Marilisa Berti de Azevedo Barros

Prevalence and social inequalities in the use of cancer screening tests in Campinas, Brazil (ISACamp 2014/15)

ABSTRACT Objective: To analyze the prevalence of early detection tests for cervical, breast, prostate, and colorectal cancers in the population of Campinas, São Paulo and the presence of social inequalities in access. Methods: Population-based cross-sectional study using data from ISACamp 2014/15. Dependent variables were the performance of Pap smear, mammogram, prostate-specific antigen (PSA), fecal occult blood test (FOBT) and colonoscopy/sigmoidoscopy within the age ranges recommended by national guidelines. Independent variables included sex, age, schooling, income, race/skin color, and private health insurance. Prevalence and prevalence ratio adjusted for sex and age were estimated using Poisson regression. Analyses were performed using Stata 14, considering sampling weights. Results: The prevalence of mammography (77.7%) and Pap smear (87.8%) met the targets set by the Brazilian Ministry of Health, while FOBT (22.3%) and colonoscopy/sigmoidoscopy (21.5%) showed low coverage. PSA testing in the previous three years was reported by 55.2% of eligible men. Higher prevalence of test performance was observed among individuals with higher schooling and income levels and those with private health insurance. Inequalities varied by type of test. For instance, individuals with private health insurance had 11 and 162% higher prevalence of Pap test and colonoscopy/sigmoidoscopy, respectively, compared to those without insurance. Racial inequality was observed only for mammography. Conclusion: The results indicate high coverage and lower inequalities for Pap and mammography, and low coverage with significant disparities for FOBT and colonoscopy/sigmoidoscopy. Findings highlight the need to monitor coverage and to implement public policies aimed at reducing inequities in access to cancer screening.

Social inequalities in the incidence, mortality, and survival of neoplasms in women from a municipality in Southeastern Brazil

This study aims to analyze inequalities in the incidence, mortality, and survival of the main types of cancer in women according to the Social Vulnerability Index (SVI). The study was conducted in Campinas, São Paulo State, Brazil, from 2010 to 2014, and used data from the Population-based Cancer Registry and the Mortality Information System. Incidence and mortality rates standardized by age and 5-year survival estimates were calculated according to the social vulnerability strata (SVS), based on the São Paulo Social Vulnerability Index. Three SVS were delimited, with SVS1 being the lowest level of vulnerability and SVS3 being the highest. Rate ratios and the concentration index were calculated. The significance level was 5%. Women in SVS1 had a higher risk of breast cancer (0.46; 95%CI: 0.41; 0.51), colorectal cancer (0.56; 95%CI: 0.47; 0.68), and thyroid cancer (0.32; 95%CI: 0.26; 0.40), whereas women from SVS3 had a higher risk of cervical cancer (2.32; 95%CI: 1.63; 3.29). Women from SVS1 had higher mortality rates for breast (0.69; 95%CI: 0.53; 0.88) and colorectal cancer (0.69; 95%CI: 0.59; 0.80) and women from SVS3 had higher rates for cervical (2.35; 95%CI: 1.57; 3.52) and stomach cancer (1.43; 95%CI: 1.06; 1.91). Women of highest social vulnerability had lower survival rates for all types of cancer. The observed inequalities differed according to the location of the cancer and the analyzed indicator. Inequalities between incidence, mortality, and survival tend to revert and the latter is always unfavorable to the segment of highest vulnerability, indicating the existence of inequality in access to early diagnosis and timely treatment.