Tese
Fatores individuais e contextuais associados ao rastreamento do câncer de mama e colo do útero
Fecha
2021-05-14Autor
Sabrina Daros Tiensoli
Institución
Resumen
Introduction: Evidence shows that in addition to individual factors, contextual factors also interfere in the screening of breast and cervical cancer, and the identification of these factors makes it possible to study aspects of the complex relationship of the environment as a determinant of individuals’ health. Thus, the aim of this thesis was to analyze the association of individual and contextual factors with the screening for breast and cervical cancer in Brazil. Methods: These are cross-sectional studies, using the databases of the National Health Survey (PNS) and the Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey (Vigitel), carried out in 2013 and 2016, respectively, with representative samples of the Brazilian population. Individual and contextual factors of the Federative Units (UFs), associated with the screening of breast and cervical cancer were analyzed. Contextual variables were inserted in these surveys databases, been extracted from other secondary sources, such as Department of Primary Care, National Register of Health Facilities, Brazilian Institute of Geography and Statistics, Institute of Health Metrics. The outcomes of interest were cervical and breast cancer screening which were measured by not having a mammogram (Vigitel), having a mammogram in women aged 50 to 69 in the last 2 years (PNS), and having a Pap smear in women aged 25 to 64 in the last 3 years (PNS). For the association analysis, traditional and multilevel logistic regression were performed, with a significance level of 0.05. The sample of 12,740 women were studied at Vigitel and 9,049 women at PNS, aged 50 to 69 years in the breast cancer screening studies, and 26,443 women aged 25 to 64 years (PNS) in the cervical cancer screening one. Results: The coverage of mammography was 78.2% (Vigitel) and 54.4% (PNS), and the Pap smear coverage was 79.4% (PNS). Regarding individual factors, women with low education, who lived without a partner, were underweight, negatively self-rated their health and had one or more negative health behaviors had a lower chance of having a mammogram (Vigitel). In the PNS, similar results were observed and the greatest chances of undergoing the screeening exam were in women with high education, with a partner, overweight, who practiced physical activity, were former-smokers or had never smoked and who had health insurance. As for the Papanicolaou smear, the highest chances of completion were in women aged 35 to 44 years, with high education, with a partner, who practiced physical activity, had never smoked or were former-smokers, and had health insurance coverage. Regarding the multilevel analysis, it was possible to observe variability in the chance of having a mammogram between UFs in Brazil and in UFs with the highest HDI, SDI and the highest number of mammographs per 100 thousand inhabitants, the chance of undergoing the exam was greater. Variability in the chance of performing the Pap smear was also observed between UFs, and the contextual variables used did not explain the variability attributed to the context. Conclusions: Variability in the screening of breast and cervical cancer was observed in the national territory, among UFs, which was higher for mammography. In addition to individual sociodemographic factors, other individual factors, such as behavioral ones and contextual factors are associated with screening for breast and cervical cancer in Brazil. There are individual socioeconomic and contextual inequities in the performance of mammography and Pap smears which need to be considered in strategies, programs and policies to achieve a reduction in the incidence and mortality from these types of cancer in the country.