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Published by PAHO in 20251 in collaboration St. Jude Children’s Research Hospital, Early diagnosis of cancer in children and adolescents: Interactive quick reference guide represents an essential global contribution to addressing cancer in children and adolescents. As part of the Global Initiative for Childhood Cancer, this 44-page, interactive technical guide brings together practical tools for early detection of warning signs, urgency classification and specification of referral flows.1
The proposal combines clinical, operational and public health knowledge in accessible, action-oriented language. It forms part of the technical package of the Global Initiative for Childhood Cancer (GICC), led by the World Health Organization and operationalized by way of the strategic CureAll structure2. The model is designed to strengthen health systems across the health care continuum, to reduce inequalities and improve clinical outcomes2.
CureAll rests on four fundamental pillars (Centres of excellence and Care networks, Universal health coverage, Regimens optimized for delivery of quality diagnostic and treatment services, Evaluation and monitoring), in addition to three essential enablers: Advocacy, Leveraged financing and Linked governance2. This framework steers sustainable, contextualized solutions to expediting early diagnosis, expanding treatment access and mitigating adverse effects, especially in resource-scarce settings2,3.
In response to persistent inequalities in paediatric oncology, and in collaboration with St. Jude’s and regional partners, the PAHO has prioritized action to improve child cancer outcomes in Latin America and the Caribbean2-4. Expedited implementation of the GICC has included the development of culturally-sensitive technical resources aligned with the CureAll model, including this interactive quick-reference guide3-4.
On the assumption that early diagnosis is a necessary condition for increasing survival and reducing morbidity and, guide reasserts the WHO’s global goal of achieving minimum 60% survival by 2030 in all countries, including the Americas2,5. To that end, it emphasizes continued professional development, standardization of screening protocols, early detection of warning signs and coordination with specialized services.
In most countries, child cancer represents from 1% to 4% of neoplasms and may account for 10% of the total cancer burden in contexts with proportionally larger paediatric populations, especially in low- and middle-income countries6-7. In high-income countries, up to 80% of cases can be cured, while in lower-income regions, children are at nearly four times higher risk of dying as a result of late diagnosis, access barriers and lack of proper supporting care5 8.
In that scenario, the PAHO guide is particularly strategic in that it offers practical tools for recognizing suspected signs and symptoms, classifying by urgency and ensuring quick referral to specialized services. By capacitating multi-professional teams from primary to specialized care, it contributes to saving lives and reducing the physical, emotional and social harm resulting from late diagnosis.4,5,9
The guide’s introduction stresses early diagnosis as a cornerstone of paediatric cancer care policies. Acknowledging health systems’ structural heterogeneity, it proposes a practical approach based on clinical signs and levels of probability. Symptoms are organized by three colours – red (immediate), yellow (priority) and green (scheduled) – to guide prompt action and reduce decision-making variability.
The content of the guide is organized into clear sections covering prevalent types of cancer, signs and symptoms, classification criteria, complementary diagnostic tests and support materials. Categorization of neurological, haematological and abdominal symptoms guides users from anamnesis and physical examination through to specialized referral. Signs such as progressive headache at night, palpable abdominal mass or unexplained, enlarged lymph nodes activate protocols with specified timeframes, preventing the critical delays that impair clinical outcomes.
In addition to its clinical applicability, the guide offers input to strengthen care networks and integrate different levels of complexity. By directing primary care flows to specialized paediatric cancer haematology services, it improves professional practices and reduces inequities in access to diagnosis. This approach is particularly strategic where the burden of disease is high and resources are limited, as in many Latin American and Caribbean countries.
From the Collective Health standpoint, the guide aligns with the principles of equity, comprehensiveness and effectiveness and is also a powerful tool for epidemiological surveillance and system performance evaluation. The indicators suggested make it possible to monitor time to diagnosis, treatment onset and appropriate referral rate. PAHO personnel and partners have played a prominent role in developing the material, contributing to its legitimation in member countries.
