Loss to follow-up of women with initial cervical cytology of ASC-US/LSIL in Tocantins, Brazil

Jucimária Dantas Galvão,Fábio Russomano,Felipe Campos

doi:10.33448/rsd-v10i6.15660

Abstract

Objective: The study aims to characterize loss to follow-up of women with initial cytological diagnosis of atypical squamous cells of undetermined significance, possibly non-neoplastic (ASC-US), or low-grade squamous intraepithelial lesion (LSIL), in Tocantins State, Brazil, from 2011 to 2013. Study Design: Cervical cytology data from the Information System on Uterine Cervical Cancer (SISCOLO) was used to identify women with initial diagnosis of ASC-US or LSIL in 2011. Nominal database record linkage was used to identify women with previous altered Pap smear results (who were excluded) and those who returned (versus failed to return) by the year 2013. Results: Record linkage identified 1,174 women with diagnoses of ASC-US (65.9%) or LSIL (34.1%) and without previous altered tests. According to the data, 55.9% and 53.5%, respectively, failed to undergo follow-up tests in the subsequent years. Conclusion: Failure to return for repeat cervical cytology suggests a missed opportunity for diagnosis and treatment of women with precursor lesions or cervical cancer not detected in the initial cytology, thus compromising the effectiveness of cervical cancer control in the State of Tocantins.

Highlights

Cancer of the uterine cervix (CCU) is an important public health problem in Brazil, with relevant regional differences
The control of follow-up cervical cytology is affected by organizational deficiencies and difficulties in locating women via active search, resulting in an unknown loss to follow-up rate with a possible missed opportunity for the diagnosis and treatment of precursor lesions or initial cancer, undiagnosed in the initial examination (Galvão, 2017; INCA, 2016)
The current study aimed to identify the magnitude of loss to followup of women with ASC-US or low-grade squamous intraepithelial lesion (LSIL) cytology and possible factors associated with women’s non-adherence to follow-up in Tocantins State, Brazil, using data available in the SISCOLO database and probabilistic record linkage

Summary

Introduction

Cancer of the uterine cervix (CCU) is an important public health problem in Brazil, with relevant regional differences. In Tocantins State, located in the North of Brazil, cervical cancer is the most frequent neoplasia in females, with an estimated incidence of 33/100,000 women, greater severity of diagnosed cases and high mortality (Galvão, 2017; INCA, 2017). The current CCU screening strategy in Brazil is cytopathological examination every three years after two negative annual tests, for women between 25 and 64 years of age (INCA, 2016). The control of follow-up cervical cytology is affected by organizational deficiencies and difficulties in locating women via active search, resulting in an unknown loss to follow-up rate with a possible missed opportunity for the diagnosis and treatment of precursor lesions or initial cancer, undiagnosed in the initial examination (Galvão, 2017; INCA, 2016). A possibility for reducing loss to follow-up of these women is the identification of those at increased risk of presenting more important lesions, based on screening tests such as dual stain testing of proteins involved in viral oncogenesis or presence of oncogenic human papilloma virus (HPV) DNA (Cuschieri et al, 2018; de Melo et al, 2016)

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Conclusion