Getting to 90-70-90 with digital tools: How Mexican healthcare is transforming cervical cancer screening

• Mexico is committed to achieve the WHO's cervical cancer 90-70-90 elimination targets by transitioning to an organized care model that utilizes self-collection and a lowered screening age, from 35 to 30

• The national women's cancer information system, SICAM, serves as a vital digital backbone that tracks patient care pathways in real time, improves data quality, and actively prevents loss to follow-up across Mexico's 32 states

• Investing in digital health tools and organized programs drives health equity and optimizes resources by ensuring vulnerable populations complete the entire continuum of care

In 2020, the World Health Organization (WHO) set a global goal to eliminate cervical cancer as a public health problem, anchored in the now-familiar "90-70-90" targets for 2030: 90 percent of girls fully vaccinated against HPV by age 15, 70 percent of women screened with a high-performance test by age 35 and again by age 45, and 90 percent of those with disease receiving treatment.³

Mexico has made that elimination goal a matter of national policy and has set even more ambitious goals. Over the past year, the country has broadened HPV-based screening, lowered the screening age from 35 to 30, introduced self-collection to reach women who have never been screened, and begun synthesizing these efforts through a sophisticated digital system, the National Women's Cancer Information System, or Sistema de Información de Cáncer de la Mujer (SICAM).^4,5

To understand what that transformation looks like from the inside, Healthcare Transformers spoke with two of the officials leading it. Teresa Ramos leads the public health and equity strategy for Mexico's national women's cancer program. Ricardo Gaeta leads the technical and health-information work for the program, including the SICAM women's cancer information system that underpins Mexico's move to organized, traceable screening.

Ramos: Today, Mexico is living through one of the most important moments in the transformation of cervical cancer prevention. The Government of Mexico has taken on the commitment to advance toward eliminating this disease as a public health problem, in line with the World Health Organization's global strategy. This effort starts from a very clear conviction: prevention is also a policy of equity. For many years, women who lived in rural communities, belonged to Indigenous peoples, or faced conditions of vulnerability had fewer opportunities to access screening and timely follow-up. Today, we are transforming that reality through public policies that place women at the center of care. We have strengthened screening with high-risk human papillomavirus (HPV) testing; we are expanding coverage to women aged 30 to 64, when only a few months ago it began at age 35; and we have incorporated self-collection as an innovative strategy to bring services closer to those who have historically been excluded.

Gaeta: The most important change Mexico is making is moving from a system where detection depended mainly on whether a woman came to health services spontaneously, to an organized model that identifies, invites, follows up, and accompanies each woman along the entire care pathway, with traceability. To achieve this, we have strengthened strategic tools such as the women's cancer information system, SICAM. We have worked to improve traceability, and above all combine high-risk tests, so that it is no longer only a yes-or-no decision but one in which the woman can choose from a test that is administered to her toward one she can perform herself, through self-collection.

Ramos: The greatest challenge for us is not incorporating technology, but transforming the way we organize health services and healthcare. An organized program requires institutional leadership, coordination across the different levels of care, standardized processes, and a shared strategic vision among all the institutions that make up our National Health System. Digital transformation needs to be understood as a tool to strengthen that organization and to guarantee that no woman falls outside the system because of administrative or coordination failures.

Gaeta: We are identifying the main areas for intervention with follow-up of each individual woman, and we are building strategies tailored to each state. Within Mexico's 32 states, each one is diverse, and we are working to close the gaps that women have historically faced across different states. We are also careful not to lose the identity of each state; women in the west of the country live very different realities from women in the south, so we adjust every day, including in our communication campaigns, so that women feel a sense of belonging and know that health is their decision and is in their hands.

Ramos: Loss to follow-up is one of the greatest challenges for health systems, because it is precisely there that inequalities beyond the clinical sphere are reflected. Many women face geographic, economic, cultural, and informational barriers that make it difficult to complete their care. But there are also barriers within the system itself: We still have fragmented processes, little interoperability, and insufficient mechanisms to accompany patients. The challenge is to build a model where follow-up no longer depends solely on the woman's initiative, but becomes a shared responsibility. When we achieve that, we advance not only in efficiency but in equity and in the guarantee of the right to health.

