Prevenção do câncer de colo de útero: fatores associados a não realização do exame Papanicolaou em participantes da Coorte de Universidades Mineiras (projeto CUME)

Abstract

Introduction: Neoplasms are the second leading cause of death worldwide, especially cervical cancer among the female population. It is noteworthy that one of the forms of prevention, diagnosis, and detection of precursor lesions of this type of cancer is the Pap smear, recommended in Brazil for women aged 25 to 64 years old. Although the proportion of women who undergo this test is high in the country, it is important to know which factors are associated with the failure to have it done among the target audience, to expand coverage. Objective: To analyze the factors related to the non-performance of the Pap smear of women aged from 25 to 64 years old participating in the Cohort of Universities of Minas Gerais (CUME study). Methods: This is a cross-sectional study with data from the baseline of the CUME. All women in the target age group were studied, totaling 2,898 participants. Initially, the prevalence of failure to perform the Pap smear was assessed according to the sociodemographic, behavioral and health characteristics of women. Then, a multivariate analysis was performed to identify factors independently associated with failure to perform the exam through multiple logistic regression. The level of statistical significance was set at 5% and all data analyses were performed using the software Stata® version 13. Results: The prevalence of failure to perform the Pap smear was 11.8%. The factors associated with an increased chance of not having Pap smears were: black skin color (OR: 2.16; 95% CI: 1.37-3.42) or brown (OR: 1.44; 95% CI: 1.11-1.87) and an undergraduate course that was not in the health field (OR: 1.45; 95% CI: 1.10-1.91). The factors associated with decreased chance of not having the exam were: age, with emphasis on the age group 45 to 54 years (OR: 0.40; 95% CI: 0.22-0.72); being married/in a stable union (OR: 0.27;95% CI: 0.19-0.39) or separated/divorced (OR: 0.38; 95% CI: 0.15-0.93); having specialization (OR: 0.62; 95% CI: 0.44-0.87), masters (OR: 0.69; 95% CI: 0.51-0.93), doctorate/post doctorate (OR: 0,63; 95% CI: 0.39-0.99); income from 5 to 10 minimum wages (OR: 0.59; 95% CI: 0.41-0.84) and greater than 10 minimum wages (OR: 0.27; 95% CI: 0.10-0.68); being a smoker (OR: 0.53; 95% CI: 0.30-0.92) or former smoker (OR: 0.45; 95% CI: 0.26-0.78); having already experienced some pregnancy throughout life (OR: 0.55; 95% CI: 0.36-0.85); being physically active (OR: 0.71; 95% CI: 0.53-0.94). Conclusions: The results of this study showed a high coverage of Pap smears and the factors associated with not performing the exam were like those evidenced in previous investigations for the general Brazilian population. Such findings demonstrate that, even in a highly educated public, strategies for expanding the cervical cancer screening test involve issues that are subject to modification, such as education, income and, potentially, structural racism, in addition to health education actions for women who did not graduate in the health area.