Comparação dos Programas de rastreio do cancro do colo do útero brasileiro e português: modelo organizativo, participação no Programa e forma de adaptação face à COVID-19

Abstract

Cervical cancer is considered a global public health problem, whose gross incidence rate was estimated at 15.6 new cases per 100,000 women in 2020, with a total of 604 127 new cases each year. The introduction of well-organized screening programs and the achievement of the entire population, including HPV detection tests, as well as large-scale vaccination, are Public Health effective in reducing mortality from uterine cancer. Due to the heterogeneity of cervical cancer screening programs at a global level, their study and comparative analysis between different countries is relevant. Furthermore, a pandemic caused by Coronavirus Disease - 2019 (COVID-19) brought new challenges to health services, given that periods of population confinement and the redirection of health care to users with COVID-19 posed barriers to access to this type of preventive care. Thus, the aim of this work is to identify and compare the organization of cervical cancer screening programs in Brazil and Portugal, from its genesis to the present time. Additionally, it is intended to describe the evolution of the participation of women eligible to the Cervical Cancer Screening Programs in Brazil and Portugal, in the years 2019 and 2020, corresponding to the previous and initial period of the COVID-19 pandemic. A descriptive study of the Cervical Cancer Screening Programs in Brazil and Portugal was carried out; it contains information on the organization of the Screening Programs, written from official documents of both countries. To characterize the participation of users in the screening program in Brazil, a participation ratio was used (quotient between the absolute number of cervicovaginal cytology performed in the age group from 25 to 64 years and the total number of women in this age group divided by three). In Portugal, a proportion of participation was considered (quotient between the absolute number of women who underwent cervical cancer screening in an organized program form and as eligible women for cervical cancer screening), as well as the composition Program adherence (quotient between the absolute number of women who underwent cervical cancer screening and women eligible for cervical cancer screening) in the years 2019 and 2020. The implementation of screening programs in both countries occurred in the 1990s, using conventional cytology (Papanicolaou) as a screening method. In Brazil, this method remains the main form of screening, carried out in an opportunistic way for women aged 25 to 64 years. In Portugal, screening is carried out through an organized program, the qualification of the female population between 25 and 60 years of age, liquid cytology as the primary screening method. Brazil has a lower level of organization in the form of invitations, as well as in the monitoring and evaluation strategy. In both countries there was a negative impact of the pandemic on the participation of users in cervical cancer screening programmes. In Brazil, the ratio of women's participation in the screening program dropped by 44.8%, from 2019 to 2020. A monthly analysis indicates that the months from May to August 2020 were the most affected, with the variation of reduction between 72.4 to 81%. In Portugal, the proportion of women joining the Program in 2019 was 88%. A monthly analysis of the proportion of women's participation indicated that from June to December 2020 there was a gradual decline in participation, with a 10.6% reduction in December 2020, when compared to the previous year. It is possible to obtain increments in the level of organization of the Cervical Cancer Screening Program in Brazil, namely through the implementation of systematic requirements of eligible women, as well as the implementation of qualified information systems to ensure mandatory observation and evaluation from the program. Furthermore, it will be necessary to develop and adopt strategies that succeed the participation of eligible women in the screening Program, even in periods of confinement or less availability of preventive health care.

Keywords: Cervical Neoplasms, Screening programs, COVID-19.