Trends in cervical cancer and its precursor forms to evaluate screening policies in a mid-sized Northeastern Brazilian city

Gynaecological cancer incidence and mortality trends in a Brazilian State with medium human development index: A 22-year analysis

OBJECTIVE

This study aimed to analyse trends in incidence and mortality rates of gynaecological cancer (GC) in Sergipe, a medium Human Development Index (HDI) state in northeastern Brazil during 1996-2017.

METHODS

Data were obtained from the Population-based Cancer Registry of Aracaju and Brazilian Mortality Information System database. We included vulvar (VUC), vaginal (VAC), cervical (CC), uterine (UC; C54-C55), ovarian (OC), placental (PC), and unspecified female genital organ cancers. Crude rates, and age-standardised incidence and mortality rates (ASIR and ASMR, respectively) were calculated using a denominator of 100,000 women. We assessed changes in trends using the annual percentage change (APC) and the average APC (AAPC), using the Joinpoint Regression Program.

RESULTS

From 1996-2017, GC ASIR exhibited a declining trend (AAPC: -3.1), while ASMR increased (AAPC: 2.1). CC had the highest ASIR and ASMR over the years, ranging from 11.6 to 34.3 cases and 4.2-9.0 deaths per 100,000, respectively. Annual decreases in ASIR were observed for CC (AAPC: -5.2) and VAC (AAPC: -5.5). OC saw an increase in mortality rates (AAPC: 1.9; 1996-2017), and CC experienced an increase during 1996-2003 (APC: 6.9). VUC displayed a substantial rise in ASMR from 2001 to 2009 (APC: 27.1), followed by a decrease (APC: -11.3). An increase in mortality trends for UC was observed during 1996-2004 (APC: 10.0), while its ASIR remained relatively unchanged over the years.

CONCLUSION

While overall GC incidence trends declined, mortality rates either increased or failed to decrease significantly. Therefore, additional efforts are required to enhance prevention, diagnosis, and treatment strategies, aimed at reducing and managing the burden of GC in the future.

Brazilian Survey on Preventive Actions for the Population With Access to Primary Healthcare: Inefficient Spending in a Country in Economic Crisis

BACKGROUND

Cancer ranks second as a cause of death in Brazil. Although preventive practices are part of the daily routine of primary healthcare (PHC) teams, organized screening programs are lacking. This study aimed to evaluate the adequacy of preventive interventions in the main cancer types, as defined by the Brazilian government.

METHODS

We analyzed cross-sectional data from a larger project conducted in 2016 with PHC service users and physicians from all over Brazil, interviewed by trained research staff. The sample was stratified by the number of PHC physicians per geographic region, who were eligible for inclusion if they had been working in the same PHC unit for at least one year. Twelve adult patients with at least two encounters were included per participating physician. Only the data from service users were analyzed in this study. We evaluated the questions about preventive practices and calculated the following indicators: coverage, focus, screening errors, and screening ratio. National guidelines and international evidence were used as a comparison parameter.

RESULTS

The study population consisted of 6160 service users. The data indicate that the recommendations for cervical, breast, and prostate cancer screening and for treatment of tobacco dependence are not adequately followed. Coverage for breast and cervical cancer screening presented an overutilization bias, with rates 50% and 9% above the expected, respectively. The screening focus was also inadequate: 24%, 47%, and 54% of the screening tests for the three cancer types were performed in individuals outside the recommended age range. 31% of smokers were not approached for treatment.

CONCLUSION

These findings indicate that the Brazilian population has been subjected to inadequate and potentially iatrogenic interventions in PHC. New policies based on stricter criteria of adequacy and increased use of the concept of quaternary prevention may improve the effectiveness and equity of the health system.

Incidence and mortality from breast and cervical cancer in a Brazilian town

OBJECTIVES

To analyze the magnitude of changes in the incidence and mortality from cervical cancer (CC) and breast cancer (BC) in Campinas, São Paulo State, between the five-year periods of 1991-1995 and 2010-2014.

METHODS

data on cancer were obtained from the Campinas Population-Based Cancer Registry and data on deaths from the Mortality Information System of the Computing Department of the Unified Health System. Age-standardized incidence and mortality rates were calculated by the direct method, with the respective 95% confidence intervals. The magnitude of the changes was measured by the rate ratio (rate ratio; 95%CI).

RESULTS

among the periods studied, there was a threefold increase in the detection rate of in situ CC (3.03; 95%CI: 2.64-3.47) and fivefold increase for in situ BC (5.23; 95%CI: 4.98-5.50). The proportion of cases of in situ BC in relation to the total number of cases of BC increased from 3.31% to 11.05%. The incidence rate of invasive CC decreased by 57% (0.43; 95%CI: 0.40-0.47), and the incidence rate of invasive BC increased by 40% (1.40; 95%CI: 1.33-1.47). The mortality rate of the CC decreased by 58% (0.42; 95%CI: 0.32-0.56), and that of BC by 15% (0.85; 95%CI: 0.82-0.89).

CONCLUSION

the incidence of in situ carcinomas of CC and BC increased in almost two decades. The rate of invasive carcinoma of CC decreased, and that of BC increased. Mortality from both cancers decreased. Observing these changes is useful for assessing the impact of the actions carried out in the period and for planning future actions.

Spatial pattern of mortality from breast and cervical cancer in the city of São Paulo

OBJECTIVE

To verify the spatial pattern of mortality from breast and cervical cancer in areas of primary health care, considering socioeconomic conditions.

METHODS

This is an ecological study, from January 2000 to December 2016. The study area is the municipality of São Paulo, Brazil, and its 456 coverage areas of primary health units. Information on deaths of women aged 20 years or over were geocoded according to residence address. We calculated mortality rates, standardized by age, and smoothed by the local empirical Bayesian method, and grouped into three or two years to reduce the random fluctuation of the data. In addition, bivariate global and local Moran indexes were calculated to verify the existence of spatial agglomeration of standardized mortality rates with a domain of socioeconomic condition, elaborated based on the Índice Paulista de Vulnerabilidade Social (IPVS - São Paulo Index of Social Vulnerability).

RESULTS

The success rate of geocoding was 98.9%. Mortality from breast cancer, without stratification by time, showed a pattern with higher rates located in central regions with better socioeconomic conditions. It showed a decrease at the end of the period and a change in spatial pattern, with increased mortality in peripheral regions. On the other hand, mortality from cervical cancer remained with the highest rates in peripheral regions with worse socioeconomic conditions, despite being reduced over time.

CONCLUSION

The spatial pattern of mortality from the studied cancers, over time, suggests association with the best socioeconomic conditions of the municipality, either as protection (cervical) or risk (breast). This knowledge may direct resources to prevent and promote health in the territories.