Organized Cervical Cancer Screening Program in Barretos, Brazil: Experience in 18 Municipalities of São Paulo State

Abstract

Objectives: The aim of this report is to demonstrate the Barretos Cancer Hospital initiative of organizational, laboratorial, and human resources training in the implementation of an organized cervical screening program in low-resource settings. Methods: We developed a computational program to report all epidemiological, clinical, and laboratorial findings, and to trace all necessary information to recruit women for regular screening or for referral for complementary exams after liquid-based Pap test analyses. Results: All Pap tests were collected in liquid medium and in 2014 more than 160,000 tests were analyzed and 2,900 colposcopy examinations were performed. From 2012 to 2015, the percentage of exams collected increased from 54.6% in 2012 to 62.4% in 2013, 68.4% in 2014, and 71% in 2015. Per 1,000 Pap tests, 0.4 cases of invasive cancer were diagnosed; for in situ carcinoma, 1.9 cases were identified. More importantly, between 2011 and 2015, 89.4% of all carcinomas were detected at clinical stage 0 or I (in situ carcinoma), and only 5% at stages III and IV. Conclusions: Since the organized system was implemented, 98% of women have attended their recall for colposcopy. So far, we have not reached the target of 70% of women for this proposal, as recommended by the international standards.

Overall survival and time trends in breast and cervical cancer incidence and mortality in the Regional Health District (RHD) of Barretos, São Paulo, Brazil

“…Since 1994, the Barretos Cancer Hospital has introduced the use of mobile units that offer cervical cancer screening to the target population of the RHD [ 27 ]. From 2012, women aged between 25 and 64 years are invited annually to participate in the cervical cancer prevention programme via municipality-specific health service units [ 28 ]. Letters are mailed to all women who were already registered in a database and who were not up-to-date on their Pap smear, as well as women for whom a Pap smear should be repeated when the mobile unit is present in their municipality [ 28 ].…”

“…From 2012, women aged between 25 and 64 years are invited annually to participate in the cervical cancer prevention programme via municipality-specific health service units [ 28 ]. Letters are mailed to all women who were already registered in a database and who were not up-to-date on their Pap smear, as well as women for whom a Pap smear should be repeated when the mobile unit is present in their municipality [ 28 ]. The invitations are sent to women following the screening protocol, and the exams are routinely conducted at intervals of 3 years after two annual negative exams [ 28 ].…”

“…Letters are mailed to all women who were already registered in a database and who were not up-to-date on their Pap smear, as well as women for whom a Pap smear should be repeated when the mobile unit is present in their municipality [ 28 ]. The invitations are sent to women following the screening protocol, and the exams are routinely conducted at intervals of 3 years after two annual negative exams [ 28 ]. A systematic follow-up of the women participating in the cervical cancer screening programme is performed using software developed by the Barretos Cancer Hospital for this purpose [ 28 ].…”

“…The invitations are sent to women following the screening protocol, and the exams are routinely conducted at intervals of 3 years after two annual negative exams [ 28 ]. A systematic follow-up of the women participating in the cervical cancer screening programme is performed using software developed by the Barretos Cancer Hospital for this purpose [ 28 ]. However, this government lacks reliable information on coverage rate, which is essential for programme monitoring, and future studies are needed to monitor the prevalence of abnormal cytology screening results and to quantify the effectiveness of cervical cancer screening in Brazil since the introduction of this screening programme.…”

Research Article Strategies for cervical cancer screening in the scope of the Brazilian Unified National Health System

“…In the primary health care network, the Brazilian National Program for Control of Cervical Cancer employs prevention actions including vaccination and early detection of CC guided by the Brazilian Guidelines for CC Screening (Possati-Resende et al, 2018). Although this program is comprised of a complex network responsible for the promotion and protection of health in Brazil, CC is still the second most frequent tumor type among women (Fabri et al, 2019).…”