Barriers and innovative interventions for early detection of cervical cancer / Barreras e intervenciones innovadoras para la detección temprana del cáncer cervicouterino

Abstract: Cervical cancer has decreased significantly over the past 30 years in some countries. However, it remains among the leading causes of cancer deaths in low-income, and racial/ethnic minority women. Cervical cancer prevention technologies are not always available. Laboratories are often not well equipped to use them. HPV information has not been widely disseminated. WHO guidelines, and US and Latin American data provide context for strategies on effective interventions to reduce cervical cancer disparities. Systemic, personal and cultural barriers, combined with decision-making guidelines, and impactful messaging can accelerate reductions in cervical cancer health inequities in the Americas.

Resumen: El cáncer cervicouterino ha disminuido significativamente en los últimos 30 años, pero sigue siendo una de las principales causas de muerte entre mujeres de bajos recursos y minorías raciales/étnicas. Las tecnologías preventivas del cáncer cervicouterino no están siempre disponibles y los laboratorios no están siempre bien equipados para utilizarlas. La información sobre el VPH no ha sido difundida ampliamente. La OMS y datos de EEUU y Latinoamérica ofrecen estrategias para reducir el cáncer cervicouterino. El entendimiento de las barreras sistémicas, personales y culturales, dentro de un marco de toma de decisiones, y mensajes innovadores puede reducir las barreras asociadas con el cáncer cervicouterino en las Américas.

Curitibanas não cobertas pelo rastreio do câncer de colo de útero. Quem são elas? / Curitibanas not covered by cervical cancer screening. Who are they?

Introdução: O câncer do colo do útero é o terceiro tumor mais frequente na população feminina e pode ser detectado na fase inicial de instalação por técnicas de rastreamento. Objetivo: Descrever as características sociodemográficas, econômicas e comportamentais de mulheres não cobertas pelo rastreio do câncer do colo de útero residentes na cidade de Curitiba, Brasil. Casuística e Métodos: Trata-se de um estudo transversal de dados secundários do Ministério da Saúde obtidos pelo Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas não Transmissíveis por Entrevista Telefônica para os anos de 2013 e 2014. Resultados: Participaram 2.164 mulheres adultas. Resultou em 10,2% (IC95%: 7,3 ­ 13,1) de mulheres não cobertas por exame preventivo do câncer do colo do útero; 4,6 pontos percentuais abaixo da média nacional (14,6%; IC95%: 11,8 ­ 17,1). A não cobertura foi maior nas mulheres com mais de 64 anos de idade (46,2%; IC95%: 39,7 ­ 52,2) e com menos de 25 anos (18,7%: IC95%: 15,2 ­ 21,1), sendo que 35% tinham idade que as incluíam na população de risco. A falta de cobertura do rastreio foi maior em mulheres com baixa escolaridade (43,2%; IC95%: 40,5 ­ 46,0); 76,6% delas não conviviam com companheiros e 8% percebiam negativamente o seu estado de saúde; 46,6% (IC95%; 43,1 ­ 48,7) não realizaram mamografia; 6,3% (IC95%: 5,2 ­ 7,3) eram fumantes; 3,4% (IC95%: 2,5 ­ 4,2) consumidoras abusivas de álcool; 38% (IC95%: 35,4 ­ 39,8) eram inativas no lazer e 33% (IC95%: 30,6 ­ 36,1) eram hipertensas. Conclusão: O não engajamento no rastreio do câncer do colo do útero foi maior nas classes sociais com menor poder econômico, sugerindo a necessidade de maior destinação de recursos financeiros e humanos para a população mais vulnerável no anseio de ampliar a cobertura do programa de rastreio, sem prejuízo às demais camadas da população.

Introduction: Cervical cancer is the third most frequent tumor in the female population and can be detected early in the installation by screening techniques. Objective: To describe the sociodemographic, economic and behavioral characteristics of the women not covered by cervical cancer screening in the city of Curitiba, Brazil. Patients and Methods: This is a transverse study of secondary data obtained by the Surveillance System of Risk Factors and Protection for Chronic Diseases not Communicable by Telephone Interview for the years of 2013 and 2014 from the Ministry of Health. Results: There were 2,164 adult women participating. It resulted in 10.2% (95% CI: 7.3 - 13.1) of women not covered by a cervical cancer preventive exam; 4.6 percentage points lower than the national average (14.6%, 95% CI: 11.8 - 17.1). Non-coverage was higher in women older than 64 years (46.2%; 95% CI: 39.7 - 52.2) and younger than 25 years old (18.7%: 95% CI: 15.2- 21.1), 35% of whom were included in the at-risk populationdue to their age. The lack of screening coverage was higherin women with low schooling (43.2%; 95% CI: 40.5 - 46.0);76.6% of them do not live with their companions and 8%negatively perceived their health status; 46.6% (95% CI: 43.1- 48.7) did not undergo mammography; 6.3% (95% CI: 5.2- 7.3) were smokers; 3.4% (95% CI: 2.5-4.2) were abusivealcohol consumers; 38% (95% CI: 35.4 - 39.8) were inactive atleisure and 33% (95% CI: 30.6 - 36.1) had high blood pressure.Conclusion: Non-engagement in the cervical cancer screeningis greater among the lower social classes, suggestingthe needfor a greater allocation of financial and human resources tothe more vulnerable populations to expand the coverage of thecervical cancer screening program, without prejudice to theother layers of the population.

