IARC 60th Anniversary - 19-21 May 2026
Session : Translating Evidence into Action for Cervical Cancer Elimination: HPV Vaccination and HPV-Based Screening
Building local capacities for the implementation of IARC/WHO-supported HPV testing practices: The ESTAMPA study experience in Bolivia (LMIC)
TERAN C. 1,2, FLORES B. 1,2, ZAMBRANA O. 1, MURILLO V. 1, FLORES M. 1,2, NAVIA G. 1, LLANOS D. 1,3, LORA O. 1,4, TERAN L. 1, GOURDAK D. 1, ROL M. 5, HERNANDEZ M. 6, RAMIREZ T. 5, LUCAS E. 5, BAENA A. 7, HERRERO R. 8, ALMONTE M. 6
1 Facultad de Medicina - Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca , Sucre, Bolivia; 2 Area de Salud. Universidad Andina Simon Bolivar, Sucre, Bolivia; 3 Instituto de Anatomía Patológica. Facultad de Medicina - USFX, Sucre, Bolivia; 4 Hospital Gineco-Obstétrico y Neonatal “Jaime Sánchez Pórcel”, Sucre, Bolivia; 5 Early Detection, Prevention & Infection Branch, International Agency for Research on Cancer, Lyon, France; 6 Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland; 7 Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, MD, United States; 8 Agencia Costarricense de Investigaciones Biomédicas, San Jose, Costa Rica
Background
Cervical cancer (CC) is a significant public health problem and leading cause of cancer death among women in many low- and middle-income countries (LMICs), including Bolivia. Additionally, Bolivia's public healthcare model has mainly relied on secondary prevention strategies (Pap smears) resulting in suboptimal impact on its overall CC burden.
Objective
The ESTAMPA study (“Multicentric Study of Cervical Cancer Screening with Human Papilloma Virus Testing and Assessment of Triage Methods” in English) is the largest HPV-based CC screening study in Latin America. It aims to evaluate strategies for the implementation of organized screening programs that include HPV testing and triage methods in LMICs such as Bolivia.
Methods
In 2014, the Universidad Mayor Real y Pontificia de San Francisco Xavier (USFX) was invited to participate and represent Bolivia in the ESTAMPA study, led by the IARC/WHO. The central IARC team and the regional collaborators assessed local capacity to conduct the study on-site, and developed a high-pace strategy for the implementation of HPV testing.
Several meetings were conducted among local USFX-promoted stakeholders, including researchers, national/regional health authorities, clinicians, and community health workers to establish a supportive network for the implementation process. Additionally, the IARC central team established the Quality Management System (QMS) which consists of essential elements to ensure accurate HPV test results and treatment of precancerous lesions in compliance with standard operating procedures (SOPs), and protocol-complaint training of study-personnel.
Results
Between December 2014 and July 2017, clinical and laboratory personnel from USFX and the local health system completed appropriate training on CC screening and follow-up according to the ESTAMPA protocol. This includes consultation/follow-up by: three public health physicians, two gynecologists/colposcopists, two pathologists, two biochemists, two laboratory technicians, and two epidemiologists (researchers).
In September 2017, USFX upgraded the local laboratory in Sucre, Bolivia, implementing the first HPV molecular detection laboratory (HC2) and integrating new technology (HPV testing) into existing local health systems.
Between March 2018 and August 2022, the ESTAMPA Bolivia study center screened 3486 participants with these high-performance tests. The team continued screening using the study platform, reaching a total of 5225 women by December 2025. Among these, 635 were HPV positive (12%) and referred to colposcopy for diagnostic evaluation. Of these, 103 were CIN2+, 98 of which were CIN2/3 (CIN2 53 and CIN3 45), reaching a prevalence of 1.88% (98/5225). Of these, 85 received treatment (LLETZ), and 5 CC cases were referred for management by the local health system.
Conclusions/implications