'Missing adenocarcinomas': are they a real problem in cervical cancer screening in Brazil?

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Idade Precoce De Início Da Atividade Sexual Está Associada A Elevada Prevalência De Lesão Intraepitelial Escamosa De Alto Grau

To evaluate the association of age at first sexual intercourse with the results of the cervicovaginal cytology. Study Design Observational analytical study about the prevalence of altered cervicovaginal cytology results in women aged between 18 and 34 years from a densely populated area in Brazil, during 10 years. The patients were stratified into 2 categories according to their age at first sexual intercourse (13-16 years and 17-24 years). Results From the total of 2,505,154 exams, 898,921 tests were in accordance with the inclusion criteria. Considering women with 4 years or less from the first sexual intercourse as a reference, those with 5 to 9 years and 10 years or more showed a higher prevalence of high-grade squamous intraepithelial lesions (HSILs). Women with an earlier onset of sexual intercourse (13-16 years) showed higher prevalence ratios for atypical squamous cells (ASC), low-grade squamous intraepithelial lesion (LSIL) and HSIL. The prevalence ratio for HSIL adjusted by age at diagnosis and by age at first sexual intercourse was higher only for women with an earlier onset of sexual intercourse. Conclusions The age of first sexual intercourse could be a variable that might qualify the selection among young women who are really at a higher risk for HSIL.3928085FAPESP - FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULOAvaliar a associação entre idade de início da atividade sexual e os resultados de citologia cervico-vaginal. Métodos Estudo observacional sobre a prevalência dos resultados de citologia cervico-vaginal alterados em mulheres com idade entre 18 e 34 anos na região de Campinas – SP, Brasil, durante 10 anos. As pacientes foram estratificadas em dois grupos de acordo com a idade de início da atividade sexual (13 a 16 anos e 17 a 24 anos). Resultados Do total de 2.505.154 exames, 898.921 preencheram os critérios de inclusão. Considerando mulheres com tempo desde a primeira relação sexual menor ou igual a 4 anos como grupo de referência, mulheres com intervalos de 5 a 9 anos e 10 anos ou mais entre a data do exame e a primeira relação sexual mostraram maior prevalência de lesão intraepitelial escamosa de alto grau (LIEAG). Mulheres com início da atividade sexual mais precoce (13–16 anos) mostraram altas prevalências de atipia de células escamosas, lesão intraepitelial escamosa de baixo grau e LIEAG. A razão de prevalência de LIEAG ajustada pela idade na data do exame e pela idade do início da atividade sexual foi maior somente para mulheres que apresentaram início mais precoce da atividade sexual. Conclusão A idade de início da atividade sexual pode ser uma possível variável de seleção das mulheres com maior risco de LIEA

Estimating the public health impact of a national guideline on cervical cancer screening: an audit study of a program in Campinas, Brazil

A Brazilian guideline on cervical cancer screening was released in 2011. The objective was to verify changes in screening indicators around this period. Methods An audit study which sample was all screening tests performed by the public health system of Campinas city from 2010 to 2016. Variables were absolute tests numbers, excess tests, intervals and results, by age. For trend analysis was used Cochran-Armitage x 2 and linear regression. Results Were carried out 62,925 tests in 2010 and 43,523 tests in 2016, a tendency at a reduction (P = 0.001). Excess tests were higher than 50% over the years, with a tendency at a reduction (P < 0.001). Tests performed on women under 25 ranged from 20.2 to 15.4% in the period (P < 0.001), while in the 25-64 years age-group, it ranged from 75.1 to 80.2% (P < 0.001). In 2010 the most frequent interval was annual (47.5%) and in 2016 biennial (34.7%). There was a tendency at a reduction in the proportion of tests performed at the first time and those with an annual interval (P < 0.001), and also a tendency at an increase in tests with intervals equal to or greater than biannual (P < 0.001). We observed a tendency at a reduction in LSIL and HSIL-CIN2 results (P = 0.04 and P = 0.001, respectively), and a tendency at an increase in HSIL-CIN3 result (P = 0.02). Conclusion The proportion of cervical cancer screening tests performed out of the recommendation showed a significant reduction in the period. This indicates a tendency to align cervical cancer screening in Campinas with the standards recommended19CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQSem informaçã

