Avaliação do rastreamento do câncer do colo do útero em Minas Gerais a partir de dados do SISCOLO

Abstract

The objective of this thesis was to evaluate the cervical cancer screening actions by the Public Health System (SUS), in Minas Gerais and its compliance with the recommendations of the Ministry of Health. For this purpose, three studies were carried out: in the first, the actions of screening were evaluated through a descriptive study based on aggregated data from SISCOLO, referring to the period from 2006 to 2011, available at DATASUS. Indicators related to the characteristics of the offer of cytopathological exams, the quality of the exam, the occurrence of cellular changes and the informed follow-up of high-grade injury cases in Minas Gerais were analyzed. It was found that the ratio of cervical cytopathological examinations in women aged 25 to 59 years remained stable in Minas Gerais from 2006 to 2011. Approximately 75% of the examinations were performed in women aged 25 to 59 years and there was a progressive reduction in the proportion of cervical cytopathology without previous cytology. On average, 51.2% of the examinations were performed within a period of up to one year. Regarding the quality of the exam, the positivity index stands out, categorized as low throughout the analyzed period. The second study consisted of a descriptive, non-concurrent cohort study, based on identified data from SISCOLO in order to estimate the coverage of cervical cancer screening in 2008 and the proportion of over-screnning by periodicity and age group in the state. Coverage was calculated using examinations of women aged 25 to 59 and 25 to 64 years after excluding duplicates and separating the follow-up exams, leaving only one exam record per woman in that year. Over-screening by age group corresponded to the percentage of women aged <25 and ≥65 years. Over-screening due to excessive periodicity was assessed based on the follow-up of women aged 25 to 64 years who were screened in 2008 through the probabilistic relationship between the bases from 2008 to 2012 (follow-up 2008-2012). The time until the next cytopathologic exam was defined as the interval between the date of the first normal exam with a satisfactory sample carried out in 2008 and the date of the first repetition of this exam. For women who started screening in 2008, over-screening by periodicity was defined as repetition in less than 9 months and, for those who started screening previously, repetition in less than 30 months. It was found that, in 2008, 1,211,014 women underwent CC screening by SUS in Minas Gerais, with 75.8% in the 25 to 59 age group and 79.8% in the 25 age group. to 64 years. Coverage was 77.6% in the age group from 25 to 59 years old and 76.2%, from 25 to 64 years old. The follow-up of 1,162,405 women was identified, with overscreening at 3.9% intervals for those who started screening in 2008 and 62.6% for those who had a previous examination. Over-screening by age group corresponded to 20.2% of the total number of women submitted to screening in 2008, whereas in women who were starting screening in 2008 it was 49.6% and, in those with prior exam, it was 14.9%. In the third study, the indicators obtained in the second were used to carry out an ecological study, whose units of analysis were the 77 health micro-regions of Minas Gerais. This study aimed to assess the regional inequality of coverage of cervical cancer screening in 2008 in Minas Gerais and its association with

socioeconomic and assistance indicators, and to describe the spatial distribution of over-screening in the state's micro-regions. The results indicated that the microregions with the lowest coverage were mostly concentrated in the Northeast, Jequitinhonha, Leste and Leste do Sul macroregions, which are characterized by the worst socioeconomic indicators. The HDI showed a positive association with coverage. The over-screening by periodicity and by age group showed a different pattern of spatial distribution among themselves and among women who are starting the screening and those who have had a previous examination. It can be concluded, then, that although the coverage in the state is close to the 80% target, there was regional inequality in access to the exam, with areas of better socioeconomic level presenting greater coverage. Exam quality indicators were below target and over-screening was high in the state. Regarding the frequency, the over-screening was more important in women who should have the exam every three years and in terms of age, in women who were starting the screening. The results corroborate the opportunistic nature of cervical cancer screening and highlight the need to improve the program in the state of Minas Gerais. It is noteworthy that the present study enabled the development of a methodology that made it possible to estimate coverage and follow up women submitted to screening using data from SISCOLO. Such methodology can be used in other contexts with the objective of monitoring the actions and contributing to the improvement of the screening program.