Fatores associados à não realização do Exame Papanicolau: estudo transversal de base populacional em duas capitais brasileiras

Abstract

Cervical cancer corresponds to about 15% of all cancer types in women, in the world. In Brazil, in 2002, the cervical cancer was responsible for 7.1% of all cancer deaths in women, occupying the fourth position. In the same year, the age standardized mortality rate for cervical cancer was of 5.03/100,000. The age standardized incidence rate varied from 14.3 per 100,000 women in Salvador to 50.7 per 100,000 women in Federal District, for the period between 1991 and 2001. Cervical cancer arises from a pre-invasive lesion, curable in up to 100% of the cases, that progresses usually slowly, per years, before reaching the invasive stage, when the cure becomes more difficult, if not impossible. The most effective approach for the control of cervical cancer continues to be screening through the Pap smear. The aim this study was to identify factors associated with failure of women from 25 to 59 years old to be submitted to the exam in the last three years, in Fortaleza and Rio de Janeiro. To each city we used a population-based cross-sectional study with sampling for conglomerates with two stages of selection and self-weighted. Data analysis used Poisson regression according to a previously determined hierarchical framework. The women's percentage not submitted to the Pap smear three years previous to the survey, in Fortaleza and in Rio de Janeiro, was 19.1% (95%CI: 16.1-22.1) and 16.5% (95%CI: 14.1-18.9), respectively. Women of low education and per capita income, old age, not married, not submitted mammography, breast clinical examination, glycemia and cholesterolemia presented the largest prevalence ratios of failure to be submitted to the Pap Smear, in both places. The smokers were less submitted to the exam in relation to the other women, being that difference statistically significant only in Rio de Janeiro. Finally, the information presented points to the necessity of intervention in a specific group of women. Education activities must have priority for early diagnosis and screening in symptomatic and assymptomatic women, respectively, providing access to adequated methods of diagnosis and treatment.