Trends in Cervical Cytology Test Reports and Cervical Dysplasia Severity according to Social Deprivation in Mexico (2013–2019): An Analysis of a National Database
Abstract
Background:
Cervical cancer is a leading cause of cancer-related mortality in women living in low- and middle-income countries such as Mexico. Preventive and screening programs are often inaccessible to socially deprived populations, whose limited access to timely diagnosis and treatment reduces the chance of detecting premalignant lesions early.
Methods:
Cervical malignant and premalignant lesion positivity rates were analyzed from 2013 to 2016 using the Bethesda system, whereas human papillomavirus (HPV) positivity rates were analyzed from 2017 to 2019. Both were stratified according to state-level Social Deprivation Indices in Mexico, published by the National Council for the Evaluation of Social Development Policy. The data originated from the four main healthcare providers in Mexico. Data processing and statistical analyses were performed using Joinpoint Regression Software and SPSS version 25.
Results:
Positivity rates for dysplasia and atypia varied across social deprivation levels. A downward trend in premalignant lesion positivity rates was observed. This varied across social deprivation groups, with differing annual percentage changes (APC). The greatest decrease occurred in high-grade cervical intraepithelial dysplasia (CIN 2–3) in states with very high social deprivation, with an estimated APC of −22.1% (−30% to −14.7%; P = 0.001). HPV positivity by PCR ranged from 11% to 24% between 2017 and 2019. The estimated APC for invasive cervical carcinoma was −22.3% [95% confidence interval (CI); −54.4% to 19.8%], which was not statistically significant (P = 0.223).
Conclusions:
Our study highlights a decline in cervical dysplasia positivity rates. These declines were uneven across social deprivation levels.
Impact:
Reducing health inequities is essential to prevent, detect, and treat cervical cancer and its precursors.