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. 2015 Sep 24;10(9):e0138945.
doi: 10.1371/journal.pone.0138945. eCollection 2015.

Historical Analysis of the Brazilian Cervical Cancer Screening Program from 2006 to 2013: A Time for Reflection

Ricardo Filipe Alves Costa  1 , Adhemar Longatto-Filho  2 , Céline Pinheiro  3 , Luiz Carlos Zeferino  4 , José Humberto Fregnani  5
Affiliations

Historical Analysis of the Brazilian Cervical Cancer Screening Program from 2006 to 2013: A Time for Reflection

Ricardo Filipe Alves Costa et al. PLoS One. .

Abstract

Background: The Cervical Cancer Database of the Brazilian National Health Service (SISCOLO) contains information regarding all cervical cytological tests and, if properly explored, can be used as a tool for monitoring and managing the cervical cancer screening program. The aim of this study was to perform a historical analysis of the cervical cancer screening program in Brazil from 2006 to 2013.

Material and methods: The data necessary to calculate quality indicators were obtained from the SISCOLO, a Brazilian health system tool. Joinpoint analysis was used to calculate the annual percentage change.

Results: We observed important trends showing decreased rates of low-grade squamous intraepithelial lesions (LSIL) and high-grade squamous intraepithelial lesions (HSIL) and an increased rate of rejected exams from 2009 to 2013. The index of positivity was maintained at levels below those indicated by international standards; very low frequencies of unsatisfactory cases were observed over the study period, which partially contradicts the low rate of positive cases. The number of positive cytological diagnoses was below that expected, considering that developed countries with low frequencies of cervical cancer detect more lesions annually.

Conclusions: The evolution of indicators from 2006 to 2013 suggests that actions must be taken to improve the effectiveness of cervical cancer control in Brazil.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Historical description of the following indicators.
(A) % exams performed (2006–2013: APC = -0.7 CI 95%: -2.1; 1.2). (B) % positivity index (2006–2013: APC = 0.56 CI 95%: -0.5; 1.7). (C) % unsatisfactory (2006–2013: APC = -2.1 CI 95%: -4.3; 0.1). (D) % rejected (2006–2010: APC = 4.5 CI 95%: -5.1; 15.0) (2010–2013: APC = 35.4 CI 95%: 16.3; 56.6).
Fig 2
Fig 2. Historical description of the following indicators.
(A) % ASC-US (2006–2013: APC = 2.2 CI 95%: 0.9; 3.5). (B) % ASC-H (2006–2009: APC = 2.1 CI 95%: -2.0; 6.4) (2009–2013: APC = 6.8 CI95%: 4.0; 9.6). (C) % LSIL (2006–2013: APC = -4.6 CI 95%: -6.6; -2.5). (D) % HSIL (2006–2013: APC = -1.8 CI 95%: -3.2; -0.6). (E) % ASC (2006–2013: APC = 3.0 CI 95%: 2.1; 3.8). (F) ASC/SIL (2006–2013: APC = 7.0 CI 95%: 5.2; 8.9).
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References

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