Prevenção do câncer do colo uterino de quilombolas à luz da teoria de Leininger / Prevención del cáncer de cuello uterino de quilombolas a la luz de la teoría de Leininger / Cervical cancer prevention among quilombola women in the light of Leininger's theory

Resumo OBJETIVO Discutir as práticas de prevenção do câncer do colo do útero de mulheres quilombolas. MÉTODO Estudo qualitativo, realizado em 2014 com vinte mulheres de uma comunidade quilombola, localizada na Bahia. Os dados foram coletados por meio de entrevista semiestruturada e analisados através da etnoenfermagem. RESULTADOS As quilombolas apontaram como práticas preventivas para o câncer do colo uterino o cuidado cultural, através do uso de plantas medicinais, e o cuidado profissional, caracterizado pela realização do Papanicolau. Contudo, uma maioria de mulheres não realizavam prevenção. CONCLUSÃO Questões de ordem social, cultural e de acesso relacionam-se com as práticas preventivas para o câncer do colo uterino de quilombolas. Assim, torna-se imprescindível um planejamento de cuidados congruentes com a realidade dessas mulheres.

Resumen OBJETIVO Discutir las prácticas de prevención del cáncer de cuello de útero de mujeres quilombolas. MÉTODO Estudio cualitativo, realizado en 2014 con veinte mujeres de una comunidad quilombola, localizada en Bahía. Los datos fueron recolectados por medio de entrevista semiestructurada y analizados a través de la etnoenfermería. RESULTADOS Las quilombolas apuntaron como prácticas preventivas para el cáncer de cuello uterino el cuidado cultural a través del uso de plantas medicinales y el cuidado profesional, caracterizado por la realización del Papanicolau. Sin embargo, la mayoría de las mujeres no realizaron prevención. CONCLUSIÓN Cuestiones de orden social, cultural y de acceso se relaciona con las prácticas preventivas para el cáncer de cuello uterino de quilombolas. Así que se torna imprescindible un planeamiento de cuidados congruentes con la realidad de esas mujeres.

Abstract OBJECTIVE Our purpose was to discuss practices of cervical cancer prevention among Quilombola Women. METHOD This study used, in 2014, a qualitative research approach aiming twenty women from a quilombola community (people who live in quilombos, descendants of Afro-Brazilian slaves), which is located in Bahia. A semi-structured interview was developed by researchers in order to collect data. The Ethno-nursing Research method was used to analyze the data. RESULTS The use of cultural care through medicinal plants, and the nursing professional care (Pap Smear exam procedure) were stated by Quilombola women as serving as prevention practices against cervical cancer. However, most women stated that they did not use any prevention practices. CONCLUSION Social, cultural and health access issues are practices that are linked to the cervical cancer prevention among Quilombola Women. Therefore, it is indispensable to create an appropriate care plan for Quilombola women's reality.

Disparities in cancer epidemiology and care delivery among Brazilian indigenous populations / Disparidades na epidemiologia e no tratamento de câncer nas populações indígenas brasileiras

ABSTRACT Objective: To assess aspects related to cancer in indigenous population. Methods: This is a retrospective study developed in a public university hospital. We included patients with 18 or more years of age, diagnosed with solid tumors, and followed between 2005 and 2015. Clinical features were assessed by descriptive statistics, and survival was evaluated by Kaplan-Meier curves and multivariate Cox regression. Results: Fifty patients were included. The cancer incidence was 15.73 per 100,000. The mean age at diagnosis was 54 years and most patients were female (58%). Cancer of the cervix (28%) and prostate (16%) were the most common. The mean time between the onset of symptoms and the diagnosis was 9 months and from diagnosis to the treatment was 3.4 months. Disease diagnosed at stage IV (17%) had worse overall survival (HR: 11.4; p<0.05). The 5-year survival rate ranged from 88% for prostate cancer to 0% for lung cancer. All 5-year survival rates were lower as compared to other populations. Conclusion: The most prevalent cancer sites were cervix and prostate. Disease stage and primary site were prognostic factors.

