Câncer cérvico-uterino como condição marcadora: uma proposta de avaliação da atenção básica

MONITORING OF CERVICAL CANCER CONTROL ACTIONS AND ASSOCIATED FACTORS

ABSTRACT Objective: to analyze factors associated with the monitoring of actions to control cervical cancer in the Family Health Strategy, in a health region of northeastern Brazil. Method: a cross-sectional study conducted from January to March 2019 by means of interviews with 241 physicians and nurses from the Family Health Teams of the Vitória da Conquista health region, Bahia, Brazil. Adequate monitoring was assessed by the degree of actions taken to promote, prevent and actively seek to control cervical cancer. Three blocks of variables were tested as explanatory: professional characterization and training; organization of the unit and access to cytopathological exam; and care coordination and integration. Poisson regression with robust variance was employed, adopting hierarchical entry of variables. Results: 51.9% (95% CI: 45.5-58.2) of the professionals performed adequate monitoring for the control of cervical cancer. Being a nurse, working in the municipality’s primary care network (≥2 years), disclosure of results collection through posters and other communication means, existence of a high-grade lesion, time to perform the biopsy ≤1 month, and agility in the release of the reports were elements associated to the outcome. Conclusion: even with the extended coverage of the Family Health Strategy, small municipalities in the Northeast have characteristics that impose obstacles to comprehensiveness, favoring the incidence of high-grade lesions and greater difficulty in the control of cervical cancer. Assessing the assistance quality in this level revealed challenges in the regionalized network.

[Access to uterine cervical cytology in a health region: invisible women and vulnerable bodies]

This article evaluates access to the Papanicolaou test in the Family Health Strategy (FHS) in municipalities in a health region. Cervical cancer control depends on a well-organized Family Health Strategy, so assessment of access to the Papanicolaou test reflects the quality of care at this level. This is a qualitative study with data produced in 10 focus groups, totaling 70 participants in four municipalities. We analyzed the organizational, symbolic, and technical dimensions of access to the Pap test, with cervical cancer control as the marker. The results indicate that living in rural areas was a barrier to access to the Papanicolaou test and exacerbated the inequalities. Nurses were the principal reference for access to the Pap test. The absence of necessary items for collecting cervical cytopathology specimens was a barrier to access in all the municipalities. There were obstacles to access for women with disabilities and lesbian women, with care that was fragmented and out of sync with individual characteristics. The numerous obstacles to access to the Papanicolaou test exposed the selectiveness of the Family Health Strategy in the health region, since it reproduced the invisibility of women with greater social vulnerability and exacerbated the existing inequalities.

Integrality in cervical cancer care: evaluation of access

OBJECTIVE

To evaluate integrity of access to uterine cervical cancer prevention, diagnosis and treatment services.

METHODS

The tracer condition was analyzed using a mixed quantitative and qualitative approach. The quantitative approach was based on secondary data from the analysis of cytology and biopsy exams performed between 2008 and 2010 on 25 to 59 year-old women in a municipality with a large population and with the necessary technological resources. Data were obtained from the Health Information System and the Regional Cervical Cancer Information System. Statistical analysis was performed using PASW statistic 17.0 software. The qualitative approach involved semi-structured interviews with service managers, health care professionals and users. NVivo 9.0 software was used for the content analysis of the primary data.

RESULTS

Pap smear coverage was low, possible due to insufficient screening and the difficulty of making appointments in primary care. The numbers of biopsies conducted are similar to those of abnormal cytologies, reflecting easy access to the specialized services. There was higher coverage among younger women. More serious diagnoses, for both cytologies and biopsies, were more prevalent in older women.

CONCLUSIONS

Insufficient coverage of cytologies, reported by the interviewees allows us to understand access difficulties in primary care, as well as the fragility of screening strategies.

