Abstract
Brazil is a country with strong socioeconomic disparities, which may explain the different rates of cervical cancer incidence and mortality and influence the quality of cervical cancer screening tests. The aim of this study was to perform a trend analysis of some quality indicators of Pap smears according to the Municipal Human Development Index (MHDI). Information about cytopathological exams (approximately 65,000,000) performed from 2006 to 2014 in women ages 25 to 64 years was obtained from the Cervical Cancer Information System (SISCOLO). The average annual percentage change (AAPC) for each indicator was calculated using the Joinpoint Regression Program, according to MHDI levels. Very low frequencies of unsatisfactory cases (<5%) were observed at different MHDI levels. Although the positivity index in the low- and medium-MHDI groups has increased, the values remained below international recommendations (3%-10%). The HSIL (high-grade squamous intraepithelial lesion) percentage remained stationary at all levels of the MHDI. In the low- and medium-MHDI groups, most quality indicators were below the recommendations by Brazilian National Cancer Institute INCA, with no improvement trend; in the high-MHDI group, the majority of the indicators also presented no improvement, although they show slightly better quality indicators. The MHDI should be considered in the definition of the policies of the screening program for cervical cancer in Brazil, and the current program may require adjustments to achieve improved efficiency.
Highlights
Cervical cancer, with an estimated 570,000 new cases and 311,000 deaths in 2018 worldwide, is the fourth-most frequently diagnosed cancer and the fourth-leading cause of cancerrelated death in women
A yearly significant increase was observed in the percentage of atypical squamous cells (ASC)-US (AAPC 1⁄4 3.51), percentage of atypical squamous cells (ASC-H) (AAPC 1⁄4 4.78), percentage of ASC (AAPC 1⁄4 3.90), percentage of ASC/abnormal (AAPC 1⁄4 2.81) and ASC/squamous intraepithelial lesion (SIL) ratio (AAPC 1⁄4 6.94), and a significant decrease was observed in the percentage of low-grade squamous intraepithelial lesion (LSIL) (AAPC 1⁄4 À3.64)
It should be noted that a different behavior in the trend during the period under study was observed for the percentage of ASC-H, which remained stationary until 2009 and underwent a significant increase of 7.57% per year from 2009 to 2014, and for the percentage of LSIL, which suffered a significant decrease of 7.84% per year from 2006 to 2009 and remained stationary until 2014
Summary
With an estimated 570,000 new cases and 311,000 deaths in 2018 worldwide, is the fourth-most frequently diagnosed cancer and the fourth-leading cause of cancerrelated death in women. Economic profile, cervical cancer is the second-most common in incidence and mortality [1]. In 2017, Brazil was classified as a high HDI country (0.759; http://hdr.undp.org/en/countries/profiles/BRA), whereas in 2010, the Municipal Human Development Index (MHDI) varied from 0.418 (Melgaco) to 0.862 (S~ao Caetano; http:// www.atlasbrasil.org.br/2013/pt/download). Because of these MHDI disparities, the incidence and mortality rates of cervical cancer vary widely in Brazil. For 2019, 16,379 new cases are estimated in Brazil, with an estimated risk of 15.43/ 100,000 women, as cervical cancer is the third-most common cancer among women
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
