Abstract
With the aim of assessing the occurrence of severe intimate partner physical violence as a risk factor for inadequate screening of uterine cervical cancer, a case-control study was performed with a multidimensional questionnaire in a sample of 640 users of the Family Health Strategy in the Municipality of Nova Iguaçu, Rio de Janeiro State, Brazil. Cases were defined as women who had not had a cervical cytology test in the previous three years. The results showed that severe physical violence against the woman (adjustedOR = 2.2; 95%CI: 1.1-4.4) and co-occurrence of the event in the couple (adjustedOR = 3.8; 95%CI: 1.4-9.8) were risk factors for inadequate screening. Alcohol abuse by the woman was an effect modifier for not having the test among victims of violence (adjustedOR = 10.2; 95%CI: 1.8-56.4) and in cases of co-occurrence of violence (adjustedOR = 8.5; 95%CI: 1.4-50.7). In addition to known causal factors for intimate partner violence, the results point to a risk association between women's exposure to abuse and inadequate screening. The findings call for an expanded view of women's absenteeism from screening, since this indicator can represent unmet demands not readily detected by health teams.
Highlights
Uterine cervical cancer is still a leading cause of death in women and is a relevant and challenging public health problem 1
Based on the proposed theoretical model, the current study aims to assess severe intimate partner physical violence as a risk factor for inadequate cervical cancer screening in the context of the Family Health Strategy (FHS)
In order to maintain the procedure for entering the regression model, the calculations were presented for the respective odds ratio (OR) for the variables “age bracket” and “economic class” in their continuous form, respectively 1.0 (95%CI: 1.0-1.0; p-value = 0.001) and 0.99 (95%CI: 0.9-1.0; p-value = 0.708), as well as for the race/color variable in its original format, that is, with all the categories
Summary
Uterine cervical cancer is still a leading cause of death in women and is a relevant and challenging public health problem 1. The combination of strategies to prevent human papillomavirus infection and systematic cervical screening has been identified as one of the most cost-effective measures for reducing morbidity and mortality from the disease, and is the basis for strategies to control this cancer in Brazil [2,3]. Since 2011, Brazil has expanded the target age bracket for screening, recommending that women 25 to 64 years of age have a cervical cytology test at least every three years after two subsequent negative results with an interval of less than a year. The use of other diagnostic techniques, and when applicable confirmatory tests for the disease, are only indicated in the presence of atypical results in the first screening phases, avoiding unnecessary tests and rationalizing health system costs 4. The survey’s results show coverage close to 80%, as recommended by the World Health Organization (WHO) 6, there are large regional screening differences, ranging from 73.1% to 81.3% in the Northeast and Southeast of Brazil, respectively
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