Social inequalities in access to cancer screening and early detection: A population-based study in the city of São Paulo, Brazil

Objective: This study monitors trends in access to cancer screening, focusing on mammography, Papanicolaou (Pap smear), and Prostate-Specific Antigen (PSA), assessing the magnitude of inequality in the city of São Paulo from&nbsp;2003&nbsp;to&nbsp;2015 according to education level. Method: This is a cross-sectional population-based study conducted with data from the&nbsp;2003, 2008, and&nbsp;2015 editions of the Health Survey of the City of São Paulo (ISA-Capital). Outcome variables were the proportion of mammography, Papanicolaou (Pap smear), and Prostate-Specific Antigen (PSA) tests according to the protocols. Inequality was measured by education level according to years of study. For static analysis, Poisson regression was used to estimate proportion ratios. Results: The proportion of Pap smears remained stationary at a high level (&gt;89%) throughout the study period, while access to mammography and PSA tests significantly increased in the&nbsp;2003‒2015&nbsp;period. The present results indicate inequalities in access to cancer screening due to education, and being more expressive for mammography and PSA tests. However, this inequality significantly decreased over the period analyzed comparing the most educated individuals with those with the lowest educational level. In addition, an increase in the proportion of tests performed in the Brazilian Unified Health System was identified, especially for mammography and PSA tests, in the period&nbsp;2003‒2015. Conclusions: The inequalities observed in the access to preventive exams were influenced by the level of education. The offer of exams was expanded, more significantly for mammography and PSA, especially among the less educated group

Frequency of atypical squamous cells of undetermined significance (ascus) for pregnant and non-pregnant women

PURPOSE: To compare the frequency of an ASCUS Pap Smear result in pregnant and non-pregnant women, stratified by age group. METHODS: We analyzed the results of 1,336,180 cytopathologyc exams of Pap smears performed between 2000 and 2009 (ten years) with the purpose of screening for cervical carcinoma. Comparisons were made between pregnant and non-pregnant women, and the sample was stratified into three age groups (20–24, 25–29 and 30–34 years). The χ2 test was used and the magnitude of association was determined by the by Odds Ratio (OR) with the 95% confidence interval (95%CI). RESULTS: A Total of 447,489 samples were excluded on the basis of the criteria adopted, for a total final sample of 37,137 pregnant women and 851,554 non-pregnant women. An ASCUS result was detected in 1.2% of cases, with a significant difference between pregnant and non-pregnant women in the age groups of 20-24 years (OR=0.85; 95%CI 0.75–0.97) and 25-29 years (OR=0.78; 95%CI 0.63–0.96). There was no difference in the group between 30–34 years (OR=0.76; 95%CI 0.57–1.03). CONCLUSIONS: This study suggested that non-pregnant women have a higher frequency of ASCUS, most evident in the age group of 20 to 29 years. The collection of cervical cancer screening should not be a compulsory part of the prenatal routine. © 2015, Federacao Brasileira das Sociedades de Ginecologia e Obstetricia. All rights reserved.Comparar a frequência do resultado citopatológico de ASCUS em mulheres gestantes e não gestantes, estratificadas em grupos etários. MÉTODOS: Foram analisados 1.336.180 resultados de exames citopatológicos realizados de forma oportunística, no período entre 2000 e 2009 (10 anos) com a finalidade de rastreamento do carcinoma do colo do útero. Foram feitas comparações entre gestantes e não gestantes, com estratificação das amostras em três grupos etários (20–24, 25–29 e 30–34 anos). Foi utilizado o teste do χ2 e a medida da magnitude da associação foi analisada por valores estimados de Odds Ratio (OR) com intervalo de confiança de 95% (IC95%). RESULTADOS: Ao total, 447.489 amostras foram excluídas com base nos critérios adotados, totalizando uma amostra final de 37.137 mulheres gestantes e 851.554 não gestantes. O resultado citopatológico de ASCUS foi detectado em 1,2% dos casos, havendo diferença significante entre gestantes e não gestantes nas faixas etárias entre 20–24 anos (OR=0,85; IC95% 0,75–0,97) e 25–29 anos (OR=0,78; IC95% 0,63–0,96). Não houve diferença no grupo entre 30–34 anos (OR=0,76; IC95% 0,57–1,03). CONCLUSÕES: Este estudo sugeriu que mulheres não gestantes apresentam maior prevalência de ASCUS, mais evidente no grupo etário de 20 a 29 anos. A coleta do exame citopatológico não deve ser um exame compulsório na rotina do pré-natal375229232To compare the frequency of an ASCUS Pap Smear result in pregnant and non-pregnant women, stratified by age group. METHODS: We analyzed the results of 1,336,180 cytopathologyc exams of Pap smears performed between 2000 and 2009 (ten years) with the purpose of screening for cervical carcinoma. Comparisons were made between pregnant and non-pregnant women, and the sample was stratified into three age groups (20–24, 25–29 and 30–34 years). The χ2 test was used and the magnitude of association was determined by the by Odds Ratio (OR) with the 95% confidence interval (95%CI). RESULTS: A Total of 447,489 samples were excluded on the basis of the criteria adopted, for a total final sample of 37,137 pregnant women and 851,554 non-pregnant women. An ASCUS result was detected in 1.2% of cases, with a significant difference between pregnant and non-pregnant women in the age groups of 20-24 years (OR=0.85; 95%CI 0.75–0.97) and 25-29 years (OR=0.78; 95%CI 0.63–0.96). There was no difference in the group between 30–34 years (OR=0.76; 95%CI 0.57–1.03). CONCLUSIONS: This study suggested that non-pregnant women have a higher frequency of ASCUS, most evident in the age group of 20 to 29 years. The collection of cervical cancer screening should not be a compulsory part of the prenatal routin

