Fatores determinantes do acesso ao papanicolaou por mulheres idosas no município de Juiz de Fora-MG

Abstract

Brazil is going through a process of population aging, and thus, its epidemiological profile tends to change, with increased prevalence of chronic diseases, especially cancer, over infectious ones. Among women, including older women, cervical cancer is characterized as a public health problem. Since the Pap test is the instrument for early detection of the disease, it is thus extremely relevant to carry out crosssectional studies on the prevalence, for elderly women, of access to this health service, and to investigate the factors associated with screening in Juiz de Fora - MG. In 2010, included in the Health Survey conducted in the northern district of the city of Juiz de Fora, a cross-sectional epidemiological study was conducted, using cluster and simple sampling, with women aged 60 or over. This study made use of four instruments for data collection: a Mini-Mental State Examination (MMSE), a scale to assess functional capacity to perform the Basic Activities of Daily Living (BADLs) and a scale to assess functional capacity to perform the Instrumental Activities of Daily Living (IADLs), and a semi-structured questionnaire divided into sociodemographic characteristics, questions concerning the general health of the elderly woman, and finally, questions related to the history of whether or not having been screened for cervical cancer and breast cancer. Of the total questionnaires administered, 252 women responded to the outcome of interest. A hierarchical theoretical model was built grouping the distal variables, related to sociodemographic characteristics, the intermediate variables, related to questions about the general health of the elderly women, and the proximal variables, gathered into a third block, corresponding to preventive practices in women's health. The prevalence of Pap test screening was 84.1% (CI95% 79% - 88.4%). In the multivariate regression, three variables showed significant association (p 0.05) with getting Pap testing: among the more distal level variables (Block 1 of the chart), the marital status of single, widowed, separated, or divorced, with PRadjusted (CI95% = 3.642 CI95% 1.465; 9.057). In the second block, the functional capacity of carrying out IADLs, with PRadjusted (CI95% = 6.932 CI95% 2.022; 23.764). And, in the third block, regarding preventive practices in women's health, mammography screening was the variable with the highest association with getting Pap testing, with PRadjusted (CI95% = 2.112 CI95% 1.140; 3.913). In the interblock analysis these variables remained significantly associated with the outcome variable. The present study suggests that increased access to preventive screening for elderly women was associated most strongly with the group composed of single, widowed, separated, or divorced, able to perform IADLs, and who also are or had been getting mammography screening. The aging of the population should lead to reflection about the direction of public policy. In the case of cervical cancer, there must be incentives for Pap test screening in order to implement a secondary prevention routine (early diagnosis and prompt treatment) for elderly women, although not the target population of screening today.