply clinical protocols for disease-specific diagnosis, staging, treatment and follow-up, including cytology and colposcopy for cervical disease, imaging and biopsy where indicated, and specialist hospital protocols for complex staging and treatment.[3][21][22][23]
• Provide palliative care through inpatient, outpatient, hospital-support and community teams, with at least a doctor, nurse, psychologist, social worker and physiotherapist; identify eligible patients early, plan discharge and coordinate hospital and primary-care continuity.[14][24][15]

Information and accountability mechanisms include cancer-registration and referral forms that capture patient characteristics, diagnosis, tumour morphology and staging, treatment, referring and receiving institutions, follow-up status and death information.[25][26]The source does not specify a comprehensive national performance framework, reporting timetable, independent evaluation process or funded implementation plan.[10][27][28][29]

Financing details are limited: no budgets, allocations, funding sources or resource-mobilisation plan are specified.[16][3]Population-based screening is presented as more economical than opportunistic screening, whereas combined liquid-based cytology and human papillomavirus testing is described as costly.[7][8]

Monitoring & Evaluation

Monitoring combines cancer registration, screening records, referral documentation, multidisciplinary decision records and clinical follow-up. However, the manual does not establish a unified programme-wide evaluation framework, named reporting authority, comprehensive indicator set, reporting timetable or independent accountability process.[17][19][20][10][25][26]

• Maintain a cancer registry at health-centre level and use the registration form to capture patient and provider details, diagnostic basis, tumour site and morphology, staging, treatment, referral institutions, treatment dates, last contact and death information.[17][25][26]
• Monitor local programme performance, quality and efficiency through health-centre focal points working with the Health Delegate.[17]
• Record screening consultations, cytology and other clinical information, sample transfer and results, communicate results to service users, and actively follow up people who do not attend screening.[19]
• Submit internally or externally evacuated cases to the PPRC at the end of each quarter and maintain complete referral and counter-referral documentation.[20]
• Limit the interval between diagnosis in primary care and specialist referral care to no more than four weeks; the diagnostic-to-first-treatment interval should also normally not exceed four weeks, exceptionally extending to 12 weeks.[20][10]
• Document multidisciplinary oncology decisions through records signed by all group members, and use tumour-node-metastasis classification to standardise assessment of tumour extent and diagnostic effectiveness.[10]
• Assess cervical screening coverage and quality control, with population-based coverage above 70% identified as important to effectiveness; apply screening intervals according to test sensitivity.[7][8]
• Monitor treatment and survivorship through disease-specific clinical follow-up schedules, including cytology and colposcopy after cervical intraepithelial neoplasia treatment, breast surveillance, prostate specialist review, Barrett’s oesophagus endoscopy, and colorectal cancer consultations and carcinoembryonic antigen testing.[23][30][31][32][33]
• Assess palliative-care symptoms at every consultation or visit using validated tools, involve patients and families in treatment monitoring, and reassess and revise individual care plans when needs or condition change.[24][34][35]
• Use structured pain assessment, record pain intensity numerically, and repeat assessment with the same validated instrument unless the clinical situation requires a change.[36]

A major information-system gap is the identified absence of a reliable, centralised national cancer morbidity registry.[3]Clinical classifications and pathology results support diagnostic quality, but they are not presented as programme performance indicators.[37][38][39][40]

Costing & Financing

Costing and financing arrangements are largely unspecified. The material identifies financial difficulties and substantial service-capacity constraints, but provides no national budget, expenditure plan, funding source, resource-mobilisation strategy, allocation, quantified funding gap or economic assumption.[3]

• Address financial difficulties affecting the ability to meet cancer-control needs.[3]
• Strengthen diagnostic and treatment equipment, qualified staffing, multidisciplinary capacity and facilities for chemotherapy-waste management, which are identified as resource weaknesses.[3]
• Organise the human and logistical resources needed for local screening delivery, including health-centre focal points and multidisciplinary teams.[17][20]
• Provide medical, surgical, examination and administrative materials for primary-healthcare screening and follow-up activities, although no associated allocation is specified.[19]
• Recognise that population-based cervical screening is presented as more economical than opportunistic screening, while liquid-based cytology combined with human papillomavirus testing is described as high cost and of unclear mortality benefit.[7][8]
• Consider the higher cost of vacuum-assisted biopsy compared with core biopsy when selecting tissue-sampling approaches; no monetary value is provided.[41]
• Resource chemotherapy preparation through laminar-airflow chambers to reduce contamination and occupational-health risks, without specified capital or operating costs.[42]

No quantified cost items are provided. Numeric clinical values, including medicine doses and epidemiological statistics, are not budgetary amounts and are therefore excluded from the machine-readable cost items.[42]