Cervical cancer screening program of Paraná: Cost‐effective model in a developing country

Abstract

The purpose of this study is to report the organization of a cost-effective screening program for cervical cancer in a developing country such as Brazil. The Cervical Cancer Screening Program of Paraná (CCSPP) was launched in October 1997 and was the result of a joint collaboration between the government of Paraná (Secretary of Health of the State of Paraná), scientific societies (pathologists, gynecologists, and nurses), and a non governmental organization called the Women's Popular Forum of Paraná. The main goal of the program was to enhance the Papanicolaou (Pap) smear screening to coverage up to 85% of female adult population with a 3-yr interval between examinations, as well as to reduce the incidence and mortality from cervical cancer in the state of Paraná, a Southern state of Brazil. The cytological findings in all Pap smears recorded in a central computer-based register during 5 yr of the program (October 1997-October 2002) are discussed. During that period, 2,244,158 Pap smears were performed in women included in the program from the 398 cities of the state of Paraná. The cytological smears were analyzed according to the Bethesda System. The previous year, before the program was launched, a Pap smear was taken from 43% of women of Paraná. At the end of 5 yr, coverage was increased to around 86%. The great majority of examinations had a negative result (98%). Only 2% of examinations had cytological abnormalities (n = 44,621). Low-grade lesions predominated in women aged 15-30 yr, and the high-grade lesions were more common in women aged 25-45 yr. Patients older than 40 yr had the greatest incidence of invasive cancer. Although the program is only 5 yr old, a decrease in the mortality from cervical cancer in women from Paraná is clearly apparent: in 1998, 297 women died of cervical cancer, as compared with 188 as of September 2002.

100% Rapid Rescreening for Quality Assurance in a Quality Control Program in a Public Health Cytologic Laboratory

“…11,12 A systematic review of 10% in a prevention program can improve the quality of the cytologic examination. 13 Rapid, or partial, review (RR) of all smears initially interpreted as within normal limits or as inadequate has been introduced in the United Kingdom as an alternative and more useful QC standard. 14 This method consists of quickly rescreening, for 30-120 seconds, all negative and inadequate slides to detect those that might contain missed abnormalities.…”

Quality assurance in cervical screening of a high risk population: A study of 65,753 reviewed cases in Parana screening program, Brazil

“…When the review diagnosis was not in agreement with the primary diagnosis, the case was discussed with other QAU members by using a multiheaded microscope. 13 The slide screeners were provided with feedback of their individual performance. The professionals who were two standard deviations below the mean performance score were submitted to a reeducational program.…”

Monitoring the profile of cervical cancer in a developing city

“…The Brazilian state of Paraná, in southern of Brazil, increased the Pap test coverage from 43% in 1997 to approximately 86% in 2002; this was sufficient to reduce mortality by approximately 30% [12]. This also demonstrates the feasibility of implementation of an opportunistic Pap screening program in developing countries, which can effectively reduce cervical cancer mortality rates.…”