Delineamento epidemiológico do câncer do colo do útero no Brasil e da cobertura de estratégias de prevenção, com auxílio de modelo geoespacial, para fundamentar ações para seu controle

Abstract

Introduction: According to the latest data from the World Health Organization (WHO), cervical cancer (CC) was classified as the fourth female tumor in incidence and mortality in the world. In Brazil, the National Cancer Institute (INCA) predict around 16,710 new cases for the 2020-2022 triennium, with an estimated risk of 16.35 cases per 100 thousand women, and registered 6,526 deaths in 2018, corresponding to the third tumor in incidence (except non-melanoma tumors) and the fourth in mortality. The Ministry of Health (MS), in partnership with INCA, developed the Brazilian Guidelines for Cervical Cancer Screening, which determine the cervical cytology collection in patients aged 25 to 64 years. The MnS has incorporated a tetravalent vaccine against subtypes 6, 11, 16 and 18 of HPV for girls aged 9 to 14 years old and boys aged 11 to 14 years old. Objectives: CC's epidemiological profile at national level and by federative units, relating incidence and mortality together with the coverage of screening and immunization programs, determining priority areas for intervention through improvements in public health policies. Material and Methods: Ecological study evaluating data on incidence, mortality, vaccination coverage against HPV in girls aged 9 to 14 years and proportion of Pap screening in women aged 25 to 64 years, provided by the MS and INCA. Using the geospatial model, the variables were classified by states and maps were elaborated from the overlap of these variables for visualization and comparison of deficient areas, conceiving a geographical representation of the priority areas for directing interventions by health managers. Results: Seven of the 27 (25.9%) Brazilian states have an incidence of more than 20 cases per 100,000. There is a greater burden of the disease in the North, where all states, except Roraima, have an incidence of more than 18.85 cases per 100,000 women per year, and where all states, without exception, have a mortality rate greater than 6.93 cases per 100,000 women per year. Our analysis also shows an overlap of higher incidence and higher mortality from CC concentrated in the northern region of the country (states of Acre, Amapá, Amazonas, Pará, Roraima, Tocantins) and in a state in the northeast region (Maranhão). Brazil's geographic mapping highlighted a national disparity in HPV vaccination and Pap coverage, both with low median rates. Conclusion: Despite the promise of the recent implantation of HPV vaccination, its full impact will take decades to occur, and these data argue that continuous efforts are needed to improve access to screening and treatment for CC and reduce the lives lost by this preventable disease. The results also suggest that vaccination rates against HPV are below the target, at the risk of repeating Pap test trajectory: an efficient but underutilized tool for CC control.