RESUMO
OBJECTIVE: To assess the risk factors for delayed diagnosis of uterine cervical lesions. MATERIALS AND METHODS: This is a case-control study that recruited 178 women at 2 Brazilian hospitals. The cases (n = 74) were composed of women with a late diagnosis of a lesion in the uterine cervix (invasive carcinoma in any stage). The controls (n = 104) were composed of women with cervical lesions diagnosed early on (low- or high-grade intraepithelial lesions). The analysis was performed by means of logistic regression model using a hierarchical model. The socioeconomic and demographic variables were included at level I (distal). Level II (intermediate) included the personal and family antecedents and knowledge about the Papanicolaou test and human papillomavirus. Level III (proximal) encompassed the variables relating to individuals' care for their own health, gynecologic symptoms, and variables relating to access to the health care system. RESULTS: The risk factors for late diagnosis of uterine cervical lesions were age older than 40 years (odds ratio [OR] = 10.4; 95% confidence interval [CI], 2.3-48.4), not knowing the difference between the Papanicolaou test and gynecological pelvic examinations (OR, = 2.5; 95% CI, 1.3-4.9), not thinking that the Papanicolaou test was important (odds ratio [OR], 4.2; 95% CI, 1.3-13.4), and abnormal vaginal bleeding (OR, 15.0; 95% CI, 6.5-35.0). Previous treatment for sexually transmissible disease was a protective factor (OR, 0.3; 95% CI, 0.1-0.8) for delayed diagnosis. CONCLUSIONS: Deficiencies in cervical cancer prevention programs in developing countries are not simply a matter of better provision and coverage of Papanicolaou tests. The misconception about the Papanicolaou test is a serious educational problem, as demonstrated by the present study.
Assuntos
Modelos Estatísticos , Displasia do Colo do Útero/diagnóstico , Displasia do Colo do Útero/prevenção & controle , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/prevenção & controle , Adulto , Brasil , Estudos de Casos e Controles , Colo do Útero/patologia , Países em Desenvolvimento , Feminino , Seguimentos , Humanos , Gradação de Tumores , Invasividade Neoplásica , Estadiamento de Neoplasias , Teste de Papanicolaou , Papillomaviridae , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/prevenção & controle , Infecções por Papillomavirus/virologia , Prognóstico , Fatores de Risco , Neoplasias do Colo do Útero/virologia , Esfregaço Vaginal , Displasia do Colo do Útero/virologiaRESUMO
In Brazil, many cases of breast and cervical cancers are only diagnosed in advanced stages. Information on prevention of cancer in women is increasingly available. However, prevention or early treatment alternatives are often not practiced. This study investigated the issues hindering the practice of prevention against cancer in women. A qualitative method was employed in this exploratory and descriptive study. The sample included thirty-three randomly selected women undergoing treatment. The survey data was collected at the South Parana Institute of Oncology, Ponta Grossa - PR in September 2007 using a semi-structured individual interview after approval by the Research Ethics Committee of the Brazilian College of Systemic Studies - CBES, Curitiba - PR, under protocol 0462/07, in compliance with CNS Resolution number 196/96. Absence of symptoms, embarrassment, long waiting list for treatment, and indifference to the campaigns of prevention were some obstacles encountered. A lack of information about cancer and its causes and consequences was the biggest issue found regarding the acceptance of prevention of cancer in women. The pharmacist, in the role of educator in the prevention of cancer in women, can emphasize the importance of regular prevention practices and highlight the implications of late treatment, disseminating information that can have greater impact on society.
No Brasil, muitos casos de câncer de mama e de colo uterino são diagnosticados em estádios avançados. Informações sobre prevenção de câncer na mulher são cada vez mais frequentes. No entanto, prevenção do câncer na mulher e diagnóstico precoce da doença muitas vezes não se realizam. Investigaram-se as causas que dificultam a prevenção de câncer na mulher por método qualitativo sob modalidade exploratória e descritiva. A amostra incluiu trinta e três mulheres em tratamento, selecionadas ao acaso atendidas no Instituto Sul Paranaense de Oncologia, Ponta Grossa - PR, em setembro de 2007, por meio de entrevista semi-estruturada individual com aprovação do Comitê de Ética em Pesquisa do Colégio Brasileiro de Estudos Sistêmicos - CBES, Curitiba - PR, sob o protocolo 0462/07, cumprindo-se a Resolução CNS nº 196/96. Ausência de sintomas, vergonha, longa espera em filas de atendimento e indiferença às campanhas de prevenção foram alguns obstáculos encontrados. Carência de informação sobre câncer, suas causas e consequências, foi a maior questão encontrada quanto à aceitação da prevenção do câncer na mulher. O farmacêutico como educador na prevenção de câncer na mulher pode ressaltar a importância dessa prática feita de modo regular e apontar implicações de tratamentos tardios, difundindo informações que causem maior repercussão social.
