Regional and Socioeconomic Differences in the Coverage of the Papanicolau Test in Brazil: Data from the Brazilian Health Survey 2013

Abstract

Keywords► papanicolaou test ► cervical neoplasms ► women's health ► early detection of cancer ► inequalities in health ► epidemiology AbstractPurpose To evaluate the coverage of the Papanicolaou test in Brazil and the associated factors. Methods Cross-sectional study based on data from the Brazilian Health Survey 2013 comprising the proportion of 25-to 64-year-old women who had undergone a Papanicolaou test within the previous 3 years, categorized by sociodemographic variables and access to healthcare services. Results The screening coverage in Brazil was of 79.4% (95% confidence interval [95%CI]: 78.4-80.3), showing significant differences between the different states of the country, with the highest rate in the state of Roraima (86.5; 95%CI: 83.5-89.4), and the lowest one in the state of Maranhão (67.7; 95%CI: 61.3-74.0). Undergoing the test was significantly more frequent among married women (83.6%; 95%CI: 82.4-84.8), those with higher educational levels (88.7%; 95%CI: 87.0-90.5), of white ethnicity (82.6%; 95%CI: 81.3-83.9) and who reside in urban areas (80.1%; 95%CI: 79.1-81.2). Those who had undergone the test more than three years prior to the survey and the ones who had never undergone it were associated with a lower level of education, being of black or brown ethnicity, single or divorced, and rural dwellers. Conclusions The coverage of cervical cancer screening in Brazil is below the recommended rate and presents regional and sociodemographic disparities. ResumoObjetivo Avaliar a cobertura do exame Papanicolau no Brasil e os fatores associados. Métodos Estudo transversal a partir dos dados da Pesquisa Nacional de Saúde 2013 relativos à proporção de mulheres de 25 a 64 anos que realizaram pelo menos um exame Papanicolau nos últimos 3 anos, categorizados por variáveis sociodemográficas e de acesso aos serviços de saúde.

Differential Impact of Education Level, Occupation and Marital Status on Performance of the Papanicolaou Test among Women from Various Regions in Brazil

“…However, two recent studies from Jordan and Saudi Arabia, as well as a study from India, revealed no association between education and Pap smear performance (Dinshaw et al, 2007;Rifai and Nakamura, 2015;Salem et al, 2017). An increased chance of Pap smear performance for women with higher educational levels, was also reported by most authors of Brazilian studies (Novaes et al, 2006;Muller et al, 2008;Albuquerque et al, 2009;Fernandes et al, 2009;Gasperin et al, 2011;Correa et al, 2012;Martínez-Mesa et al, 2013;Oliveira et al, 2014;Filha et al, 2016;Barbosa, 2017). However, a study including 6,750 households in the state of São Paulo, and a study of 493 women from Piauí revealed that education was not significantly associated with performance of the Pap smear (Albuquerque et al, 2014;Amorim and Barros, 2014).…”

“…Recent studies from Saudi Arabia and Iran, by contrast, did not show an association between civil status and Pap smear performance (Farzaneh et al, 2017;Salem et al, 2017). Most Brazilian studies that included civil status in their analysis also showed that women who lived in stable relationships had a higher chance to perform Pap smear than did women who did not live in a stable relationship (Novaes et al, 2006;Gasperin et al, 2011;Albuquerque et al, 2009;Albuquerque et al, 2014;Amorim and Barros, 2014;Oliveira et al, 2014;Filha et al, 2016;Barbosa, 2017). Two previous Brazilian studies, by contrast, did not show an association between civil status and Pap smear performance (Muller et al, 2008;Fernandes et al, 2009).…”

“…Regarding socio-economic variables that affect women's screening behavior, several previous Brazilian studies focused on public databases without explaining causal factors of differences between distinct populations (Novaes et al, 2006;Correa et al, 2012;Martínez-Mesa et al, 2013;Amorim and Barros, 2014;Filha et al, 2016;Barbosa, 2017). Other studies focused on single local populations of different regions in Brazil (Muller et al, 2008;Fernandes et al, 2009;Albuquerque et al, 2009;Gasperin et al, 2011;Albuquerque et al, 2014;Oliveira et al, 2014).…”

Câncer cervical: uma análise descritiva da incidência, mortalidade e métodos de rastreamento em diferentes países

“…O estudo de Gakidou et al (2008) [30] revelou que no Brasil a cobertura é de 73%, variando de 60% a 90% entre a população mais pobre e a mais rica, respectivamente. Recentemente, o estudo de Barbosa (2017) [31] mostrou uma taxa de cobertura de 79,4% com diferenças entre os Estados que variaram de 67,7 % no Maranhão (mais baixa) a 86,5% em Roraima (mais alta). É evidente que a taxa de cobertura tem melhorado nos últimos anos [32], mas ainda há diferenças expressivas entre as diferentes regiões que precisam ser corrigidas [31].…”

“…Recentemente, o estudo de Barbosa (2017) [31] mostrou uma taxa de cobertura de 79,4% com diferenças entre os Estados que variaram de 67,7 % no Maranhão (mais baixa) a 86,5% em Roraima (mais alta). É evidente que a taxa de cobertura tem melhorado nos últimos anos [32], mas ainda há diferenças expressivas entre as diferentes regiões que precisam ser corrigidas [31]. Essas diferenças regionais de cobertura podem refletir também em importantes diferenças regionais da incidência e mortalidade pelo câncer cervical [33].…”