In short, this interactive PAHO guide constitutes a milestone for implementing the GICC in the Americas. By integrating evidence-based recommendations, practical clinical flows and capacity-building tools, it strengthens health systems’ ability to achieve timely and equitable responses to child cancer. It was issued at a good time for Brazil, which relaunched the national CureAll Brasil initiative in a partnership among the Ministry of Health, PAHO/WHO and the Hospital de Amor during the Brazil against Youth Cancer seminar (Brasil contra o Câncer Juvenil) held in Brasília in June 202410. The goal is to increase survival rates among children and adolescents with cancer, by strategies directed to expanding early diagnosis, guaranteeing access to quality treatment and implementing comprehensive palliative care10, so as to reduce regional inequalities and strengthen paediatric cancer networks, thus signalling convergence between global agendas and Brazil’s national priorities. In that context, the guide stands as an essential technical resource for managers, health personnel and policy makers, and will contribute to saving more lives and offering comprehensive, effective care centred on the specific needs of the paediatric population with cancer.
With clarity, technical rigour and practical applicability, the guide offers clinical guidelines and strategic vision for strengthening cancer care networks. Its adoption can contribute to overcoming inequalities and building health systems that are more responsive to the real needs of children and adolescents with cancer.
References
1. Pan American Health Organization. Early diagnosis of cancer in children and adolescents: Interactive quick reference guide. Washington, D.C.: PAHO; 2025. Available from: https://doi.org/10.37774/9789275129906
2. World Health Organization. CureAll framework: WHO Global Initiative for Childhood Cancer. Increasing access, advancing quality, saving lives. Geneva: WHO; 2021. Available from: https://apps.who.int/iris/handle/10665/347370
3. Vásquez L, Fuentes-Alabi S, Benitez-Majano S, Ribeiro KB, Abraham M, Agulnik A, et al. Collaboration for success: the Global Initiative for Childhood Cancer in Latin America. Rev Panam Salud Publica. 2023;47:e144. doi:10.26633/RPSP.2023.144.
4. Vásquez L, Fuentes-Alabí S, Loggetto P, Benitez-Majano S, Metzger ML, Jarquin-Pardo M, et al. Advances in the Global Initiative for Childhood Cancer: implementation in Latin America and the Caribbean. Rev Panam Salud Publica. 2023;47:e128. doi:10.26633/RPSP.2023.128.
5. Lima RAG, Lopes-Júnior LC, Maia EBS, Fuentes-Alabi S, Ponce MLV. Global Initiative for Childhood Cancer Control: Increasing access, improving quality, saving lives. Rev Lat Am Enfermagem. 2023 Oct 6;31:e3998. doi:10.1590/1518-8345.0000.3998.
6. Bhakta N, Force LM, Allemani C, Atun R, Bray F, Coleman MP, et al. Childhood cancer burden: a review of global estimates. Lancet Oncol. 2019 Jan;20(1):e42–53. doi:10.1016/S1470-2045(18)30761-7.
7. GBD Childhood Cancer Collaborators. The global burden of childhood and adolescent cancer in 2017: an analysis of the Global Burden of Disease Study 2017. Lancet Oncol. 2019;20(1211):1211–25.
8. Lopes-Júnior LC, Lima RAG, Maia EBS, Ribeiro KCB, Fuentes-Alabí S, Sullivan CE, et al. Essential core competencies for scope of practice of paediatric oncology nurses in Latin America: a scoping review protocol. BMJ Open. 2022 Jul 22;12(7):e061853. doi:10.1136/bmjopen-2022-061853.
9. Lima RAG, Maia EBS, Lopes-Júnior LC. Global initiative for childhood cancer and the practice of pediatric oncology nursing in Latin America and the Caribbean. Ciênc Saúde Colet. 2023;28:2455–7.
10. Ministério da Saúde. Brasil relança iniciativa CureAll e reafirma compromisso no combate ao câncer infantojuvenil. Brasília: Ministério da Saúde; 2024 [acesso em 14 jul 2025]. Disponível em: https://cee.fiocruz.br/?q=Brasil-relanca-iniciativa-Cure-All-compromisso-no-combate-ao-cancer