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.
Highlights
Cervical cancer is one of the top causes of cancer morbidity and mortality in Colombia despite the existence of a national preventive program
The largest proportion of women who failed to collect the results was in Boyacá (17.4%) which had the lowest proportion of women looking for medical advice when cervical abnormalities were reported (64%) (Table 1)
The proportion of women looking for treatment after an abnormal result was associated moderately with mortality by cervical cancer
Summary
Colombia is a middle income South American country with 46 million inhabitants. It is divided in 32 departments plus the capital district, Bogotá. Study design An ecological analysis was carried out comparing rates of cervical cancer mortality with screening coverage and follow up indicators at the departmental level. Dependent variable Mortality rates by cervical cancer were estimated using the 2000-2004 mortality records from the National Department of Statistics An additional variable included in the analysis was the proportion of women covered by any of the health insurance regimes by department. Analysis The 33 departments were classified according to values of mortality and screening characteristics They were grouped within 4 categories according to the frequency of cervical cancer mortality (0-9.9 per105, 10.4-12.7 per105, 12.9-15.6 per 105, and 16.0-21.8 per105.) Variables related to cervical cancer screening were categorized by quartiles. Proportion of women with an abnormal cervical cytology who contacted their health care provider to receive treatment 4.
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