- The ESCUDDO study was published by The New England Journal of Medicine, classified as one of the most prestigious journals for its high impact on medical science and health.
- This journal only accepts 5% of the manuscripts received.
San José, December 2025. The results of the ESCUDDO study, conducted by the Costa Rican Agency for Biomedical Research of the Inciensa Foundation (ACIB-FUNIN), in collaboration with the National Cancer Institute of the United States, were published this December 3 in the prestigious scientific journal The New England Journal of Medicine (NEJM), considered the most important worldwide, for its high level of scientific influence.
This journal only accepts 5% of the manuscripts received, since one of the aspects to be evaluated is that they are investigations whose results can guide medical practices, clinical guidelines and health policies, as it has been done by the Costa Rican ESCUDDO study.
This research, which began in Costa Rica in 2017, demonstrated that a single dose of either of the two main human papillomavirus (HPV) vaccines is no less effective than two doses in protecting against HPV types 16 and 18. These two HPV types are responsible for more than 70% of cervical cancer cases worldwide. Furthermore, one dose of the nonvalent vaccine is no less effective than two doses, meaning it protects against all nine HPV types that cause approximately 90% of cervical cancer and genital wart cases.
The first findings of ESCUDDO were announced last April at the annual meeting of the American Association for Cancer Research (AACR), globally considered one of the most important scientific events in this field.
“Currently, the World Health Organization recommends administering one or two doses of the vaccine to children aged 9 to 14, leaving the number of doses to the discretion of governments. The ESCUDDO results provide robust evidence for regulatory bodies to consolidate their recommendation of vaccination to a single dose, opening the door to broader global coverage, especially in low- and middle-income countries, where access to complete vaccination schedules has been limited for economic or logistical reasons,” emphasizes Dr. Carolina Porras, Director of Biomedical Research of ACIB-FUNIN, principal investigator of ESCUDDO and of the scientific article published in NEJM.
The ESCUDDO study is the only one worldwide that sought to verify whether the protection provided by one dose of the HPV vaccine was no less than that provided by two doses, so its results were of special attention to various international organizations and authorities.
Currently, 78% of Latin American and Caribbean countries use a single dose in their vaccination schedule, according to the Pan American Health Organization, highlighting the contribution of this Costa Rican study to global public health. In Costa Rica, two doses are still administered to 10-year-old girls and boys.
The publication of ESCUDDO’s scientific article in The New England Journal of Medicine reflects the outstanding work carried out in our country by Costa Rican scientists who have dedicated decades to researching ways to prevent HPV and cervical cancer. A study of this magnitude and importance is a national milestone in biomedical research, given that this journal has a 200-year history and is a leading publication in more than 150 countries, placing Costa Rica on a prominent global stage and on the height with other countries that have been recognized for years for their scientific contributions,” explains Dr. Rolando Herrero, Scientific Director of ACIB-FUNIN and senior author of the publication.
The ESCUDDO study was conducted in more than 50 cantons of Costa Rica, with the participation of over 23,000 women between the ages of 12 and 20. This research was carried out in collaboration with the National Cancer Institute of the United States (NCI).
“We extend our deepest gratitude to the young women and girls of Costa Rica who participated in the ESCUDDO study in an extraordinary display of solidarity with all women and their families,” emphasizes Dr. Porras.
ACIB-FUNIN will continue evaluating the duration of protection provided by a single dose. This Costa Rican non-governmental, non-profit organization has leading researchers who have dedicated more than 30 years to conducting biomedical research with a significant impact on global public health.
San José, Costa Rica, April 2025. The first results of the ESCUDO study, conducted in Costa Rica by the Costa Rican Agency for Biomedical Research (ACIB-FUNIN) in collaboration with the National Cancer Institute of the United States, were announced at the annual meeting of the American Association for Cancer Research (AACR), considered one of the most important scientific events in this field worldwide.