[Pap test coverage and adequacy in the South and Northeast of Brazil]

Cervical cancer is the second most common cancer among women both in Brazil and elsewhere in the world and can be averted through early detection of precursor lesions. Pap smear is still the most effective and efficient screening test. This study focused on the coverage and adequacy of Pap test and associated factors. The authors adopted a cross-sectional design with a sample of 3,939 women who had given birth in the two previous years in 41 municipalities (counties) of Brazil. Lifetime Pap test coverage was 75.3% (95%CI: 74.0-76.7), and prevalence of adequacy was 70.7% (95%CI: 69.3-72.1). Adequacy was positively associated with age over 25 years, schooling, prenatal care in the last pregnancy, and gynecological visit in the previous year, and was less frequent among primiparous women and those with lower socioeconomic status. It is thus necessary to strengthen preventive measures in vulnerable subgroups and maximize situations for use of health services.

[Reflections on health policy evaluation in Brazil]

This article aims to contribute to the debate on public policy evaluation, specifically in the Brazilian health sector. The objective is to analyze some of the key issues in this field through a literature search in the SciELO database. Sixty-six articles were selected using the descriptors "health evaluation" and "evaluation of health programs and projects" in indexed Brazilian public health periodicals from 1994 to 2009. The article explores aspects of academic output according to an established typology and in relation to possibilities for developing the theme of policy evaluation, linked to interventions focused on efficacious, efficient, and effective treatment of the population's health problems.

Opinions and expectations of women in the treatment of cervical and uterine cancer in Spain

AIM

To know the experiences, needs and expectations of women in the treatment of cervical and uterine cancer in the Andalusian Health Service.

METHODS

Focus groups and in-depth interviews with women being treated for cervical-uterine cancer within the Andalusian Health Service. Analysis with Nudist Vivo 1.0 (QSR International Pty Ltd, Doncaster, Victoria, Australia).

RESULTS

The needs and expectations detected were: coherence in the promotion strategies and the presence of a proactive approach by health professionals, availability of comprehensive information and understanding, possibility of expressing to health professionals one's doubts and fears, and of participation in decision-making, technical quality, humane treatment and continuity of care and attention to psychosocial aspects.

CONCLUSION

The knowledge of women in the treatment of cancer of the cervix and uterus plays a crucial part in improving the delivery of these services.

Im perfect tools for a difficult job: colposcopy, 'colpocytology' and screening for cervical cancer in Brazil

The quasi-totality of social scientists who studied screening for cervical tumours identified such screening with a single method: the Pap smear (exfoliative cytology). This article explains that this method was not valid everywhere. The history of screening for cervical cancer in Brazil displays an alternative method for detecting cervical malignancies: a direct observation of the cervix with a specific instrument--the colposcope. The development of this method in Brazil in the 1940s and 1950s reflected a complex mixture of professional interests, government policies, and regional, local and charitable initiatives. While the use of colposcopy for cervical tumour screening was phased out in the 1970s and 1980s, the long lifespan and widespread diffusion of this method illuminates the irreducible contingency of specific developments in science, technology and medicine. Seen from the vantage point of Brazil, the Western model for preventing cervical malignancies no longer appears self-evident Alternative choices might have led to the development of different material and visual cultures of medicine, stimulated different patterns of medical specialization and division of medical labour, produced different links between malignancies, women, gynaecologists, epidemiologists and public health experts, and shaped different health policies.

[Assessment of the cervical cancer screening in the Family Health Strategy in Amparo, São Paulo State, Brazil]

Uterine cervical cancer mortality has not been declining. The territorial distribution and registration of families in Brazil's Family Health Strategy help identify women that have performed a Pap smear or that have not had one for more than three years. This study analyzed whether cervical cancer screening in Amparo, São Paulo State, Brazil, made progress in complying with the prevailing guidelines during the seven years of experience with the Strategy. The annual examination rate remained high, with a slight trend towards greater intervals between follow-up tests. Distribution of tests tended to increase in the 40-59-year age bracket and decrease in the over-60 age group, while annual coverage tended to decrease. The proportions of excess tests varied from 61.2% to 65.5%. Concluding, the upgrading of cervical cancer screening was slight, and did not change the opportunistic pattern of follow-up tests. Considering that community health agents can act to increase the coverage of these measures, it is essential to train them for this work.