Recomendações para o uso de testes de DNA-HPV no rastreamento do câncer do colo útero no Brasil

Evidence-based clinical guidelines ensure best practice protocols are available in health care. There is a widespread use of human papillomavirus deoxyribonucleic acid (HPVDNA) tests in Brazil, regardless of the lack of official guidelines. On behalf of the Brazilian Association for the Lower Genital Tract Pathology and Colposcopy (ABPTGIC, in the Portuguese acronym), a team of reviewers searched for published evidence and developed a set of recommendations for the use of HPV-DNA tests in cervical cancer screening in Brazil. The product of this process was debated and consensus was sought by the participants. One concern of the authors was the inclusion of these tests in the assessment of women with cytologic atypia and women treated for cervical intraepithelial neoplasia (CIN). Testing for HPV is recommended in an organized screening scenario to identify women with precursor lesions or asymptomatic cervical cancer older than 30 years of age, and it can be performed every 5 years. It also has value after the cytology showing atypical squamous cells of undetermined significance (ASC-US) or low-grade squamous intraepithelial lesions (LSILs) as a triage test for colposcopy, in the investigation of other cytological alterations when no abnormal findings are observed at colposcopy, seeking to exclude disease, or, further, after treatment of high-grade cervical intraepithelial neoplasia, to rule out residual disease.O uso de diretrizes clínicas baseadas em evidências visa assegurar as melhores práticas na área de cuidado à saúde. O uso de testes de ácido desoxirribonucleico de papilomavírus humano (DNA-HPV) vem crescendo e se disseminando sem que existam recomendações de uso no cenário brasileiro.Emnomeda Associação Brasileira de Patologia doTrato Genital Inferior e Colposcopia (ABPTGIC), grupos de revisores pesquisaram evidências e formularamrecomendações para o uso dos testes de DNA-HPV no rastreamento do câncer do colo do útero, no seguimento de mulheres com atipias citológicas, e após tratamento de neoplasia intraepitelial cervical (NIC). O produto desse processo foi debatido e foi buscado consenso entre participantes. Os testes de DNA-HPV são recomendados num cenário de rastreamento organizado para identificação de mulheres portadoras de lesões precursoras ou câncer assintomático com mais de 30 anos e podem ser realizados a cada 5 anos. Também têm valor após a citologia mostrando células escamosas atípicas de significado indeterminado (ASC-US) ou lesão intraepitelial escamosa de baixo grau (LSIL) como teste de triagempara colposcopia, na investigação de outras alterações citológicas quando não são observados achados anormais à colposcopia, buscando excluir doença, ou, ainda, no seguimento após tratamento das neoplasias intraepiteliais de alto grau, para exclusão de doença residual