The main findings confirm that a single dose of the Human Papillomavirus (HPV) vaccine offers the same protection as two doses against HPV types 16 and 18, which are responsible for more than 70% of cervical cancer cases worldwide.
The two vaccines used in the study demonstrated more than 95% efficacy in preventing HPV 16 and 18 infections, both when administered with one dose and when administered with two doses.
ESCUDDO is the only study worldwide that sought to verify whether the protection provided by one dose of the vaccine was not inferior to the provided by two doses in preventing HPV types 16 and 18 infections. This research, which has been conducted in more than 50 cantons of Costa Rica since 2017, involves more than 20,000 women between the ages of 12 and 20.
The study is supported by the U.S. National Cancer Institute (NCI), the Bill & Melinda Gates Foundation, the NIH Office of Research on Women’s Health, and the International Agency for Research on Cancer.
Global impact: greater access, greater equity
With scientific confirmation that a single dose is just as effective as the traditional two-dose regimen, it opens the door to broader global coverage, especially in low- and middle-income countries, where access to complete vaccination regimens has been limited for economic or logistical reasons.
“Reducing vaccination to a single dose represents a more efficient, accessible, and scalable strategy for saving lives,” said Dr. Carolina Porras, director of biomedical research at ACIB-FUNIN. She also expressed her gratitude to the thousands of young people who participated in the ESCUDDO study, whose contributions made such important findings possible.Principio del formulario
The ESCUDDO results provide robust evidence for regulatory agencies to definitely, change their vaccination recommendation to a single dose. Currently, the WHO recommends administering one or two doses to girls and boys aged 9 to 14, as well as to the 15 to 20-year-old group, leaving the number of doses to governments’ discretion.
“Now, with the results of the ESCUDDO study, the recommendation to administer a single dose is supported by highly scientifically rigorous data, and we know this will be a significant contribution to countries improving their vaccination coverage,” emphasizes Dr. Rolando Herrero, scientific director of ACIB-FUNIN.
ACIB-FUNIN will continue developing the ESCUDDO study in Costa Rica to further evaluate the duration of protection provided by one dose. This Costa Rican non-governmental, non-profit organization has distinguished researchers who, for more than 30 years, have dedicated themselves to conducting biomedical research with a significant impact on global public health.
The full manuscript of this study, currently under preparation, will include detailed analyses of the efficacy of one or two doses against the different types of viruses associated with this cancer, as well as details of the immune response to them.
The AACR Annual Meeting presents the latest discoveries in basic, translational, and clinical cancer research and brings together thousands of experts to share knowledge that will guide the future of the fight against cancer.
- · Cervical and breast cancer are the main causes of death in women between 20 and 39 years of age.
Dr. Loretto Carvajal, a researcher at ACIB-FUNIN, led an exhaustive analysis of the 20 most common cancers in young adults in Costa Rica, covering the years from 2006 to 2015 for incidence, and from 2000 to 2021 for mortality. The research provides a detailed understanding of how this disease affects young adults differently. Additionally, the research analyzed the behavior of different types of cancer over the time.
Using data from the National Tumor Registry of the Ministry of Health and the National Institute of Statistics and Census of Costa Rica, the research determined that the incidence (number of new cases) of cancer in women was double in comparison with men; a difference that is even more pronounced in the age group of 35 to 39 years.
According to the study, thyroid, cervical and breast cancer were the most common cancers in women, with the latter two, followed by stomach cancer, being the tumors with the highest mortality for this group of the population. Although thyroid cancer was the most diagnosed cancer among young women, its mortality rate is very low, ranking 20th in terms of mortality, with 19 deaths recorded.
In the case of men, testicular cancer was the most frequent, while stomach and brain cancer were the main causes of death from cancer.
The analysis showed that, in this age group, the overall incidence of cancer remained stable between 2006 and 2015, except in young women, in whom the incidence of thyroid cancer increased significantly by 6.2% annually. According to the researchers, the observed increase is probably due to the use of more sensitive diagnostic methods.
