Incidence of cervical cytological abnormalities following a negative smear result in an opportunistic screening scenario: A cohort study.

OBJECTIVES: To analyse the incidence of atypical cells and their risk factors in an opportunistic screening context. STUDY DESIGN: This cohort study with passive follow-up is based on analysis of 86,609 women living in Maranhão State - Brazil, who had a negative cervical cytological test recorded in the Cervical Cancer Information System (SISCOLO) in 2007 and who had at least 1 follow-up test up to 31 December 2012. The cumulative incidence (CI) and incidence rate (IR) of low grade squamous intraepithelial lesion (LSIL) and high-grade squamous intraepithelial lesions and cancer (HSIL+) were calculated. A Cox regression model was used to identify independent factors associated with the risk of presenting atypical cells. RESULTS: At 60 months follow-up the CI of LSIL reached 10.7 per 1000 and that of HSIL + was 3.9 per 1000. LSIL and HSIL + IRs were 334.7 and 120.3 per 100,000 person-years (PYs), respectively. LSIL and HSIL + occurred in 65.0% and 57.3% of women <3 years after the study entry, respectively. The risk of presenting HSIL + increased when a previous cervical cytological test had not been performed, with advancing age and when the Municipal Human Development Index (MHDI) decreased. CONCLUSION: This study highlights a significant tendency towards increased IR and risk of presenting HSIL + as MHDI decreased.

Patterns of cervical cytological abnormalities according to the Human Development Index in the northeast region of Brazil.

BACKGROUND: Disparities in cancer incidence and mortality rates between regions arise due to differences in socioeconomic conditions and in human development factors. The major purpose of this study was to measure the role of the Human Development Index (HDI) in the pattern of cervical cytological abnormalities (CCAs). METHODS: This was an analytical sectional study involving a review of secondary cervical cytology data collected from women living in the state of Maranhão, Brazil, in 2007-2012 and collected from the Cervical Cancer Information System (Sistema de Informação do Câncer do Colo do Útero - SISCOLO). The cervical screening results were classified according to the Brazilian Classification of Cervical Reporting (Nomenclatura Brasileira para Laudos Cervicais), an adaptation of the Bethesda System. The Municipal Human Development Index (MHDI) was used, which is an adaptation of the global HDI. The association between CCAs and MHDI was evaluated using the chi-squared test and odds ratios (ORs) with 95 % confidence intervals (95 % CI). The significance level used for all tests was 5 %. RESULTS: We analysed 1,363,689 examinations of women living in the state of Maranhão. CCAs were identified in 2.0 % of smears in municipalities with high MHDI, 2.2 % in those with medium or low MHDI and 4.1 % in those with very low MHDI. In addition, potentially malignant changes and suspected cervical cancer (HSIL+) were 40.0 % more frequent (0.3 %) in municipalities with medium or low MHDI and 3.6 times more frequent (0.8 %) in municipalities with very low MHDI compared to those with high MHDI (0.2 %). CONCLUSION: The association between MHDI and the occurrence of CCAs and HSIL+ shows that more developed areas with more effective health services have a lower prevalence of these lesions. To control cervical cancer, it is necessary to reduce social inequality and improve the availability of health services.