Cervical cytology results among pregnant and non-pregnant women in Brazil

OBJECTIVE

To compare the prevalence of abnormal cervical smear results among pregnant and non-pregnant women with and without representation of the transformation zone (TZ) in a mid-sized city in Brazil.

STUDY DESIGN

This observational analytical and retrospective study analyzed cervical smear results from pregnant and non-pregnant women in a mid-sized city in Brazil. Private data were collected at private clinics over seven years and from public services over 16 years. All results were reported according to Bethesda System. Pregnant women were separated from non-pregnant women, and women were stratified into two age groups (25-29 years and 30-34 years) in general analyses. For TZ representation and cytologic-histologic correlation, there was no age stratification.

RESULTS

Among public services cervical smears, the frequency of atypical squamous cells of undetermined significance (ASC-US) was higher for pregnant women in the entire group (odds ratio [OR] 1.91; confidence interval [CI] 1.07-3.39) and among women from 30 to 40 years old (OR 2.79; CI 1.38-5.66). The same occurred for low-grade squamous intraepithelial lesion (LSIL) in the total group (OR 3.50; CI 1.44-8.53) and among women 30 to 40 years old (OR 4.57; CI 1.45-14.42). The frequency of ASC-US was higher in pregnant women with TZ representation exams than those without (OR 4.62; CI 2.17-9.84). The same occurred for those with atypical squamous cells, which cannot exclude high-grade squamous intraepithelial lesion (OR 9.81; CI 1.63-59.15) and LSIL (OR 10.47; CI 3.39-32.36). Among pregnant women with abnormal cervical smear results, 85.74% were followed up through cytology, and an average of 26.12% of patients underwent biopsy, of which almost all were positive for dysplasia.

CONCLUSION

Pregnant and non-pregnant women did not differ in cervical smears with actual precursor lesions. Nevertheless, considering the opportunistic nature of Brazilian cervical cancer screening, prenatal visits present an opportunity to perform cervical smears in pregnant women. TZ representation correlated with higher rates of abnormal cervical smears, reinforcing the clinical importance of endocervical/metaplastic cell representation, including among pregnant women.

Comparison of cervical cancer screening results among public and private services in Brazil

OBJECTIVE

To compare the frequency of cervical smear test results between women seen in private and public health services in a medium-sized city in Brazil.

METHODS

This was an observational analytical study analyzing cervical cytologic results over 16 years. Public data were collected from the Brazilian National Health System, and private refers to those collected at private clinics.

RESULTS

The overall frequency of unsatisfactory/rejected results was higher in public service examinations (odds ratio [OR] 0.05; 95% confidence interval [CI] 0.04-0.06). The same occurred for atypical squamous cells of undetermined significance (ASC-US) (OR 0.90; 95% CI 0.85-0.95) and atypical squamous cells cannot exclude high grade intraepithelial lesions (ASC-H) (OR 0.55; 95% CI 0.47-0.64) categories. For low-grade squamous intraepithelial lesions, the frequency was higher among women from private services (OR 1.39; 95% CI 1.24-1.55). Among women aged 25-64 years, the frequency of high-grade squamous intraepithelial lesions was higher among women seen in the public service (OR 0.81; 95% CI 0.66-0.99).

CONCLUSION

Brazilian public services showed higher frequencies of unsatisfactory/rejected results and higher rates of ASC-US and ASC-H. Focusing on pre-analytical phases and establishing an internal quality control program can help improve these rates even though national protocols guide them.