Determinants of late stage diagnosis of cervical cancer in Brazil

Abstract

To assess the determinants of late stage in women with cervical cancer in Brazil. A cross-sectional study of secondary basis. Women with invasive cervical cancer enrolled in the Cancer Hospital Registry between January 2000 and December 2009 were included. Late clinical stage (≥IIB) was the outcome considered. The following variables were studied: age at diagnosis, race or ethnicity, years of education, marital status, alcohol consumption, smoking status, place of residence, year of diagnosis, initial treatment received, and status after the first treatment. Odds ratio (OR) with 95% confidence intervals (95%CI) and a logistic regression model were used. P values<0.05 were considered statistically significant. 37,638 cases were included, with a mean age of 52.4±14.1 years. Late clinical stages were observed in 70.6% of cases and were associated with the presence of squamous cell carcinoma (OR=1.8; 95%CI 1.7-2.0), age ≥50 years (OR=1.5; 95%CI 1.4-1.6), living with a partner (OR=1.3; 95%CI 1.2-1.4), black skin color (OR=1.2; 95%CI 1.1-1.4), and low educational level (OR=1.2; 95%CI 1.1-1.3). In Brazil, the diagnosis of cervical cancer is a delayed event. Although the main factor associated with late stage of cervical cancer identified in this study is a biological factors (histological type) and, consequently, not eligible for intervention, it was confirmed that socioeconomic disparities in the country are associated with late stage disease.