Introduction/Background Organized screening programs reduce cervical cancer incidence and mortality. However, in many low-middle income countries, the screening programs are opportunistic. In this work, we investigated the trends in cervical cancer mortality, advanced-stage at diagnosis, and screening coverage in an opportunistic setting.
Methodology In this large retrospective cohort, we analyzed data on invasive cervical cancer diagnosed between January 2000 and December 2014. Cancer data were provided by Fundação Oncocentro de São Paulo (FOSP) and screening coverage by the Instituto Brasileiro de Geografia e Estatistica (IBGE). Five-year cervical mortality was calculated using the Fine and Gray regression model. Joinpoint regression analysis was used to estimate annual percentage changes (APC) for five-year mortality, the proportion of advanced stage, and screening coverage.
Results From 18,206 cases, we identified 6,479 deaths in five years of follow up due to cervical cancer. The leading risk factor was the advanced stage (sHR = 6.48, 95% CI 5.75 to 7.30). The rate of cervical cancer mortality was stable from 2000 to 2014 (APC=–0.106; 95%CI -0.730 to 0.522; P=0.720). The estimated proportion of women screened (in the last three years) was 81%in 2003, 83% in 2008, and 85% in 2013 (APC=0.443; 95%CI -4.913 to 6.102; P=0.492). The proportion of advanced stage reduced from 77% in 2000 to 71% in 2006 (APC=–1.294; 95%CI -2.322 to -0.256; P=0.020) and increased to 76% in 2014 (APC=0.924; 95%CI 0.248 to 1.605; P=0.012).
Conclusion Opportunistic screening strategies fail to achieve a similar proportion of early-stage diagnosis and reduced mortality in invasive uterine cervix cancer compared to organized screening programs.
Disclosures The authors have no conflict of interest to disclose.
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