“Although this group represents only 10% of cancer cases, the findings of our study raise the need for public health policies from an early age, especially preventive interventions such as vaccination against the human papillomavirus in girls and boys, good nutrition, physical activity, and breastfeeding, which not only reduce the risk of breast cancer in women, but also help prevent excess weight in childhood. In addition, it is crucial to promote non-consumption of tobacco and alcohol, as well as prompt attention to symptoms in health services,” explains Dr. Loretto Carvajal, researcher at ACIB-FUNIN.
“Historically, public health efforts regarding cancer care have focused primarily on cancer in older adults, which has led to a lack of awareness and attention among young people regarding the symptoms and signs of the disease. As a result, diagnoses in this age group are often late, aggravated by the frequent misattribution of symptoms to other conditions, both by young people themselves and by health professionals, which makes effective treatment even more difficult in advanced stages,” adds the doctor.
According to the experts, the study also underlines the importance of cancer prevention in young men, especially testicular cancer, which was the most common cancer in this group. It is essential that health policies include campaigns to make young men be aware of the importance of self-examination of the testicles and of seeking medical attention for any suspicious symptoms.
In addition, they point out the importance of implementing effective measures for prevention, early detection and treatment of stomach cancer, which is the most fatal cancer in men and the third most common in women.
“The study reinforces the importance of epidemiological research to identify risk groups, generate hypotheses about the causes of diseases and adapt public health interventions to different population groups. Prevention through vaccination against hepatitis B and human papillomavirus, healthy lifestyles and participation in screening programs according to institutional guidelines are the main tools against these diseases. The Latin American Code against Cancer is a very useful resource to remind us what people can do to avoid developing cancer: https://cancer-code-lac.iarc.who.int/”, explains Dr. Rolando Herrero, scientific director of ACIB-FUNIN.
This research, entitled “A surveillance study of cancer incidence and mortality among young adults in Costa Rica,” is published in The Lancet Regional Health – Americas, volume 38.
- Residents of rural areas had lower mortality from pancreatic, lung, breast, prostate, kidney and bladder cancer.
San José, August 2024. A recent study in Costa Rica revealed important findings on the behavior of cancer mortality, according to the areas of residence and the wealth levels of the country’s districts.
Research conducted between 2010 and 2018 by the Costa Rican Agency for Biomedical Research (ACIB-FUNIN), the University of Costa Rica, the International Agency for Research on Cancer, and the National Cancer Institute of the United States found that mortality from most types of cancer in our country is lower in rural areas compared to urban areas.
Specifically, residents of rural areas had lower mortality from pancreatic, lung, breast, prostate, kidney and bladder cancer. However, stomach cancer was found to be the most common cancer in these areas.
According to experts, the fact that rural areas have lower mortality from most types of cancer may be due to more traditional and healthy lifestyles, in terms of diet, alcohol and tobacco consumption.
In urban areas, on the other hand, lifestyles vary, as the consumption of tobacco, alcohol and unhealthy foods is more common. This tendency has been supported by various studies carried out in our country by various organizations, which have shown, for example, a significant increase in childhood obesity, mainly in urban areas.
This study showed that cancers related to tobacco, such as pancreatic, lung, kidney and bladder cancer, are less frequent in residents of rural areas, compared to residents of urban areas.
“This is consistent with the distribution of tobacco consumption in Costa Rica, since it is known that it is lower in rural areas. In addition, it is known that alcohol consumption in the country is also associated with a high socioeconomic position, which is more frequent in urban areas,” explains Dr. Cristina Barboza, a researcher at the University of Costa Rica.
On the other hand, the study also analyzed the behavior of cancer in districts with higher and lower incomes, and determined that cervical cancer is more common in areas with lower economic levels. Meanwhile, colorectal cancer, non-Hodgkin lymphoma and leukemia are more frequent in districts with higher purchasing power than in districts with lower purchasing power.