In public health, we often say that a test without follow-up does not save lives. The real success of a program is not measured by the number of tests performed, but by the number of women who complete the entire care pathway—screening, diagnosis, treatment, and follow-up. Every patient who is lost represents a missed opportunity to prevent cancer, and also a greater cost to the health system, because late diagnoses mean more complex treatments, higher mortality, and greater social and economic impact. That is why we are strengthening the organized screening model with digital tools such as SICAM, which lets us identify in a timely way the women pending follow-up, coordinate between institutions, and accompany each patient to the resolution of her case. That is the true potential of digital health: Turning data into continuity of care, and continuity of care into lives saved.

Ramos: Digital transformation has enormous potential because it helps turn clinical guidelines into everyday practice. What that means is that regardless of where a woman receives care, the system can guide health personnel to offer evidence-based, safe care with consistent standards. For us, technology does not replace clinical expertise—it strengthens it. It is a tool to reduce variability, to close gaps in the quality of care, and to guarantee that all women receive the same diagnostic opportunities and timely treatment. That is the essence of health equity, which is enormously important to us.

Gaeta: Digital health lets us move from having clinical guidelines sitting in documents to having guidelines that are integrated and interoperable—from the written word to activation, to follow-up, to people. A decision-support system automatically indicates the next step required for each patient, and generates alerts when a follow-up is pending. That reduces errors, strengthens adherence to national guidelines, and greatly improves diagnostic timeliness. In Mexico, we are advancing toward that vision—strengthening data capture, implementing a universal model of care (currently for breast cancer, and in due course for cervical cancer), and standardizing care pathways so we can integrate digital innovation and better information for clinical and public health decisions. When technology guides the right decisions at the right moment, we don't just standardize processes—we increase the probability of saving lives.

Gaeta: We are evolving toward a system that records on a platform in real time—we already have some early experience where health personnel can see how each woman is progressing. The challenge is not only to have a digital tool in the care units, but to consolidate a culture across the entire National Health System: A culture of belonging and of follow-up. Beyond simply capturing data, we want to improve data quality so that each record can be translated into effective follow-up. When all of this information is integrated into a single platform, we can automatically identify the women pending follow-up, prioritize the highest-risk cases, and monitor care times. The true digital transformation happens when each captured datum becomes an action to protect a woman's health—when each datum represents a life, represents a woman.

Ramos: Digital transformation also transforms the way we govern public health. Having real-time information lets us leave behind decisions based on estimates and move toward decisions grounded in evidence. For those of us who design public policy, data is an essential tool: With it we can identify gaps, reduce inequalities, and direct resources to where they can  generate the greatest impact—more assertive, better-targeted decisions based on the needs of the population. 

Gaeta: In this administration, we often say that what isn't seen cannot be improved—but today the challenge goes further: What isn't analyzed in time can become a missed opportunity to save a life. Strengthening our system lets us evolve from a registry into a management platform for decision-makers. Cervical cancer is a cancer we can avoid, one we can change, and that is what motivates our efforts to ensure continuity of care for women throughout the pathway. We are not only concentrating information; we are working to turn all of that data into decisions, and strengthening data capture through strategic alliances with the rest of the health sector. That capture is fundamental—even the best platform, with the most advanced technology, would be useless without committed data-entry staff working under a single, standardized system. The real innovation happens when information stops being merely an administrative indicator and becomes a tool that lets us make decisions and mark a before and after in women's lives.

Ramos: Data let us stop merely administering programs and start managing them strategically. When we know where there is lower screening coverage, greater loss to follow-up, or longer waiting times, we can direct resources, strengthen the resolving capacity of services, and design specific interventions for each population. That is the principle of a smarter, more equitable public health. In Mexico, we are consolidating this by strengthening the SICAM women's cancer information system so that it evolves from a registry into a platform for managing the program—in coordination with IMSS-Bienestar, the states, and the institutions of the National Health System. We are no longer only talking about increasing screening coverage; we are building a comprehensive management model for women's cancer, where information connects prevention, diagnosis, treatment, and continuous follow-up of patients. Because behind every indicator there is a woman and her family waiting for a response from the health system.

Gaeta: Something I have learned in this joint work is that equity does not mean offering everyone the same thing. It means guaranteeing that those who face the greatest barriers receive the care they truly need. That is our motto, and we repeat it to ourselves every day: we are going for them—for the ones we have not yet reached.

