Inequalities in Pap smear screening for cervical cancer in Brazil

• Published in: Preventive medicine Vol. 57; no. 4; pp. 366 - 371
• Main Authors: Martínez-Mesa, Jeovany, Werutsky, Gustavo, Campani, Raquel Barth, Wehrmeister, Fernando César, Barrios, Carlos Henrique
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Inc 01.10.2013; Elsevier
• Subjects: Adult; Age Factors; Biological and medical sciences; Brazil; Brazil - epidemiology; Cancer screening; Cervical cancer; Continental Population Groups - statistics & numerical data; Early Detection of Cancer - statistics & numerical data; Educational Status; Epidemiology; Female; Female genital diseases; Gynecology. Andrology. Obstetrics; Health Care Surveys; Health inequities; Healthcare Disparities - statistics & numerical data; Humans; Inequalities; Internal Medicine; Medical sciences; Middle Aged; Miscellaneous; Papanicolaou Test - statistics & numerical data; Papanicolau smear; Poverty - statistics & numerical data; Prevalence; Prevention and actions; Public health. Hygiene; Public health. Hygiene-occupational medicine; Rural Population - statistics & numerical data; Screening; Socioeconomic Factors; Tumor virus infection; Tumors; Urban Population - statistics & numerical data; Uterine cervical neoplasm; Uterine Cervical Neoplasms - diagnosis; Uterine Cervical Neoplasms - prevention & control; Vaginal Smears - statistics & numerical data; Women; South America; Brazil; America; Papanicolau smear; Tumor virus infection; Uterine cervical neoplasm; Epidemiology; Health inequities; Cancer screening; Equity; Cervical smear; Malignant tumor; Medical screening; Female genital diseases; Infection; Uterus; Viral disease; Female genital system; Uterine cervix diseases; Cervical cancer; Public health; Cancer; Inequality
• ISSN: 0091-7435; 1096-0260
• DOI: 10.1016/j.ypmed.2013.06.026

Abstract Objective To examine the risk factors associated with never being screened for cervical cancer (CC) in Brazil. Methods Using the National Household Sample Survey 2008 (PNAD), we analyzed data from 102,108 Brazilian women ages 25–64 years. The patients were analyzed as having been or never having been screened with a Pap smear (Yes/No). Age-adjusted prevalence of never-screening was analyzed using a Chi-squared test. Crude and adjusted models using Poisson regression were performed. Results The prevalence of never-screened women for CC was 12.9%, 11.5% and 22.2% in Brazil in general, urban and rural areas, respectively. The Brazilian region with the highest prevalence of never-screening was the North (17.4%, 14.7% and 27.3% in general, urban and rural areas, respectively). The factors associated with a higher risk for never being screened were the following: poverty, younger age, lower educational level, non-white skin color, a greater number of children, no supplemental health insurance and not having visited a doctor in the past 12 months. Conclusion Socioeconomic and demographic conditions lead to inequalities in access to Pap smear screening in Brazil. Public health policy addressing these risk groups is necessary.