Incidence and mortality from breast and cervical cancer in a Brazilian town

OBJECTIVES To analyze the magnitude of changes in the incidence and mortality from cervical cancer (CC) and breast cancer (BC) in Campinas, São Paulo State, between the five-year periods of 1991–1995 and 2010–2014. METHODS data on cancer were obtained from the Campinas Population-Based Cancer Registry and data on deaths from the Mortality Information System of the Computing Department of the Unified Health System. Age-standardized incidence and mortality rates were calculated by the direct method, with the respective 95% confidence intervals. The magnitude of the changes was measured by the rate ratio (rate ratio; 95%CI). RESULTS among the periods studied, there was a threefold increase in the detection rate of in situ CC (3.03; 95%CI: 2.64–3.47) and fivefold increase for in situ BC (5.23; 95%CI: 4.98–5.50). The proportion of cases of in situ BC in relation to the total number of cases of BC increased from 3.31% to 11.05%. The incidence rate of invasive CC decreased by 57% (0.43; 95%CI: 0.40–0.47), and the incidence rate of invasive BC increased by 40% (1.40; 95%CI: 1.33–1.47). The mortality rate of the CC decreased by 58% (0.42; 95%CI: 0.32–0.56), and that of BC by 15% (0.85; 95%CI: 0.82–0.89). CONCLUSION the incidence of in situ carcinomas of CC and BC increased in almost two decades. The rate of invasive carcinoma of CC decreased, and that of BC increased. Mortality from both cancers decreased. Observing these changes is useful for assessing the impact of the actions carried out in the period and for planning future actions.OBJETIVOS Analisar a magnitude das mudanças na incidência e mortalidade por câncer do colo do útero (CCU) e câncer de mama (CM) em Campinas (SP) entre os quinquênios 1991–1995 e 2010–2014. MÉTODOS Os dados sobre câncer foram obtidos do Registro de Câncer de Base Populacional de Campinas e os dados sobre óbitos do Sistema de Informação de Mortalidade do Departamento de Informática do Sistema Único de Saúde. Foram calculadas taxas de incidência e de mortalidade padronizadas por idade pelo método direto, com os respectivos intervalos de confiança de 95%. Mensurou-se a magnitude das mudanças por meio da razão de taxas (RT). RESULTADOS Entre os períodos estudados, houve aumento de três vezes na taxa de detecção do CCU in situ (RT = 3,03; IC95% 2,64–3,47) e de 5 vezes para o CM in situ (RT = 5,23; IC95% 4,98–5,50). A proporção de casos de CM in situ em relação ao total de casos de CM aumentou de 3,31% para 11,05%. A taxa de incidência do CCU invasivo declinou em 57% (RT = 0,43; IC95% 0,40–0,47), e a do CM invasivo aumentou em 40% (RT = 1,40; IC95% 1,33–1,47). A taxa de mortalidade do CCU caiu em 58% (RT = 0,42; IC95% 0,32–0,56), e a do CM em 15% (RT = 0,85; IC95% 0,82–0,89). CONCLUSÃO A incidência de carcinomas in situ de CCU e CM aumentou nessas quase duas décadas. A taxa de carcinoma invasivo do CCU diminuiu, e a do CM aumentou. A mortalidade pelos dois cânceres foi reduzida. Observar essas alterações é útil para avaliar o impacto das ações realizadas no período e planejar ações futuras