Ramos: I would start by changing the conversation. The question is not how much digital transformation costs; the question is how much it costs us not to transform the system. Every woman lost to follow-up represents a missed opportunity to prevent cancer, but also a greater clinical, social, and economic cost—a late diagnosis means more complex treatments, greater impact on families, and more pressure on health services.^2,6 Investing in digital health is investing in a more organized, more efficient, more equitable system. It is a decision that generates public value, because it improves the quality of care, optimizes resources, and above all protects women's lives.^7,4 The most valuable investment is not the one that seeks immediate savings, but the one that prevents a woman from facing a cancer that was avoidable. When prevention succeeds, it is a shared victory—for the woman, for the health system, and for the community as a whole.

Gaeta: From a technical perspective, the conversation must center on the value that an organized program generates. When we use digital tools to strengthen screening, standardize care pathways, and give timely follow-up to patients, we make better use of resources and make better decisions—we reduce unnecessary studies and we avoid loss to follow-up. Those last two have been strategic axes for us, because they let us prioritize the highest-risk women and favor more timely diagnoses, which directly reduces the need for complex, costly treatments.

Ramos: The 90-70-90 targets are a roadmap to eliminate cervical cancer as a public health problem, but they also remind us that this goal will only be possible if we transform the way we organize health services.

A few days ago, I was shown a video in which Purépecha women were being given a talk in their mother tongue, guiding them on how to use the self-collection kit and what it means to live with HPV. It moved me immensely to have reached this part of the population, because their response was that they had never received this kind of information and had no knowledge of it. Technology is an enabler of that change, but the real transformation happens when innovation translates into better opportunities for women and into a system capable of accompanying them through their entire care process. Our commitment is not only to reach an international target—of course it is that—but also to guarantee that no woman is left behind.

Ramos:  The National Pact toward the Elimination of Cervical Cancer is a nationwide multisectoral alliance that aligns Mexico's public health policy with the World Health Organization’s (WHO) global initiative to eliminate cervical cancer.⁸ Dr. Lascano, head of the National Institute of Public Health (INSP), gave us the honor of hosting us, together with the 32 state cancer leads from across the health sector, where we signed the National Pact toward the Elimination of Cervical Cancer with them. We had very enriching discussions about the research on self-collection—the innovation we are introducing in Mexico—and the INSP noted that they have studies on its benefits dating back to 2002. It is good that it has been implemented in other countries, but above all that it is now being implemented in Mexico. I have the signatures of all 32 state leads, so they cannot say no or back out.

Gaeta: We have strengthened our information systems and work every day to enhance them with new mechanisms—for example, we have now incorporated the ability to count and follow up all self-collection tests, which also increases screening coverage. It is important to see all of these components as part of a single strategy, and to remember that the digital solution is not an end in itself, but the axis that connects prevention, screening, diagnosis, treatment, and follow-up, while also enabling evidence-based decision-making as a strategic pillar of the health system. If you have a digital solution that lets you analyze and trace all of this, the important thing is to then analyze that information and draw solutions from it. We are evolving toward a comprehensive management model for women's cancer, where information is the guide for our clinical and technical decisions and for strengthening the management of programs and resources, so that no woman is lost along the care pathway. The true digital transformation is not about having more information; it is about making each data point become an action—and each action reaches a woman who then has a real opportunity to prevent cancer.

Ramos: More than three technological recommendations, I would share three principles that have guided our work in Mexico:

1. Always put women at the center of decisions: Digital transformation only makes sense when it reduces inequalities, removes barriers, and guarantees the right to health.

2. Build alliances: No information system transforms a program on its own; coordination among institutions, health teams, and the different levels of care is indispensable for achieving continuity of care.

3. Understand that innovation is not about digitizing processes, but about transforming the way we care for people. When technology improves women's experiences within the health system, that is when we are truly innovating.

Gaeta: From a public health perspective, I would add three lessons: 

1. Do not digitize a fragmented program. First, design an organized, systematized program, and know what you want and where you want to go. Technology enhances processes, but it does not replace good organization.

2. Invest in quality information: Timely, reliable data lets us identify the women pending follow-up, direct resources, and make better decisions. 

3. Measure success by outcomes for people, not by the number of records. The true indicator of success is not how many tests were performed, or how many screenings were done, or how much data a system stores, but how many women we manage to accompany from prevention through to the resolution of their case. Because in the end, the best innovation is not the one that generates data, but the one that ensures no woman is left behind.

**This interview was translated from the Spanish original into English with an AI tool, then checked for accuracy by a human reviewer.