CERVICAL CANCER SCREENING AS A REFLECTION OF THE ROLE OF PRIMARY CARE FOR UNIVERSAL ACCESS TO HEALTH IN BRAZIL
Letícia Yabushita Rigoti
Romana Suely Della Torre Marzarotto
Universidade Estadual do Oeste do Paraná
The screening for cervical cancer is done through cytopathological examination (1), aiming to reduce mortality through early diagnosis of the disease. In Brazil, the Unified Health System (UHS), through universality, guarantees access to health for all citizens, and so, applies strategies for disease control in an integrated manner in the population (2). In women aged 25 to 64, the exam should be performed every three years, after two consecutive normal annual exams, except in abnormal situations, such as family history of cervical cancer. Despite the satisfactory coverage, the lack of periodicity between examinations has led to continued high rates of this cancer in the developing countries, which is almost eradicated in the developed world (1).
With universality of access to health services and actions as one of its three doctrinal principles, UHS surpasses the position of the service provider to become a tool of equity. Within the scope of its Primary Care, UHS is identified as the “gateway” to the health system, being the service sought for the provision of preventive and assistive tests to women (2). However, this system is not immune to flaws, which are significant when comparing the scope and effectiveness of Brazilian public primary care in populations with different socio-economic conditions, and access to health care (1).
Based on indicators such as the Human Development Index, income per capita, illiteracy rate and density of doctors compared to the population (Amazonas-0.6 doctors/1,000 and São Paulo-1.97 doctors/1,000), it is evident that the poorest regions of the country have a higher mortality rate due to cervical cancer (3) (4.6 in São Paulo and 22.9 in Amazonas-between 2008-2012), which denotes the fragility of the tracking system in the Primary Care of these places. Another concerning factor is that only 15% of laboratories affiliated with UHS fulfilled the requirements made by the public system for the performance of anatomopathological tests related to cervical cancer screening (1).
The correlation between cervical cancer screening in primary care and the lower mortality rate related to this condition is an indication of the importance of primary care for health promotion, disease prevention, and treatment (4), but UHS has failed to provide even basic services in primary care, such as access to medicines and vaccines to the marginalized populations and economically disadvantaged regions of Brazil.
In order to achieve this goal, there should be the presence of an integrated network, with medical record systems, which allows the monitoring of patients, both the performance of the cytopathological examination and the follow-up, in addition to a large area of coverage, regardless of the social, political and economic variables. Although UHS is an internationally recognized system for its efficiency and universality, it is evident that much remains to be improved, especially in primary care.
1. Ribeiro, MC, Dias MBK, Pla MAS, Correa FM, Russomano FB, Tomazelli JG. Parameters for scheduling procedures for the cervical cancer care line in Brazil. Cad. Saúde Pública [online]. 2019, vol.35, n.6 [cited 2020-01-24], e00183118. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-311X2019000705008&lng=en&nrm=iso
2. Galvao JR, de Almeida PF; dos Santos AM, Bousquat A. Paths and obstacles in the Health Care Network: care trajectories of women in the health region of Northeast Brazil. Cad. Saúde Pública [online]. 2019, vol.35, n.12 [cited 2020-01-24], e00004119. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-311X2019001405011&lng=en&nrm=iso
3. Vale DB, Sauvaget C, Murillo R, Muwonge R, Zeferino LC, Sankaranarayanan R. Correlation of Cervical Cancer Mortality with Fertility, Access to Health Care and Socioeconomic Indicators. Rev. Bras. Ginecol. Obstet. [online]. 2019, vol.41, n.4 [cited 2020-01-24], pp.249-255. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-72032019000400249&lng=en&nrm=iso
4. de Pontes A P M et al. The principal of universal access to health services: What do the users think? [Online]. Esc Anna Nery Ver Enferm. Rio de Janeiro. 2009; 13 (3): 500-07 [cited 2020 Jan 21].. Available from: http://www.scielo.br/pdf/ean/v13n3/v13n3a07
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