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Observational Study
. 2018 Jun;40(6):347-353.
doi: 10.1055/s-0038-1660841. Epub 2018 Jun 20.

Cervical Cancer Registered in Two Developed Regions from Brazil: Upper Limit of Reachable Results from Opportunistic Screening

Julio Cesar Teixeira  1 , Carlos Afonso Maestri  2 , Helymar da Costa Machado  1 , Luiz Carlos Zeferino  1 , Newton Sérgio de Carvalho  3
Affiliations
Observational Study

Cervical Cancer Registered in Two Developed Regions from Brazil: Upper Limit of Reachable Results from Opportunistic Screening

Julio Cesar Teixeira et al. Rev Bras Ginecol Obstet. 2018 Jun.

Abstract
in English, Portuguese

Objective: The aim of this study was to assess the time trends and pattern of cervical cancer diagnosed in the period from 2001 to 2012 by means of an opportunistic screening program from two developed regions in Brazil.

Methods: An observational study analyzing 3,364 cancer records (n = 1,646 from Campinas and n = 1,718 from Curitiba region) available in hospital-based cancer registries was done. An additional 1,836 records of CIN3/AIS from the region of Campinas was analyzed. The statistical analysis assessed the pooled data and the data by region considering the year of diagnosis, age-group, cancer stage, and histologic type. The Cochran-Armitage trend test was applied and p-values < 0.05 were considered significant.

Results: The total annual cervical cancer registered from 2001 to 2012 showed a slight drop (273-244), with an age average of 49.5 y, 13 years over the average for CIN3/AIS (36.8 y). A total of 20.6% of the diagnoses (1.6% under 25 y) were done out of the official screening age-range. The biennial rate of diagnoses by age group for the region of Campinas showed an increase trend for the age groups under 25 y (p = 0.007) and 25 to 44 y (p = 0.003). Stage III was the most recorded for both regions, with an annual average of 43%, without any trend modification. There was an increasing trend for stage I diagnoses in the region of Campinas (p = 0.033). The proportion of glandular histologic types registered had an increased trend over time (p = 0.002), higher for the region of Campinas (21.1% versus 12.5% for the region of Curitiba).

Conclusion: The number, pattern and trends of cervical cancer cases registered had mild and slow modifications and reflect the limited effectivity of the opportunistic screening program, even in developed places.

Objetivo: Avaliar as tendências temporais e padrão de diagnóstico de câncer de colo de útero (CCU) através de programa de rastreamento oportunístico em duas regiões brasileiras desenvolvidas, no período de 2001 a 2012. MéTODOS: Estudo observacional com 3.364 registros de câncer (n = 1.646 da região de Campinas e n = 1.718 da região de Curitiba) obtidos de sistemas de registro hospitalar de câncer. Para a região de Campinas foram analisados 1.836 registros adicionais de CIN3/AIS. A análise estatística avaliou os dados agrupados e por região considerando o ano de diagnóstico, grupo etário, estágio de câncer e tipo histológico, e utilizou o teste de tendência Cochran-Armitage com valor p < 0,05.

Resultados: O total anual de CCU registrado no período de 2001 a 2012 apresentou uma ligeira queda (273 para 244), com idade média de 49,5 anos, 13 a mais que a idade média (36,8 anos) para CIN3/AIS. O total de diagnósticos realizados fora da faixa etária oficial de rastreamento foi 20,6% (1,6% abaixo de 25 anos). Houve uma tendência de aumento de casos nas faixas etárias inferior a 25 anos (p = 0,007) e de 25 a 44 anos (p = 0,003) para a região de Campinas. Ambas as regiões apresentaram maior proporção diagnósticos de câncer em estágio III (43% em média), sem modificação de tendência. Houve tendência crescente para diagnóstico em estágio I na região de Campinas (p = 0,033) e da proporção de tipos histológicos glandulares em ambas regiões (p = 0,002), 21,1% para a região de Campinas e 12,5% para Curitiba. CONCLUSãO: O número, o padrão e as tendências dos casos registrados de câncer de colo de útero apresentaram modificações pequenas e lentas ao longo do tempo, reflexo da efetividade limitada do programa de rastreio oportunista, mesmo em locais desenvolvidos.

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Conflict of interest statement

The authors have no conflicts of interest regarding this manuscript.

Figures

Fig. 1
Fig. 1
Number of women with cervical cancer and cervical intraepithelial neoplasia grade 3 (CIN3) or adenocarcinoma in situ (AIS) registered yearly, total (aggregate) and by region.
Fig. 2
Fig. 2
Biennial percentage distribution of cervical cancer registered between 2001 and 2012, by age-group and region (A = Total aggregate; B = Campinas; C = Curitiba).
Fig. 3
Fig. 3
Biennial percentage distribution of cervical cancer registered in the period from 2001 to 2012 by (A) cancer stage according to the International Federation of Gynecology and Obstetrics (FIGO, in the Portuguese acronym), (B) histological type (SCC: Squamous cell carcinoma; AC: adenocarcinoma; ASC: adenosquamous carcinoma) and region.
See this image and copyright information in PMC

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