Historical Analysis of the Brazilian Cervical Cancer Screening Program from 2006 to 2013: A Time for Reflection

• Published in: PloS one Vol. 10; no. 9; p. e0138945
• Main Authors: Costa, Ricardo Filipe Alves, Longatto-Filho, Adhemar, Pinheiro, Céline, Zeferino, Luiz Carlos, Fregnani, José Humberto
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 24-09-2015; Public Library of Science (PLoS)
• Subjects: Adult; Age; Brazil; Breast cancer; Cancer; Cancer screening; Cellular biology; Cervical cancer; Cervix; Demographic aspects; Developed countries; Diagnosis; Early Detection of Cancer - history; Early Detection of Cancer - standards; Female; Health sciences; Historical analysis; History, 21st Century; Hospitals; Humans; Indicators; Information systems; International standardization; International standards; Internet; Laboratories; Lesions; Low frequencies; Mathematical analysis; Medical screening; Middle Aged; Oncology; Public health; Quality control; Quality Indicators, Health Care; Software; Uterine Cervical Neoplasms - diagnosis; Vaginal Smears; Very Low Frequencies; Womens health; Brazil; Portugal
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0138945

The Cervical Cancer Database of the Brazilian National Health Service (SISCOLO) contains information regarding all cervical cytological tests and, if properly explored, can be used as a tool for monitoring and managing the cervical cancer screening program. The aim of this study was to perform a historical analysis of the cervical cancer screening program in Brazil from 2006 to 2013.
The data necessary to calculate quality indicators were obtained from the SISCOLO, a Brazilian health system tool. Joinpoint analysis was used to calculate the annual percentage change.
We observed important trends showing decreased rates of low-grade squamous intraepithelial lesions (LSIL) and high-grade squamous intraepithelial lesions (HSIL) and an increased rate of rejected exams from 2009 to 2013. The index of positivity was maintained at levels below those indicated by international standards; very low frequencies of unsatisfactory cases were observed over the study period, which partially contradicts the low rate of positive cases. The number of positive cytological diagnoses was below that expected, considering that developed countries with low frequencies of cervical cancer detect more lesions annually.
The evolution of indicators from 2006 to 2013 suggests that actions must be taken to improve the effectiveness of cervical cancer control in Brazil.