Incidence rates and temporal trends of cervical cancer relating to opportunistic screening in two developed metropolitan regions of Brazil: a population-based cohort study

Abstract

Cervical cancer remains an important burden in relation to women's health, especially in places with limited resources. The Brazilian government estimated that there would be 16,370 new cases in 2018, 1 with great regional variability. Thus, cervical cancer was placed as between the first and fourth most prevalent forms of cancer among women. 1,2 Cervical cancer and its precursor lesions can be detected by screening. The success of population screening programs relates to their level of organization. Organized programs have defined target populations (age, screening interval and satisfactory access), predefined treatment algorithms, management teams, structures for quality assurance, surveillance systems, enough coverage and population education. Such programs have the potential to decrease cervical cancer rates by 80%. 3 In contrast, there are opportunistic screening programs, such as the official population-screening program of the Brazilian National Health System (Sistema Único de Saúde, SUS). There is no registration system to control the screened or unscreened population and cytological tests are performed opportunistically, as a result of recommendations made during routine medical consultations, based on presence of increased risk of developing cancer, or through self-referral. The Brazilian program indicates that conventional cytological tests should be performed every three years, after two consecutive negative tests with a one-year interval between them, for women aged 25 to 64 years. 4 However, the age range and test interval recommendations are

Cervical cancer in women under 25 years of age and outside the screening age: Diagnosis profile and long‐term outcomes

“…The diagnosis of CC before 25 years of age corresponded to 1.5% of all cases, with an increasingly linear trend in the studied period, although it was not statistically significant. This proportion is very low but slightly higher than that described in the literature, which is approximately 1%, corroborating some studies that indicated a progressive increased incidence of CC in young women, particularly of non‐SCC histological types 8,13,14 …”

“…Brazilian official information shows that only 1.2% of CC cases affect women under 25 years of age 12 . Additionally, a recent study showed that 1.6% (54/3364) of CC was detected in younger women in two developed regions from Brazil, with an increasing trend in the Campinas region from 0.6% in 2001–2002 to 3.1% in 2011–2012 8 …”

“…There is variable adherence to these guidelines with 20% of the cervical cytology tests performed before 25 years of age 5,6 . The efficiency of the program varies, which is reflected in the different incidence and mortality rates for different regions 7,8 …”

“…5,6 The efficiency of the program varies, which is reflected in the different incidence and mortality rates for different regions. 7,8 Squamous cell carcinoma (SCC) is the most common histological type, corresponding to 75%-90% of all CC, followed by adenocarcinoma. 9 Adenocarcinoma of the cervix usually occurs in younger women and is diagnosed at a more advanced stage than SCC.…”

“…12 Additionally, a recent study showed that 1.6% (54/3364) of CC was detected in younger women in two developed regions from Brazil, with an increasing trend in the Campinas region from 0.6% in 2001-2002 to 3.1% in 2011-2012. 8 Due to the low incidence of this cancer in young women, the evidence on its prognosis is conflicting. 13,14 This study aims to evaluate the pattern of CC diagnosed in women under 25 years, as well as the treatment outcomes and survival rate.…”