Abstract
BackgroundDisparities in cancer incidence and mortality rates between regions arise due to differences in socioeconomic conditions and in human development factors. The major purpose of this study was to measure the role of the Human Development Index (HDI) in the pattern of cervical cytological abnormalities (CCAs).MethodsThis was an analytical sectional study involving a review of secondary cervical cytology data collected from women living in the state of Maranhão, Brazil, in 2007–2012 and collected from the Cervical Cancer Information System (Sistema de Informação do Câncer do Colo do Útero - SISCOLO). The cervical screening results were classified according to the Brazilian Classification of Cervical Reporting (Nomenclatura Brasileira para Laudos Cervicais), an adaptation of the Bethesda System. The Municipal Human Development Index (MHDI) was used, which is an adaptation of the global HDI. The association between CCAs and MHDI was evaluated using the chi-squared test and odds ratios (ORs) with 95 % confidence intervals (95 % CI). The significance level used for all tests was 5 %.ResultsWe analysed 1,363,689 examinations of women living in the state of Maranhão. CCAs were identified in 2.0 % of smears in municipalities with high MHDI, 2.2 % in those with medium or low MHDI and 4.1 % in those with very low MHDI. In addition, potentially malignant changes and suspected cervical cancer (HSIL+) were 40.0 % more frequent (0.3 %) in municipalities with medium or low MHDI and 3.6 times more frequent (0.8 %) in municipalities with very low MHDI compared to those with high MHDI (0.2 %).ConclusionThe association between MHDI and the occurrence of CCAs and HSIL+ shows that more developed areas with more effective health services have a lower prevalence of these lesions. To control cervical cancer, it is necessary to reduce social inequality and improve the availability of health services.
Highlights
Disparities in cancer incidence and mortality rates between regions arise due to differences in socioeconomic conditions and in human development factors
The capital of the state, São Luís, contributed with 21.5 % of patients; 68.7 % were from municipalities with medium or low Municipal Human Development Index (MHDI), 31.0 % from municipalities with high MHDI and 0.3 % from municipalities with very low MHDI
The natural history of cervical cancer was replicated in the results found for the average age of women according to cytological atypia in squamous cell diagnoses, demonstrating its evolutionary character, with an interval between Low-grade squamous intraepithelial lesion (LSIL) and high-grade squamous intraepithelial lesion (HSIL) of 12.8 years and between HSIL and squamous cell carcinoma (SCC) of 10.8 years
Summary
Disparities in cancer incidence and mortality rates between regions arise due to differences in socioeconomic conditions and in human development factors. Cervical cancer is the fourth-most common cancer in women, with 528,000 new cases annually and 266,000 deaths in 2012. It has become a major public health problem [1]. Pinho-França et al BMC Women's Health (2016) 16:54 which historically tend to underreport data, as 23.7 % of expected cases are found in the capital São Luís, with an estimated crude incidence rate of 42.58/100,000 women [2]. In Brazil, cervical cancer screening programs are based on Pap smear testing. Defined standards and criteria are used to measure the quality of cytopathology testing and to assess the performance of public and private laboratories providing services to the Brazilian Unified Health System (Sistema Único de Saúde – SUS)
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