Cervical cancer: find out who is most at risk – 03/28/2023 – Equilíbrio

When the nurse Juliana Martinovski saw, in the Health Information System for Primary Care of the SUS (Sistema Único de Saúde), that the proportion of women in her state who underwent preventive exams for cervical cancer, she was taken aback. Only two out of ten had taken the tests. Convinced of her role as a healthcare professional, she began researching the reasons and found that many patients are embarrassed to seek an appointment.

“I worried, because sometimes within that index there may be a relative of mine, friends of mine who are not taking care of themselves”, she says.

Martinovski, who applied interviews with people from the rural area of ​​his municipality during a master’s degree developed at UFSC (Federal University of Santa Catarina), found that fear, shame, lack of transportation and even domestic services prevented these women from taking care of their own health. The results of the work were published in the Journal of Nursing Education and Practice.

In addition to these factors, a study published in The Lancet Public Health magazine points out that women with mental illnesses or psychiatric disorders, such as anxiety, depression, autism and ADHD (attention deficit hyperactivity disorder), for example, are more likely to develop illness.

According to the National Cancer Institute, 17 thousand new cases are predicted between the years 2023 and 2025, guaranteeing the sixth position among the most common types of cancer in the country. The only difference is that the tumor could be completely eradicated. In the northern region of Brazil, the disease rises to second place. In 2020, lack of treatment led a woman to death every 80 minutes.

According to the researcher, lack of knowledge is behind the embarrassment that patients feel when going to medical appointments. If they know the importance of the exam and what procedure is necessary, Martinovski reports that many feel more relaxed and inclined to seek prevention.

In addition, the active search for these patients is an effective way to reach women who work and take care of the home and family. In rural areas, this portion of the population is not always able to go alone to central regions for consultations and tests. Having someone to leave the children with is also a concern that the interviewees reported.

Martinovski also points out that many patients do not seek care because they have never experienced symptoms. Cervical cancer is a consequence of infection by the HPV virus, which can take up to 10 years to develop a lesion in the region, during which time the person remains asymptomatic. During this time, however, the tumor can evolve into more acute forms and even metastasize, processes that require more complex treatments.

The study published in the scientific journal The Lancet, developed in partnership by European and American researchers, shows that women with mental illnesses, psychiatric disorders or substance abuse are twice as likely to develop cervical cancer.

The authors of the research argue that this portion of the population should be considered as a group at risk for the disease and that they receive greater attention in awareness campaigns. In addition, vaccination coverage against HPV and the training of health professionals to care for this public are obstacles that lead to the numbers found.

Unlike much of the previous work, carried out with few participants in a short period of time, this time the scientists followed four million women between the years 1973 and 2018.

In the study, the relationship between cervical cancer risk and mental illness is complex. First, these people may need specialist care. If they don’t, the chances of getting an HPV infection increase considerably. In addition, low socioeconomic status, smoking, alcohol consumption and lack of access to health services are other complicating factors.

Doctor Fernando Sommacal adds that the disease is completely preventable, unlike other types of cancer, because it is visible, has a well-defined causative agent that can be traced by biomolecular tests and a very long preclinical phase.

The gynecological examination responsible for identifying lesions or the HPV virus is the papanicolau, which consists of collecting cells from the cervix. Once the problem is identified, however, the responsible specialist can eliminate the lesions on the cervix before they generate worse complications. In the case of patients who are in the early stages of the tumor, the chances of cure are greater. In more advanced cases, however, although cure is possible, the need for complex procedures such as surgery, radio and chemotherapy can drain the quality of life of affected women.

The number of preventive exams performed is below the necessary. In a technical note from the Ministry of Health, the government recognizes that the country is unable to achieve coverage that would guarantee testing in 80% of Brazilian women, and outlines the goal of reaching just 40%. But, according to Professor Luciana Martins da Rosa, from UFSC (Federal University of Santa Catarina), we didn’t even reach that goal. Data from the Health Information System for Primary Care show that in 2022 the national average was 19%.

She also highlights the existence of groups even more vulnerable to the disease. Schooling, income and skin color are factors that differentiate who receives basic health care and who does not. Mental health conditions are also a risk factor, worrying data according to the professor, as it is estimated that this type of commitment will increase in the next decade.

Recently, the Ministry of Health announced an investment of R$ 18 million in the National Strategy for the Control and Elimination of Cervical Cancer, based on a pilot project developed in Recife. The program’s objectives include expanding vaccination coverage against HPV in girls and boys up to 14 years of age and the inclusion of new PCR tests to identify the virus in the SUS. The first phase of the project will be carried out in Pernambuco before being extended to the entire national territory.