Organized, Population-based Cervical Cancer Screening Program: It Would Be a Good Time for Brazil Now - Revista Brasileira de Ginecologia e Obstetrícia
Revista Brasileira de Ginecologia e Obstetrícia. 2016;38(4):161-163
Estimates indicate that around 16,000 new cases of cervical cancer were diagnosed in 2014 in Brazil. This cancer is the third most frequent in Brazil, the first in the North region, and the fifth in the South region of the country. The Unified Health System (SUS), the public health care system of Brazil, has implemented several actions for qualifying cervical cancer screening, but there are challenges to be overcome, such as the large national territory and heterogeneous resources from every site. Despite the efforts made by SUS, the current cervical cancer screening has shown many weaknesses. There is no doubt that regular screening of appropriate women for cervical cancer with the cytopathology test reduces mortality from cervical cancer. However, appropriate policy and program organization remain essential to achieve a good balance between benefit and harm of any screening program. The knowledge of the potential of population-based cervical screening to reduce the burden of cervical cancer in the population is doubtless. However, as pointed out by Dillner et al, this knowledge has not always been translated into effective national programs. To be effective, cervical cancer screening should be performed in an organized, population-based screening program with comprehensive quality assurance covering all steps in the screening process. An organized program should include quality assurance in monitoring cervical cancer screening performance. The European guidelines define such a performance through achieving: (1) an invitation coverage of at least 95% of the target women; (2) an examination coverage of at least 70% (85% is desirable); and (3) a participation rate of at least 70% (85% is desirable).
The current recommendations for the SUS establish the cytology-based cervical cancer screening, conducted with a three-year interval after two consecutive annual negative exams. The target population for cervical cancer screening comprised women aged 25 to 64 years, which represents around 55 million Brazilian women. Although SUS is universal, ∼25% of all Brazilians have private health; therefore, ∼41 million women are dependent on the SUS as their health care provider. In the last decade, SUS conducted 9 to 11 million cytological exams per year. If it maintains the recommended age group and three-year interval preconized, the SUS would be able to include 27 to 33 million women in the screening program, reaching almost 70–85% women as preconized for an organized population-based program for cervical cancer screening.
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Estimates indicate that around 16,000 new cases of cervical cancer were diagnosed in 2014 in Brazil. This cancer is the third most frequent in Brazil, the first in the North region, and the fifth in the South region of the country. The Unified Health System (SUS), the public health care system of Brazil, has implemented several actions for qualifying cervical cancer screening, but there are challenges to be overcome, such as the large national territory and heterogeneous resources from every site. Despite the efforts made by SUS, the current cervical cancer screening has shown many weaknesses. There is no doubt that regular screening of appropriate women for cervical cancer with the cytopathology test reduces mortality from cervical cancer. However, appropriate policy and program organization remain essential to achieve a good balance between benefit and harm of any screening program. The knowledge of the potential of population-based cervical screening to reduce the burden of cervical cancer in the population is doubtless. However, as pointed out by Dillner et al, this knowledge has not always been translated into effective national programs. To be effective, cervical cancer screening should be performed in an organized, population-based screening program with comprehensive quality assurance covering all steps in the screening process. An organized program should include quality assurance in monitoring cervical cancer screening performance. The European guidelines define such a performance through achieving: (1) an invitation coverage of at least 95% of the target women; (2) an examination coverage of at least 70% (85% is desirable); and (3) a participation rate of at least 70% (85% is desirable).
The current recommendations for the SUS establish the cytology-based cervical cancer screening, conducted with a three-year interval after two consecutive annual negative exams. The target population for cervical cancer screening comprised women aged 25 to 64 years, which represents around 55 million Brazilian women. Although SUS is universal, ∼25% of all Brazilians have private health; therefore, ∼41 million women are dependent on the SUS as their health care provider. In the last decade, SUS conducted 9 to 11 million cytological exams per year. If it maintains the recommended age group and three-year interval preconized, the SUS would be able to include 27 to 33 million women in the screening program, reaching almost 70–85% women as preconized for an organized population-based program for cervical cancer screening.
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