Avaliação do rastreamento do câncer do colo do útero em Minas Gerais e suas macrorregiões de saúde

Abstract

Introduction: Cervical cancer (CC) is a public health issue, especially in low and middle income countries, where over 85% of cases occur. The cytopathological exam (Pap smear) is the primary screening method for the disease, but factors such as social inequality, poor socioeconomic conditions, and limited access to healthcare services hinder its effectiveness. Minas Gerais, with its vast territorial extension and regional diversity, presents a complex public health scenario. Therefore, it is essential to understand how CC screening is being implemented and the results achieved in the different macro-regions of the state. Objectives: Evaluate CC screening in Minas Gerais and macro-regions between 2017-2019 and 2020-2022 using SISCAN data. To identify overscreening by age group and frequency, as well as factors associated with cytopathological exam coverage. Methods: Process indicators on coverage, adherence to national technical guidelines, and exam quality were assessed. Overscreening was analyzed by age group and frequency. Additionally, simple and multiple regression analyses (classical and spatial) were conducted to identify factors associated with exam coverage. Results: Between 2017-2019 and 2020-2022, there was a reduction in coverage and overscreening of cytopathological exams, possibly due to the impact of the COVID-19 pandemic on healthcare services. In the state and its health macro-regions, exam coverage did not reach the expected parameter (80%), and screening patterns remained constant, with low and high coverage regions maintaining their rates. Quality indicators, such as representation of the Transformation Zone, Positivity Index, proportion of high-grade squamous intraepithelial lesion (HSIL) results and exams released within 30 days, did not perform well in relation to the parameters established by the National Cancer Institute (INCA). There was a positive association between exam coverage and municipal PIB (Gross domestic product) and the nurse ratio, and a negative association with low population income and doctors ratio. Conclusion: Despite the clear national guidelines for CC screening, obstacles prevent the achievement of established goals. Regional inequalities in Minas Gerais directly impact the effectiveness of CC diagnosis and treatment. Improvements in exam quality and access to screening are essential for effective CC control in the state.