For Dr. Rolando Herrero, scientific director of ACIB-FUNIN and researcher in this study, “it is urgent that the country strengthens its cancer prevention programs and efforts, paying special attention to risk populations. We know that many types of cancer are related to lifestyle, so it is necessary to do special work in urban areas. But, in the case of rural areas, there are types of cancer that are more related to socioeconomic factors, where there are fewer possibilities of using early detection services, so it is essential to improve access to these programs, in all segments of society.”
According to the researchers, the findings of this study provide valuable information for making of decision and the implementation of additional measures to those already established in the country.
In addition, they highlight the importance of regulating economic activities that expose workers to carcinogens (such as sun exposure), as well as implementing other strategies established in the Latin American Code Against Cancer.
San José, March 4, 2024 San José, March 4, 2024. The University of Costa Rica and the Costa Rican Agency for Biomedical Research, ACIB-FUNIN, signed this Monday a framework cooperation agreement, to promote the conduct of research, in pursuit of the comprehensive well-being of the Costa Rican population.
Both entities have been dedicated, for decades, to the generation of scientific evidence to contribute to the development of the country and the promotion of health, and on various occasions, they have even signed specific agreements to carry out joint research.
The agreement signed this Monday empowers both parties to develop research actions, social action and teaching training. Likewise, “both institutions, in a coordinated manner, will jointly define, design and execute all those programs or projects of mutual interest, in the specific terms that they will agree on at each opportunity and within the limit of their own powers faculties and attributions”, states the agreement.
“We are very pleased to sign this alliance that, without a doubt, will enhance the research capabilities of two organizations with extensive experience and highly trained human resources. This collaboration represents a great opportunity to carry out high-impact research and, thereby, contribute to make decisions in health matters”, says Dr. Carolina Porras, director of research at ACIB-FUNIN.
Likewise, the agreement also aims to establish cooperation to carry out other activities that facilitate the exchange of knowledge, the development of community ties and professional training.
“For more than 30 years, various ACIB-FUNIN researchers have participated in studies on key topics for worldwide health, such as human papillomavirus, cervical cancer, chronic kidney disease, breast cancer, SARS-CoV-2, among others. This experience and that of the UCR researchers will be transcendental for the development of innovative projects, aimed to improve knowledge, prevention and treatment of the health problems that most affect the Costa Rican population,” explains Dr. Rolando Herrero, scientific director of ACIB-FUNIN.
The agreement also presents the opportunity to train new professionals in health sciences and other related disciplines in biomedical research.
San José, March 2024 San José, March 2024. In 2022, 245 women were diagnosed with cervical cancer; around 70% of cases were recorded in women between 30 and 59 years old.
Despite being a 100% preventable cancer, this disease is the fourth most common cancer in the country; in 2022, it caused the death of 133 women, according to data from the National Institute of Statistics and Censuses.
Within the framework of the commemoration of World Cervical Cancer Prevention Day, experts from the Costa Rican Agency for Biomedical Research (ACIB-FUNIN) make call to strengthen each of the prevention actions for this disease.
In this sense, they remember that, despite the great efforts that the country has made, there are still important challenges to achieve the elimination of this disease, as a public health problem.
One of the main challenges is to increase vaccination coverage against the human papillomavirus (HPV) in girls who have turned 10 years old, as well as to incorporate children and women up to 20 years old into the vaccination program.
Experts says that, while it is true, the vaccine against the HPV virus has a higher level of protection if it is given before the start of sexual relations, it has been shown that it also works when applied after.
“Costa Rica has done extraordinary work to achieve high vaccination coverage; The Costa Rican Social Security Fund is making great efforts in this field. In addition, the replacement of the Pap smear with the HPV screening test will allow better control of the disease and by this accelerate compliance with the Worldwide Strategy for the elimination of this disease, issued by the World Health Organization (WHO) and which includes three pillars: prevent, detect and treat. Costa Rica is one of the countries that has the least mortality from this cancer in Latin America, but it is clear that there is still a lot to do”, explains Dr. Rolando Herrero, scientific director of ACIB-FUNIN.
