Abstract
ABSTRACTOBJECTIVE To examine whether demographic and socioeconomic variables and the variables of the organization of services are associated with the quality of cervical cancer screening.METHODS This is a survey carried out in the health services of the five Brazilian regions in 2012. The sample consisted of users of basic health units participating in the Program for Improving Access and Quality of the Primary Care. The independent variables analyzed were: socioeconomic characteristics (municipal context), demographic characteristics (user profile), and two domains related to the organization of basic services (work structure and process). The low quality of the screening was assessed from the lack of access, late examination, and lack of guidance. Crude and adjusted analyses by Poisson regression assessed the association between outcomes and independent variables.RESULTS The values of lack of access, late examination, and lack of guidance were 6.7%, 11.2%, and 19.2%, respectively. Problems of quality were lower according to the increase in Municipal Human Development Index and per capita household income, increasing with population size and municipal coverage of the Family Health Strategy. The Midwest region of the country presented the highest occurrences of low quality outcomes. Indigenous and yellow women had the highest prevalence of outcomes. Women with partner, who received the Bolsa Família Program, and who had paid work had less chances of having lack of access, late examination, and lack of guidance. The appropriate work process in health services decreased the likelihood of low quality in all indicators.CONCLUSIONS Investments in the work process of health teams, social cash transfer programs, and social conditions of the population are essential to improve the quality of the program of cervical cancer screening in Brazil.
Highlights
Cervical cancer is an important public health problem, being the third most frequent and the fourth cause of mortality in women in Brazil, with an annual incidence of 16,340 cases, estimated risk of 15.85 cases per 100,000 women, and mortality rate of 4.86 cases per 100,000 women[9].According to the parameters of the World Health Organization (WHO), the estimated incidence of this cancer should be up to 16.3 cases per 100,000 women and, for mortality, 7.3 per 100,000 women
Problems of quality were lower according to the increase in Municipal Human Development Index and per capita household income, increasing with population size and municipal coverage of the Family Health Strategy
Investments in the work process of health teams, social cash transfer programs, and social conditions of the population are essential to improve the quality of the program of cervical cancer screening in Brazil
Summary
Cervical cancer is an important public health problem, being the third most frequent and the fourth cause of mortality in women in Brazil, with an annual incidence of 16,340 cases, estimated risk of 15.85 cases per 100,000 women, and mortality rate of 4.86 cases per 100,000 women[9].According to the parameters of the World Health Organization (WHO), the estimated incidence of this cancer should be up to 16.3 cases per 100,000 women and, for mortality, 7.3 per 100,000 women. The challenge of Brazil is to reduce them further, using as references Western Asia, with incidence of 4.4 cases per 100,000 women, as well as Australia and New Zealand, with incidences of 5.5 cases per 100,000 women, which, along with Western Europe, have death rates of less than two per 100,000 women[28] In this context, care actions become relevant for women’s health and cervical cancer screening, priorities for the Brazilian Unified Health System (SUS) and the Brazilian research agendaa. In Brazil, the Plano de Enfrentamento de Doenças Crônicas 2011–2022 (2011–2022 Plan for Combating Chronic Diseases)[17] set a goal of 85% for the coverage of the exam Screening in this age group is justified by the increased occurrence of high grade lesions, which can have effective treatment, preventing its evolution into cancer[9]. Among the criteria for the screening test, we can mention security, easy acceptance, proven sensitivity and specificity, and good cost-effectiveness[9], which are found in the Pap smear test
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