José Cândido Caldeira Xavier‐Júnior

Introduction of DNA ‐ HPV test in the Brazilian cervical cancer screening program: When the idea is good but does not fit the budget

Abstract Objective To evaluate the financial applicability of the DNA‐HPV test for cervical cancer screening in a developing country like Brazil. Methods This was a retrospective, observational study based on documentary data, conducted to assess the cost‐effectiveness of cervical cancer screening strategies in Brazil. The study used national cervical cancer screening data collected between January 1 and December 31, 2020 for women between 25 and 64 years old, performing a cost‐effectiveness assessment of two different screening tests. No sensitivity analysis was conducted due to the descriptive nature of this preliminary cost assessment. Results Based on the cervical smear, the Brazilian protocol has an estimated cost of US$117.5 million. In contrast, when using the HPV DNA test, the estimated cost is US$1.39 billion. Conclusion The current use of the cervical smear is the least expensive and the only one that aligns with Brazil's financial resources allocated to health.

Comparison of cervical cancer screening results among public and private services in Brazil

AbstractObjectiveTo compare the frequency of cervical smear test results between women seen in private and public health services in a medium‐sized city in Brazil.MethodsThis was an observational analytical study analyzing cervical cytologic results over 16 years. Public data were collected from the Brazilian National Health System, and private refers to those collected at private clinics.ResultsThe overall frequency of unsatisfactory/rejected results was higher in public service examinations (odds ratio [OR] 0.05; 95% confidence interval [CI] 0.04–0.06). The same occurred for atypical squamous cells of undetermined significance (ASC‐US) (OR 0.90; 95% CI 0.85–0.95) and atypical squamous cells cannot exclude high grade intraepithelial lesions (ASC‐H) (OR 0.55; 95% CI 0.47–0.64) categories. For low‐grade squamous intraepithelial lesions, the frequency was higher among women from private services (OR 1.39; 95% CI 1.24–1.55). Among women aged 25–64 years, the frequency of high‐grade squamous intraepithelial lesions was higher among women seen in the public service (OR 0.81; 95% CI 0.66–0.99).ConclusionBrazilian public services showed higher frequencies of unsatisfactory/rejected results and higher rates of ASC‐US and ASC‐H. Focusing on pre‐analytical phases and establishing an internal quality control program can help improve these rates even though national protocols guide them.

Underestimated Cervical Cancer among Women over 65 Years Old: Is It Time to Revise the Screening Target Age Group?

Abstract Objective To compare cytological and histological results from women > 64 years old who followed the Brazilian national cervical cancer screening guidelines with those who did not. Methods The present observational retrospective study analyzed 207 abnormal cervical smear results from women > 64 years old in a mid-sized city in Brazil over 14 years. All results were reported according to the Bethesda System. The women were divided into those who followed the screening guidelines and those who did not. Results Atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesion cytology results were found in 128 (62.2%) cases. Of these, 112 (87.5%) had repeated cytology with positive results. The other 79 (38.1%) with abnormal results should have been referred to colposcopy and biopsy. Out of 41 (51.9%) biopsied women, 23 (29.1%) had a confirmed diagnosis of neoplasia or precursor lesion. In contrast, among the 78 (37.7%) biopsied patients, 40 (51.3%) followed the guideline recommendations, with 9 (22.5%) positive biopsies. Of the 38 (48.7%) women who did not follow the guidelines, there were 24 (63.1%) positive results. Women who did not follow the guidelines demonstrated higher chances of cancer and precursor lesions (odds ratio [OR]: 5.904; 95% confidence interval [CI]: 2.188–15.932; p = 0.0002). Conclusion Women > 64 years old who did not follow the national screening protocol showed significant differences in the frequency of abnormal results and severity of diagnosis compared with those who followed the protocol.