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1、Chapter9CervicalCancerandtheDevelopmentofHPVVaccinesinGuanacaste,CostaRicaNuriaHomedesandAntonioUgalde9.1IntroductionCervicalcanceristhesecondmostfrequentcancerinwomenworldwide,andthesecondmostfrequentcauseofcancerdeathforwomenbetweentheagesof1445years.Eighty-threepercentofcervicalcancerca
2、sesoccurinresidentsofdevelopingcountries,anditistheprimarycauseofcancerdeathsinwomenofCentralAmerica(WHO/ICO2009).Unfortunately,cytology-basedpreventionprograms(suchasPapsmears)havebeenlesseffectiveindevelopingcountriesthanincountrieswithadequatehealthsystems(RoblesandRosesPeriago2004),lea
3、dingtocontinuedeffortstodevelopbettermethodstopreventandtreatthedisease.Between1985and1987,theUnitedStatesNationalCancerInstitute(NCI)sponsoredamulti-centerstudytoidentifyriskfactorsforcanceroftheuterinecervix.ThestudygroupwascomposedofwomenlivingintheUnitedStates,CostaRica,Mexico,Panama,a
4、ndColombia.Thestudyresultedinoneofthemajorhealthdiscoveriesinthepasttwodecades:thatcervicalcancerresultedfrominfectionwiththeHumanPapillomaVirus(HPV)(Herreroetal.1997).Thepresenceofthevirustriggersaseriesofeventsthatovertheyearscanresultincancer.OncetherelationshipbetweenHPVinfectionandcan
5、cerhadbeenrecognized,hopearosethatavaccinetopreventinfectionandanyresultingcancerscouldbedeveloped.ButnotallwomeninfectedwithHPVdevelopedcancer,anditremainednecessarytolookforothercontributorstothedevelopmentofthedisease.Onesuchstudy,alsosponsoredbytheNCI,tookplaceinGuanacaste,CostaRica,be
6、tween1993and2001.ItisnowknownthatthemajorityofHPVinfections(morethan90%)N.Homedes(*)SchoolofPublicHealth,DivisionofManagementPolicyandCommunityHealth,UniversityofTexasHoustonHealthScienceCenter,ElPaso,TX,USAe-mail:nhomedes@utep.eduA.UgaldeDepartmentofSociology,UniversityofTexas,Austin,TX,U
7、SAe-mail:augalde@mail.la.utexas.eduN.HomedesandA.Ugalde(eds.),ClinicalTrialsinLatinAmerica:WhereEthics195andBusinessClash,ResearchEthicsForum2,DOI10.1007/978-3-319-01363-3_9,?SpringerInternationalPublishingSwitzerland2014196N.HomedesandA.Ugaldeareself-limiting
