A Federação Brasileira das Associações de Ginecologia e Obstetrícia (FEBRASGO), descreve a endometriose como uma doença crônica estrogênio-dependente, inflamatória, multifatorial em mulheres em idade fértil. Mesmo com inúmeros estudos, a endometriose ainda não tem uma causa definitiva, mas possui teorias que são aceitas para explicar a causa e buscar um melhor tratamento. Apresenta inúmeros sintomas, tendo como destaque a dispareunia, infertilidade e dor pélvica crônica; sendo os dois últimos citados como sintomas associados à diminuição da qualidade de vida de 10% a 15% das mulheres com endometriose.Logo, o impacto na qualidade de vida das mulheres com endometriose com dor pélvica crônica foi analisado, neste trabalho, por meio de uma Revisão Integrativa de Literatura fundamentada pela busca nas bases de dados, nas quais enumerou-se 24 artigos científicos para a construção textual que apresentavam todos os critérios exigidos. Posteriormente à leitura atenta dos artigos selecionados, verificou-se que a dor pélvica crônica associada à endometriose pode agravar o prognóstico das mulheres com tal diagnóstico, uma vez que prejudica a qualidade de vida delas devido ao isolamento social, dificuldade no ambiente familiar e de trabalho e evolução da doença a outros órgãos e sistemas.

Problem The burden of disease for oncological problems is significant in Portugal. Population-based screenings, such as colorectal cancer screening (CCS) with faecal occult blood tests (FIT) is a priority program to reduce the burden of disease and a cost-effectiveness measure. Description problem Algarve CCS started in 2017,to early detect colorectal cancer reducing morbidity and mortality. Screening strategy to detect and remove cancer precursors (adenomas) and early cancer detection with less invasive treatment using a non-invasive stool test was selected. A quantitative faecal immunochemical test for haemoglobin (FIT) with higher sensitivity for adenoma and cancer, specific for human globin with no dietary restriction, with a single sample screening is considered a test with higher participation. Target population all gender from 50 to 75 are invited to participate in the CCS by letter. Screening interval is 2 years and FIT cut-off- 117 (ng Hb/mL). Software was used to manage all CCS. Health units distribute the test and a flyer. All FIT-positive were invited to do a full colonoscopy at University Hospital. Results A preliminary descriptive analysis (2017/2019) was made. After exclusions 25017 of target population participate 34,4%(n = 8594),27.5%(n = 6883) submitted it for analysis, 3.9% (n = 266) had positive FIT and were invited for a full colonoscopy with 57.5% (n = 153)participation rate. Cancer detection was 0.9‰ and adenomas detection rate was 9.9%. FIT positive with colonoscopy 3.9% (n = 6) had carcinoma and 44.4% (n = 68) had adenoma. Lessons Some operational changes were made to improve participants and professionals adherence to CCS. Pathology observed in the positive cases, reinforce the need to implement strategies to increase literacy, raise public awareness, keep the screening test and improve accessibility of health facilities. Key messages The importance of a colorectal cancer early diagnosis prevent aggressive interventions in a precancerous phase. The importance of a colorectal cancer early diagnosis improves survival and population quality of life.

Issue Cervical Cancer (CC) is the 7th most frequent and the 2nd most common in women. The standardized mortality rate, in Portugal is 2.3/100000 inhabitants and Algarve is the region with highest rate, 4.9/100000. Description Programme started in 2010. Population-based screening programme can reduce incidence, mortality and morbidity with an early diagnosis, preventing aggressive interventions in precancerous phase, improving survival and life quality. Target population, woman age 25-64.are invited to primary test liquid-based cytology (ThinPrep) every 3 years. Health Centres are responsible for select, invite, collect samples and send to Hospital laboratory. For positives, a cervical pathology consultation is required. National Guidelines now indicates DNA testing for human papillomavirus (HPV) as primary screening test, each 5 years, to woman age 25 to 60 and screening program changes will be implemented in 2019 with improved response time and lower cost. Results Since 2010 the target population has increased 12% every 2 years and the adhesion rate increased ≈68% and≈108%. Nevertheless the 3rd cycle has showed 10,8% (17.975) adhesion rate. Most women 16.112 (89.6%) had a negative diagnosis, 503 (2,8%) is ASC-US + (HPV test), and 761(4,2%) had a cervical pathology consultation. From those, 117 (15.4%) had a LSIL, 69 (9,1%) HSIL and 2(0,3%) cancer. Cancer detection rate is 0,1 ‰. Lessons The small adhesion rate particularly by aged women, the users unfriendly Information System and direct screening health units management are some of the issues that requires improvement. Also population literacy, self-sampling vaginal fluid and clinical meetings are some of the options to improve screening program. Key messages Cervical Cancer early diagnosis prevent aggressive interventions in a precancerous phase, improves survival and life quality. Better access and health communication are major points in screening programs.