This Strategy sets three goals that must be met by 2030: a) That before the age of 15, 90% of girls are vaccinated against HPV, b) Achieve 70% cancer detection coverage in women between 35 and 45 years old, c) Treat 90% of precancerous lesions and invasive cancer cases.
Previously, the WHO recommended the administration of three doses, however, based on various worldwide studies, including several carried out in Costa Rica, it recommends that countries administer one or two doses. However, the agency is waiting for the results of the research being carried out in Costa Rica (ESCUDDO), to change the official recommendation to a single dose.
Cervical cancer causes more than 300,000 deaths each year worldwide; however, experts says that early detection of cases, along with rapid and quality treatment, can cure this disease.
San José, April 2024. The prevention and treatment of cancer has become one of the great challenges in global health. The growing burden of this disease, worldwide, demands more trained professionals in the approach of a condition that is one of the main causes of death in the world, since 1 in 5 people will develop cancer throughout their life, according to the World Health Organization, WHO.
The impact of cancer is such that this organization predicts more than 35 million new cases of this disease in 2050; this represents an increase of 77%, compared to the 20 million cases that were estimated for 2022.
Aware of the urgent need to have a new generation of professionals trained in the treatment of cancer, ACIB-FUNIN and the National Cancer Institute of the United States opened the competition to award a scholarship in the prevention and control of this disease, to a health professional in the country.
The call period for the pre-selection of candidates began on March 11 and closed on May 3, 2024. Those interested can visit the page https://acibfunin.com/programabecas/ , to learn more information and consult the requirements.
“Every year, a professional in the field of Health Sciences or Life Sciences has the opportunity to elect this fellowship, with full payment, to specialize in cancer prevention and control. It is one of the most prestigious programs in the world, in the training of leaders in research of this disease, and from 2020 to date, three Costa Ricans have been selected and are currently at the National
Cancer Institute of the United States. United, carrying out this program,” says Dr. Carolina Porras, research director of ACIB-FUNIN.
This internship lasts a maximum of four years and provides opportunities for laboratory studies of basic sciences, epidemiology, clinical trials, health services research, and studies of the biological and social aspects of health behavior.
The postdoctoral fellowship is possible thanks to a collaboration agreement that, in 2019, the National Cancer Institute of the United States and ACIB-FUNIN established, to promote cooperation in Costa Rica in all aspects of research, on prevention and cancer treatment.
Those interested must fill out a fellowship form, entering the link https://acibfunin.com/formulariobeca/
La prevención y tratamiento del cáncer, se ha convertido en uno de los grandes retos en materia de salud global. La creciente carga de esta enfermedad, a nivel mundial, demanda profesionales más capacitados en el abordaje de un padecimiento que se ubica como una de las principales causas de muerte en el mundo, pues 1 de cada 5 personas desarrollará cáncer a lo largo de su vida, según la Organización Mundial de la Salud, OMS. El impacto del cáncer es tal, que este organismo prevé más de 35 millones de nuevos casos de esta enfermedad, en 2050; esto supone un aumento del 77%, con respecto a los 20 millones de casos que se estimaron para el 2022. Conscientes de la urgente necesidad de contar con una nueva generación de profesionales capacitados para el abordaje del cáncer, ACIB-FUNIN y el Instituto Nacional del Cáncer de los Estados Unidos, abrieron el concurso para otorgar una beca en prevención y control de esta enfermedad, a un profesional de la salud del país. El periodo de convocatoria para la pre-selección de candidatos, inició el 11 de marzo y cerró el 3 de mayo 2024. Los interesados pueden visitar la página https://acibfunin.com/programabecas/, para conocer más información y consultar los requisitos. “Cada año, un profesional en el campo de las Ciencias de la Salud o Ciencias de la Vida, tiene la oportunidad de optar por esta beca, con todo pago, para especializarse en la prevención