Reasons for never receiving a pap test among Brazilian women: National health survey

Abstract

Objective: To identify reasons among Brazilian women for never having a Pap test. Design:We designed a cross-sectional study that used data from the National Health Survey.Sample: Two thousand four hundred and two women 25-64 years old who never had a pap test.Measures: Variables were age, race, education, marital status, housing condition, primary health care access, health insurance, self-perceived health, and social support network. We calculated the prevalence of different reasons and odds ratios for each. Results:The most frequent reason for never having a test were linked to women thinking the test was unnecessary (42.3%) which had a significant association with marital

Inequalities in Temporal Effects on Cervical Cancer Mortality in States in Different Geographic Regions of Brazil: An Ecological Study

“…Despite the reduction in the number of records classified as UCOUP from the 2000s onwards in the analyzed areas, the proportion of deaths from this cause remains high, especially in elderly women, with numbers higher than those for endometrial cancer, even in places with higher socioeconomic development. These results suggest a low level of diagnostic problem-solving capacity in the Brazilian health system, and also that part of the female population does not have access to, or does not adhere to, the screening program [13,[18][19][20][21][22]47,48]. Although Pap test coverage has increased in Brazil, it remains lower than 85% in all the regions, with the worst indexes in the places with the lowest socioeconomic development [11].…”

“…Additionally, the frequency of carrying out the test is irregular, and there are limitations in access to diagnostic services, which often results in late CC diagnosis Another point is that the diagnosis does not always ensure that treatment will be initiated and continued, since there are also limitations in access to specialized cancer services, which are also concentrated in the most developed areas. Therefore, a considerable percentage of women under cancer treatment receive care in municipalities or even states other than those where they live [48,49].…”

“…In theory, the implementation of health policies should promote period effects in all age groups included in the recommendations (in Brazil, the priority group is women from 25 to 64 years old). However, because there are differences in access to health services depending on age group, a cohort effect may exist on CC incidence and mortality, since exposure to these protective factors differs according to age [5][6][7]9,11,[18][19][20][21][22]48,[51][52][53][54][55][56][57]. The increase in relative risk (RR) of death observed in cohorts in the 1985-1999 period in the state of Rio de Janeiro deserves attention.…”

“…The increase in relative risk (RR) of death observed in cohorts in the 1985-1999 period in the state of Rio de Janeiro deserves attention. It can be conjectured that this effect may be correlated with two main situations: limits in the screening program, which still fails to reach women with higher risk of developing the disease, such as black and indigenous women, and those with a lower level of education and income, as discussed above [18][19][20][21][22]48,49] and changes in the CC histological type [3,5,56,68]. Studies in South Korea, Canada, and Estonia have shown an increase in incidence and mortality in young women diagnosed with adenocarcinoma and a reduction in these rates in women diagnosed with squamous cell carcinoma [3,5,56,68].…”