How protective is cervical cancer screening against cervical cancer mortality in developing countries? The Colombian case

Abstract

BackgroundCervical cancer is one of the top causes of cancer morbidity and mortality in Colombia despite the existence of a national preventive program. Screening coverage with cervical cytology does not explain the lack of success of the program in reducing incidence and mortality rates by cervical cancer. To address this problem an ecological analysis, at department level, was carried out in Colombia to assess the relationship between cervical screening characteristics and cervical cancer mortality rates.MethodsMortality rates by cervical cancer were estimated at the department level for the period 2000-2005. Levels of mortality rates were compared to cervical screening coverage and other characteristics of the program. A Poisson regression was used to estimate the effect of different dimensions of program performance on mortality by cervical cancer.ResultsScreening coverage ranged from 28.7% to 65.6% by department but increases on this variable were not related to decreases in mortality rates. A significant reduction in mortality was found in departments where a higher proportion of women looked for medical advice when abnormal findings were reported in Pap smears. Geographic areas where a higher proportion of women lack health insurance had higher rates of mortality by cervical cancer.ConclusionsThese results suggest that coverage is not adequate to prevent mortality due to cervical cancer if women with abnormal results are not provided with adequate follow up and treatment. The role of different dimensions of health care such as insurance coverage, quality of care, and barriers for accessing health care needs to be evaluated and addressed in future studies.

Inequities in cervical cancer screening among Colombian women: A multilevel analysis of a nationwide survey

“…Barriers for enrolling, co-payments established by health insurance companies, or lack of specialists are difficulties faced by rural people with no insurance in Colombia [39]. Additionally, Pap screening in the Atlantic and Amazon-Orinoquía regions is particularly poor [40], especially in rural areas, as we identified.…”

Acceptance of cervical and breast cancer screening and cancer awareness among women in Villupuram, Tamil Nadu, India: A cross sectional survey

“…14,15 Poor awareness of symptoms and consequences might lead to delayed health seeking and higher mortality in the absence of proactive interventions to improve early detection. 10,[16][17][18] Lack of awareness of treatment of cervical and breast cancer might lead to lack of compliance to follow-up diagnostic investigations and further treatment, which is a major hurdle for the success of the screening programs. 19 The messages in the awareness programs need to be specifically designed to enhance the understanding regarding risk factors, benefits of early detection, and the available treatment options.…”

Barreras para la detección oportuna del cáncer cervicouterino en Colombia: una revisión narrativa

“…Por otro lado, en Colombia la repetición constante y la falta de un seguimiento sistematizado de mujeres con anormalidades citológicas no aseguran un diagnóstico y tratamiento oportuno (27). Por consiguiente la literatura ha demostrado que las tasas de mortalidad en Colombia están relacionadas con las bajas tasas de seguimiento de citologías anormales no con la cobertura del tamizaje como se ha creído (29,30) en Tabla 3.…”