y control del cáncer. Se trata de uno de los programas más prestigiosos de todo el mundo, en la formación de líderes en investigación de esta enfermedad, y desde el 2020 a la fecha, tres costarricenses han sido seleccionados y están actualmente en el Instituto Nacional del Cáncer de los Estados Unidos, llevando este programa”, señala la Dra. Carolina Porras, directora de investigaciones de ACIB-FUNIN. Esta pasantía tiene una duración máxima de cuatro años y brinda oportunidades para estudios de laboratorio de ciencias básicas, epidemiología, ensayos clínicos, investigación de servicios de salud y estudios de los aspectos biológicos y sociales del comportamiento de la salud. La beca postdoctoral es posible gracias a un convenio de colaboración que, en 2019, establecieron el Instituto Nacional del Cáncer de los Estados Unidos y ACIB-FUNIN, para promover en Costa Rica, la cooperación en todos los aspectos de la investigación, sobre prevención y tratamiento del cáncer. Los interesados deben llenar un formulario de beca, ingresando al enlace https://acibfunin.com/formulariobeca/
San José, March 2024. With the object of analyzing the situation in the country and exploring possible joint actions, the National Academy of Sciences held this Friday, the Non-Traditional Chronic Kidney Disease forum: Current situation and perspectives for addressing a serious occupational health problem.
In the activity that was developed virtually, from Liberia Hospital, various experts and researchers from the country participated, who deeply addressed this problem that occurs, to a greater extent, in the province of Guanacaste.
Since 1970, Costa Rica has experienced a sustained increase in cases of non-traditional chronic kidney disease, which mainly affects young men, who carry out intense physical activity in environments with high temperatures.
Data from the National Institute of Statistics and Censuses reveal that in the period 2000-2022, in certain regions of Guanacaste, mortality was 16 times higher for men and 4 times higher for women aged between 30-59 years, this in comparison to the rest of the country.
Experts from the National Academy of Sciences, expressed their deep concern about the persistence of this silent epidemic and urged agricultural industrial businessmen, of construction and other relevant sectors, as well as the Ministry of Health, the Costa Rican Social Security Fund ( CCSS), the National Insurance Institute, municipalities and other governments, as well as local organizations, to establish urgent measures for the prevention of this occupational disease, which continues to have serious consequences in one of the most vulnerable populations in our country.
“The statistics put into perspective the seriousness of the situation that is being experienced, mainly in Guanacaste, where more forceful actions are urgently needed to stop this epidemic. We know that there are a series of recommendations to prevent kidney damage and that, in our country, the Ministry of Labor and Social Security has issued guidelines for the implementation of preventive measures in the workplace. However, we believe that these recommendations should be implemented correctly and consistently and that their effectiveness should be continually evaluated. In addition, it is necessary to design programs that reach workers in the informal sector, who make up a high proportion of the workforce at risk,” says Dr. José María Gutiérrez Gutiérrez, member of the National Academy of Sciences.
Non-traditional chronic kidney disease was initially detected in sugar cane field workers, but has also been observed in workers in other agricultural crops, as well as in the construction, mines, brick manufacturing, shrimp farms and fishing sectors, among others.
The excess heat, or thermal stress, generated in these work activities, produces an increase in body temperature and dehydration, causing severe metabolic changes that damage the kidneys. The possibility of a transplant is generally not an option for patients, who very often die at a young age.
The large number of people affected by this disease in Guanacaste made it necessary for the C.C.S.S. to build modern facilities at the Enrique Baltodano Briceño Hospital, in Liberia, to care for patients. However, new cases continue to overwhelm services and deaths continue.
This situation is aggravated by the socioeconomic condition of the majority of these workers, often migrants without a stable job and with limited access to health services.
