Cervical cancer screening coverage in a high-incidence region

Abstract

OBJECTIVE To analyze the coverage of a cervical cancer screening program in a city with a high incidence of the disease in addition to the factors associated with non-adherence to the current preventive program.METHODS A cross-sectional study based on household surveys was conducted. The sample was composed of women between 25 and 59 years of age of the city of Boa Vista, RR, Northern Brazil who were covered by the cervical cancer screening program. The cluster sampling method was used. The dependent variable was participation in a women’s health program, defined as undergoing at least one Pap smear in the 36 months prior to the interview; the explanatory variables were extracted from individual data. A generalized linear model was used.RESULTS 603 women were analyzed, with an mean age of 38.2 years (SD = 10.2). Five hundred and seventeen women underwent the screening test, and the prevalence of adherence in the last three years was up to 85.7% (95%CI 82.5;88.5). A high per capita household income and recent medical consultation were associated with the lower rate of not being tested in multivariate analysis. Disease ignorance, causes, and prevention methods were correlated with chances of non-adherence to the screening system; 20.0% of the women were reported to have undergone opportunistic and non-routine screening.CONCLUSIONS The informed level of coverage is high, exceeding the level recommended for the control of cervical cancer. The preventive program appears to be opportunistic in nature, particularly for the most vulnerable women (with low income and little information on the disease). Studies on the diagnostic quality of cervicovaginal cytology and therapeutic schedules for positive cases are necessary for understanding the barriers to the control of cervical cancer.

Critical Analyses of the Introduction of Liquid-Based Cytology in a Public Health Service of the State of São Paulo, Brazil

“…It is important to mention that between 2009 and 2011 the National Institute of Science and Technology of the Diseases Associated to the Papillomavirus (INCT-HPV) performed an assessment study of molecular techniques and proposed new algorithms for cervical cancer screening, which showed a very high negative predictive value (>99%) and high sensitivity [14]. Currently, the INCT-HPV is engaged with FOSP to initiate projects towards screening improvements.…”

“…The São Paulo State Secretary of Health (SES) is responsible for the collection and analysis of approximately 2.5 million Pap tests per year, and the Fundação Oncocentro de São Paulo - FOSP (with the third-largest volume) performs about 250,000 of these tests. Under this scenario, molecular techniques could favor cervical cancer screening because of its very high negative predictive value (>99%) and high sensitivity [14]. Data from the Hospital Cancer Registry of the FOSP show that the proportion of women under 30 years of age with invasive cervical cancer is small.…”

Cytopathologic evaluation of patients submitted to radiotherapy for uterine cervix cancer

“…However, it is only diagnosed microscopically. 8,[25][26][27] From the practical point of view, it is impossible in smears to accurately ensure that a carcinoma lesion is microinvasive. The cytological pattern may resemble a high-grade squamous intraepithelial lesion or an invasive carcinoma.…”

“…The most reliable criterion to establish the viability of neoplastic cells is the finding of mitoses. 26,27,34 Since radiotherapy is associated with characteristic cytological changes, including nuclear activation, increased cytoplasm (with preservation of the nuclear-cytoplasmic ratio), cytoplasmic vacuolization, eosinophilia, polychromasia, multinucleated giant cells, nuclear membrane blebbing and nuclear vacuolization, as well as repair cells, atypical stromal cells, endothelial cells and macrophages, 29,31,35 cytological samples should be collected a few months after radiotherapy. However, it is true that radiotherapy is associated with unsatisfactory samples.…”

Cervical cancer control in Latin America: A call to action

“…However, these algorithms are expensive and require high‐level infrastructure, well‐trained personnel, and patient participation, which is particularly challenging for vulnerable and underserved populations . For example, a study from Boa Vista, in the Brazilian state of Roraima, reported that although 86% of eligible women participate in screening, the incidence of CC remains high, presumably because screened women with abnormal findings do not receive timely care …”