RESUMO Objetivo: Avaliar os aspectos relacionados a câncer em populações indígenas. Métodos: Estudo retrospectivo conduzido em um hospital universitário público. Foram incluídos pacientes com 18 anos ou mais, diagnosticados com tumores sólidos e acompanhados entre 2005 e 2015. Os aspectos clínicos foram avaliados por meio de estatística descritiva, e a sobrevida foi avaliada por meio de curvas de Kaplan-Meier e regressão multivariada de Cox. Resultados: Foram incluídos 50 pacientes. A incidência de câncer foi 15,73 por 100 mil. A média de idade ao diagnóstico foi 54 anos, e a maioria era do sexo feminino (58%). O câncer de colo uterino (28%) e o de próstata (16%) foram os mais frequentes. O tempo médio entre o início dos sintomas e o diagnóstico foi 9 meses, e entre o diagnóstico e o tratamento, de 3,4 meses. Doença diagnosticada no estágio IV (17%) resultou em pior sobrevida global (HR: 11,4; p<0,05). A sobrevida em 5 anos variou de 88% para o câncer de próstata a 0% para pulmão. Todas as taxas de sobrevida em 5 anos foram menores em comparação a outras populações. Conclusão: Os locais mais frequentes de neoplasia foram colo de útero e próstata. O estágio da doença e o sítio primário foram fatores prognósticos.

Chlamydia trachomatis as a probable cofactor in human papillomavirus infection in aboriginal women from northeastern Argentina

Objectives: High-risk types of human papillomavirus (HPV) are strongly associated with cervical cancer (CC), and Chlamydia trachomatis (CT), the most frequent sexually transmitted bacterial infection (STBI) worldwide, seems to be a risk factor for HPV infection and for CC. It is also known that both agents are more prevalent in vulnerable communities where lack of adequate primary health care is a cause for concern. The aim of this work was to determine the impact of CT and HPV infections in women belonging to an isolated aboriginal population (Pilaga community) from a poor region in Northern Argentina (province of Formosa). For this purpose, a cross-sectional study was performed in all sexually active Pilaga women, who attended a local community-based gynecological health screening project. The polymerase chain reaction (PCR) method on a cervical brush specimen was used to detect both agents. Results: A total of 227 women (20 percent of the total female population of the Pilaga community) were studied and the overall prevalence was 26.4 percent for CT, 46.7 percent for HPV and 16.3 percent for concurrent infection. CT infection was higher in HPV DNA positive (34.2 percent) than in HPV DNA negative women (19 percent; OR: 2.22/95 percent CI = 1.16-4.28 / p = 0.009) and the most prevalent HPV types were HPV-16 (19.4 percent), 6 and 18 (5.3 percent), 58 (3.5 percent) and 33 (3.1 percent). Conclusions: The prevalence of CT and HPV observed in Pilaga women are among the worst registered in Latin America. Also, data collected suggest that chlamydial infection may play an important role in the natural history of HPV infection. On this respect, we propose that the association between these two agents seems to be more related to a mutual potentiation than to the fact that they share a common route of transmission.

Perceptions and practices of a pakistani population regarding cervical cancer screening.

Cervical cancer is among the three leading causes of cancers among females worldwide. It is also among the three most common causes of cancer deaths among females, about 80% of which occur in less developed countries. The present cross-sectional knowledge, attitude and practice survey was carried out to determine the perceptions and practices of a Pakistani female population regarding cervical cancer screening. Through convenient sampling, 192 subjects were recruited and administered a pre-tested and structured questionnaire. About 5% of subjects knew that screening was available for cervical cancer. Only 2.6% of the sample had ever received a Pap test. The most common reason cited for not having received a Pap test was the lack of information. In conclusion, the Pakistani population studied here demonstrated a very low coverage of the Pap test and a poor knowledge regarding its utility.

Aspectos sociales en el control del cáncer uterino en el departamento de Caldas / Social aspects in the control of the uterine Cancer in the department of Caldas

Este trabajo y su impacto es el resultado dela unión del sector político administrativo, académicoy comunitario; está dentro de las propuestasde la atención primaria elaboradas enla conferencia internacional en 1.978 enKazacstan (Unión de Republicas SocialistaSovieticas) con el eslogan ®Salud para todosen el año 2000¼ que planteó: La Atención Primariarefleja las condiciones económicas, políticasy socioculturales de las comunidades yse basa fundamentalmente en la aplicación delos resultados obtenidos en las investigacionessociales y biomédicas y está orientada hacialos principales problemas de salud de la comunidad,utilizando los servicios de promoción,prevención, tratamiento y rehabilitación, necesariospara enfrentarlos...

Características clínicas-sociodemográficas del cáncer de cuello uterino-1993: Bahía-Brasil

Se realiza el análisis de 482 historias clínicas registradas en el hospital Aristides Maltez (HAM), con diagnostico de cáncer de Cérvix uterino, de un total de 8.558 mujeres que consultaron en 1993. El tipo histológico más frecuentemente encontrado fue carcinoma escamocelular, con 442 casos (91.7 por ciento). El estadio clínico de mayor incidencia fue el estadio III (56.43 por ciento) seguido del estadio II (18,47 por ciento) y el estadio I (11,41 por ciento). La edad de presentación fue de 19.3 por ciento antes de los 40 años y el 80 por ciento a partir de los 41 años. Se estudiaron factores de riesgo como edad de la primera relación sexual, número de compañeros sexuales, número de gestas y antecedentes de enfermedades de transmisión sexual. El objetivo es describir característicasclínicas , sociodemográficas, que puedan ayudar a tomar medidas más eficaces para prevenir y mejorar la evolución de esta patología.