Cervical cancer: 21.4% of Brazilian women undergo screening

The study A Look at the Diagnosis of Cervical Cancer in Brazil, carried out by the Cancer Foundation, found that 21.4% of women who undergo the cytopathological exam (Papanicolaou), used in Brazil to screen for cervical cancer , are outside the age range recommended by the Ministry of Health and the World Health Organization (WHO), which is between 25 and 64 years old.

The exam should be performed every three years by women who have already started sexual activity, trans men and non-binary people designated female at birth. The survey was based on data from the National Health Survey (PNS), by the Ministry of Health, released last year. The full study can be accessed on the website.

In an interview with Agência Brasil, the medical consultant at the Cancer Foundation and collaborator of the study, Flávia Corrêa, explained that most of these women undergo the Pap smear before the age of 25, “which is very problematic, because before the age of 25 what we have a peak prevalence of HPV infection”. Doctor in collective health of children and women, the doctor clarified that when doing Pap smears before the age of 25, there is a great possibility of detecting an infection by HPV that, in this age group, spontaneously regresses, most of the time. “But, if it is diagnosed, it will require an additional investigation and, if the person mishandles the case, it may even undergo unnecessary treatment”, warned Flávia Corrêa.

The survey reveals that among Brazilian women who have never been screened for the disease, 45.7% are aged between 25 and 34 years. This pattern is repeated in all regions of the country. In the North and Midwest, however, the indexes reached 51.5% and 52.9%, respectively. “This is reflected in the mortality numbers, which are much higher there than here.” Women who are up to date with the preventive (less than 3 years) are in the range of 35 to 49 years old throughout Brazil, with a rate of 43.7%. The rate for women who have never had a Pap smear in the 35 to 49 age group reached 29.8%, remaining at 24.5% for the 20 to 64 age group.

Organization
Flávia clarified that as the Pap smear screening is not an emergency, the result does not usually come out in five days or a week. “What happens is that the organization of the public health network does not work very well and the basic health care personnel ask the woman to return in 30 or 60 days”. Often, this woman returns within that period and the exam has not arrived yet. One of the causes for this is that not all units of the Unified Health System (SUS) are computerized. “This would make it much easier to send the report over the internet.

As a result, many women, who already find it difficult to go to a health unit for financial reasons, are unable to leave work or have no one to leave their children with, for example, end up frustrated and dissatisfied when they go to get the result and this I’ts not ready. “This jeopardizes the entire line of care from then on because, if there is a change in the preventive, the woman did not seek the result, the health unit did not actively search for this woman and it did not help that she took the test. Because she did not confirm the diagnosis and any treatment, if that were the case”, argued the medical consultant of the Cancer Foundation.

According to the survey, only 40% of the women who underwent the examination through the SUS received the result within 30 days. In the private network, this percentage exceeds 90%. About 10% of the women who underwent the Papanicolaou test via SUS in the Midwest, Southeast and North regions never had access to the test results. In the private network across the country, this number drops to 2%.

Factors
The executive director of the Cancer Foundation, oncological surgeon Luiz Augusto Maltoni, drew attention to the fact that low education is one of the characteristics among women who are not up to date or who have never taken the test. Among the latter, in addition to low education (56.9%), they have low income (70.7%), are in the group that define themselves as unmarried (73.9%) and are black or brown (62 .5%). “There is a whole situation there: those who need it most are those who receive it the least”, analyzed Flávia Corrêa.

Women who underwent the preventive test more than 3 years ago have low levels of education in all regions of Brazil. The highlights are the North (62.5%) and Northeast (68.8%), whose percentages exceed the Brazilian average (60.8%). Among women who have never had a preventive test, low schooling leads across the country, with an average of 56.9%, with the exception of the Midwest, which shows a similar distribution among women with complete primary education (48.4%). and complete secondary education (43.3%).

molecular test
While there is no change in the method for screening cervical cancer in Brazil, the Cancer Foundation advises that the Brazilian female population meets the recommendation of the WHO and the Ministry of Health in relation to the target population and the periodicity for carrying out the test. Pap smear. Flávia Corrêa said that this screening model adopted in Brazil is not the most appropriate, because it is of the opportunistic type, that is, when the woman voluntarily seeks a health service to undergo the examination or when the health professional offers the test. when receiving it for another reason. “For this reason, many women are over-screened and others are not even tested”.

In the latest WHO recommendations, published in 2021 and aimed at low- and middle-income countries, the molecular test for the detection of HPV, known as the DNA-HPV test, is indicated as the preferred method. The medical consultant at the Cancer Foundation said that this test is much more sensitive and more objective, because it is done by machine, while the cytopathological examination depends on the human being.

Epidemiologist Alfredo Scaff, coordinator of the study, commented that the new method anticipates the follow-up and treatment of cancer cases by almost ten years. Among the advantages of the DNA-HPV molecular test, Scaff cites the increase in the starting age of the examination to 30 years, extending to 49 years, greater periodicity (every five years), greater detection of precursor lesions and cancer. at an early stage and, mainly, lower cost of treatment. Flávia added that several developed countries have already changed their method for screening cervical cancer, whose adoption is still being studied by the Ministry of Health.

The doctor in public health commented, on the other hand, that it is no use just changing the method. “Until we guarantee adherence to the recommendations, we have to update the guidelines and disseminate them at universities, for health professionals, and promote the training of primary care teams, which are the ones who collect the material for examination”. According to her, it is necessary to have a management mechanism that only accepts the prioritization of the test under these recommended periodicity and target population conditions. The realization outside these specificities has to have a justification. “And there has to be a system that supports all of this”.

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