Issue Breast cancer is the 2nd cause of death for women in Portugal and 6000 new cases are detected annually. The prognosis is better for women whose cancers are detected earlier. Description Algarve BCS begin in 2005 using a digital mammography with 2 incidences/breast with double reading and consensus by a 3rd radiologist. Each 2 years women age 50 to 69, are invited to a Mobile Unit to do the mammography, a partnership with Algarve Oncologic Association. In 2017, direct digital mammography with Tomosynthesis(DDMT)was implemented. This technique increase cancer detection, reduction of false positives, false negatives and radiation dose. Diagnostic accuracy is better and also improves accessibility to the most vulnerable population groups to this technology. Results BCS covers 100% of the region and the mobile unit is user friendly for women with mobility impairment. Adhesion rate is > 62%. Is the 1st screening using Tomosynthesis in Portugal.Preliminary results show that the confirmation rate increased (10 %), the detection rate per 1.000 women also increased and the positive predictive value >95%. Costs associated with the program decrease and less number of women called for false positives is observed. The number of positive mammograms increased, due to diagnostic acuity, with better visualization of the breast, namely in the patterns of greater mammary density; which leads to an improvement in further assessment rates. Lessons The technique increases the adhesion rate, with the same human resources. The decrease of the false positives improves the number of women send to further assessment and Senology Center. Earlier diagnoses, less aggressive treatments, and a higher survival rate are also expected. Messages- Using this technology is expected that cancer diagnosis will be earlier, more reliable and wiht higher survival rate for this disease. The possibility of a population based screening with DDMT is an opportunity to reduce inequalities in the region. Key messages Mammography Tomosynthesis is expected that cancer diagnosis will be earlier, more reliable and wiht higher survival rate for this disease. The possibility of a population based screening with Mammography Tomosynthesis is an opportunity to reduce inequalities in the region.

RESUMOO câncer do colo uterino está entre as causas mais comuns de morte por neoplasia no sexo feminino. O objetivo deste trabalho foi descrever a realização de Papanicolau, a cobertura vacinal para HPV e a morbimortalidade por câncer de útero, em duas cidades na região nordeste do Brasil entre os anos de 2009 a 2018. Trata-se de um estudo descritivo retrospectivo, que analisou a produção ambulatorial de exames Papanicolau, doses de vacina aplicadas, morbidade hospitalar e óbitos por câncer de colo uterino. Observou-se, no período avaliado, que para todas as variáveis analisadas houve intensa variação nos registros ao longo dos anos. Entretanto, uma vez que que a vacina foi inserida no calendário brasileiro somente a partir de 2014, o impacto dela nas cifras de morbimortalidade ainda não pôde ser observado. Dessa forma, a principal linha de ação que poderia alcançar alguma efetividade no período seria o rastreio citológico, porém não foi observada diminuição no número de casos e óbitos. Reforça-se que medidas devem ser tomadas para que tanto a realização dos exames preventivos quanto a vacinação sejam implementadas de forma efetiva no território nacional, de forma a reduzir a morbimortalidade associada à infecção pelo vírus HPV.Palavras-chave: Câncer do colo do útero, HPV, Papilomavírus humano, Vacina contra HPV.