Desigualdades regionais na adesão ao exame Papanicolau para rastreamento do câncer do colo do útero e fatores associados: uma análise com dados da pesquisa nacional de saúde 2019

Abstract

Chronic Noncommunicable Diseases (NCDs), including cancer, represent a significant challenge to global public health. In Brazil, cervical cancer is one of the most common cancers among women, with high mortality rates, despite primary (HPV vaccination) and secondary (Pap smear) prevention measures. Organized screening through Pap smears is essential for early detection, timely treatment and reduced mortality. However, given the opportunistic nature of cervical cancer screening in Brazil, adherence to preventive screening varies between regions of the country, reflecting social inequalities and access to health services. This study aimed to estimate the prevalence and verify the sociodemographic factors and possession of a health plan associated with undergoing the Pap smear in the last three years to screen for cervical cancer among women aged 25 to 64 in Brazil - with an emphasis on regional differences - as well as characterizing the self-reported reasons for not undergoing the test, using data from the National Health Survey (PNS) 2019. Using data from the 2019 PNS, models were applied Poisson regression with robust variance to examine the association between taking the exam and sociodemographic variables, such as age, education, income, race/skin color, place of residence and having health insurance, with the crude and adjusted prevalence ratios estimated with their respective 95% confidence intervals. The results confirm regional inequalities in adherence to the Pap smear, with the Northeast region presenting 76.4% coverage of the Pap smear among women aged 25 to 64, in contrast to the South and Southeast regions which presented rates of 84.8% and 84.1%, respectively. Sociodemographic factors influence the exam, with greater adherence to the exam among women aged 35 to 44, especially in the South (88.6%) and Southeast (88.2%), with higher education (90.5% in the South) and income above three minimum wages (93.9% in the South), residents of urban areas (85.4% in the South), and who have health insurance (92.8% in the North) compared to SUS users (74.0% in the Northeast). In the crude analysis, the race/skin color variable did not reach the p-value parameters <0.20, used in this study to consider the variable statistically significant, despite the differences found. In the adjusted analysis, the drop in the prevalence of the exam in the 55 and 64 years old group stands out, especially in the Northeast and South (-6%). In relation to income and education, the highest prevalence is among women with income above 3 minimum wages, in the Northeast and Central-West (+10%), and with complete secondary education or incomplete higher education, in the North (+18%) and Northeast (+16%). The prevalence of testing for women who have health insurance is also a highlight in all regions, especially in the North (+12%). When it comes to the main barriers for not taking the exam, lack of knowledge about its importance was the most cited in all regions. These results reinforce the need for public policies that expand screening coverage, reducing regional and socioeconomic inequalities, the unequal distribution of health infrastructure, with the concentration of basic units and specialized professionals in the South and Southeast regions. The findings reinforce the need for public policies aimed at equity in access to preventive health, considering regional and sociodemographic factors to optimize cervical cancer screening and reduce inequalities. Strengthening Primary Health Care and health education strategies are essential to increase test adherence in all regions of the country.