Effectiveness of cytology-based cervical cancer screening in the Colombian health system
Keywords:
Uterine cervical neoplasms, mass screening, program evaluation, cytology, Colombia
Abstract
Introduction. Despite the implementation of cytological screening since 1991, cervical cancer continuous to be the leading cause of cancer mortality among Colombian women.Objectives. The effectiveness of cytology-based cervical cancer screening was subjected to review in the context of the Colombian health system.
Materials and methods. A case-control study was done. Invasive cervical cancer cases between 25-69 years were recruited and histopathological confirmation was required. Controls without invasive cancer were matched by age and neighborhood. Cases and controls were recruited in four Colombian provinces representing different settings for cervical cancer control with respect to program performance and mortality rates. The cases were randomly selected from the pathology in each province (year 2005). A survey of risk factors and cytology history in the previous 72 months was conducted.
Results. Fifty cases and 50 controls in each department were enrolled for a total of 400 subjects. The average age was 48.4 years, illiteracy 12.5%, and persons without health insurance 13.8%.
The average number of Pap-smears was higher among controls (p<0.01). Cases with a Pap-smear in the previous 36 months was nearly half (49.5%). Oral contraceptives and the lack of cytology were associated with invasive cervical cancer.
Conclusions. Cytology-based screening continued to be effective for early detection of cervical cancer in Colombia but its effectiveness was determined by quality of Pap-smears rather than by screening coverage. Governmental guidelines need to be revisited. Case-control studies provided a useful tool for evaluation of the screening program.
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References
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8. Piñeros M, Hernández G, Bray F. Increasing mortality rates of common malignancies in Colombia: an emerging problem. Cancer. 2004;101:2285-92.
9. Murillo R, Piñeros M, Hernández G. Atlas de mortalidad por cáncer en Colombia. Bogotá: Instituto Nacional de Cancerología, Instituto Geográfico Agustín Codazzi; 2004.
10. Wiesner C, Murillo R, Piñeros M, Tovar S, Cendales R, Gutiérrez MC. El control del cáncer cervicouterino en Colombia: percepción de los actores del sistema de salud. Rev Panam Salud Pública. 2008; en imprenta.
11. Herrero R, Brinton LA, Reeves WC, Brenes MM, de Britton RC, Gaitan E, et al. Screening for cervical cancer in Latin America: a case-control study. Int J Epidemiol. 1992;21:1050-6.
12. Hernández-Ávila M, Lazcano-Ponce EC, de Ruiz PA, Romieu I. Evaluation of the cervical cancer screening programme in Mexico: a population-based case-control study. Int J Epidemiol. 1998;27:370-6.
13. Zappa M, Visioli CB, Ciatto S, Iossa A, Paci E, Sasieni P. Lower protection of cytological screening for adenocarcinomas and shorter protection for younger women: the results of a case-control study in Florence. BJC. 2004;90:1784-6.
14. Sasieni P, Adams J, Cuzick J. Benefit of cervical screening at different ages: evidence from the UK audit. Of screening histories. BJC. 2003;89:88-93.
15. Andrae B, Kemetli L, Sparén P, Silfverdal L, Strander B, Ryd W, et al. Screening-preventable cervical cancer risks: evidence from a nationwide audit in Sweden. J Natl Cancer Inst. 2008;100:622-9.
16. Piñeros M, Cendales R, Murillo R, Wiesner C, Tovar S. Cobertura de la citología de cuello uterino y factores relacionados en Colombia, 2005. Rev Salud Pública (Bogotá). 2007;9:327-41.
17. Lazcano-Ponce EC, Moss S, Alonso P, Salmerón J, Hernández M. Cervical cancer screening in developing countries: why is it ineffective? The case of Mexico. Arch Med Res. 1999;30:240-50.
18. Lewis MJ. A situational analysis of cervical cancer in Latin America and the Caribbean. Washington D.C.: Pan American Health Organization; 2004.
19. Gamboa OA, Chicaíza L, García-Molina M, Díaz J, González M, Murillo R, et al. Cost-effectiveness of conventional cytology and HPV-DNA testing for cervical-cancer screening in Colombia. Salud Pub Mex. 2008;50:276-85.
2. Ferlay J, Bray F, Pisani P, Parkin DM. Cancer incidence, mortality and prevalence worldwide. Lyon: IARC Press; 2002.
3. Sankaranarayanan R, Madhukar-Budukh A, Rajkumar R. Effective screening programmes for cervical cancer in low- and middle-income developing countries. Bull World Health Organ. 2001;79:954-62.
4. Murillo R, Almonte M, Pereira A, Ferrer E, Gamboa O, Jerónimo J, et al. Cervical cancer screening programs in Latin America and the Caribbean. Vaccine. 2008;26:L37-48.
5. Aristizábal N, Cuello C, Correa P, Collazos T, Haenszel W. The impact of vaginal cytology on cervical cancer risks in Cali, Colombia. Int J Cancer. 1984;34:5-9.
6. Liu S, Semenciw R, Probert A, Mao Y. Cervical cancer in Canada: changing patterns in incidence and mortality. Int J Gynecol Cancer. 2001;11:24-31.
7. Murillo R. Control del cáncer de cuello uterino en Colombia: triunfos y desafíos de la tamización basada en la citología cérvico-uterina. Biomédica. 2008;28:468-70.
8. Piñeros M, Hernández G, Bray F. Increasing mortality rates of common malignancies in Colombia: an emerging problem. Cancer. 2004;101:2285-92.
9. Murillo R, Piñeros M, Hernández G. Atlas de mortalidad por cáncer en Colombia. Bogotá: Instituto Nacional de Cancerología, Instituto Geográfico Agustín Codazzi; 2004.
10. Wiesner C, Murillo R, Piñeros M, Tovar S, Cendales R, Gutiérrez MC. El control del cáncer cervicouterino en Colombia: percepción de los actores del sistema de salud. Rev Panam Salud Pública. 2008; en imprenta.
11. Herrero R, Brinton LA, Reeves WC, Brenes MM, de Britton RC, Gaitan E, et al. Screening for cervical cancer in Latin America: a case-control study. Int J Epidemiol. 1992;21:1050-6.
12. Hernández-Ávila M, Lazcano-Ponce EC, de Ruiz PA, Romieu I. Evaluation of the cervical cancer screening programme in Mexico: a population-based case-control study. Int J Epidemiol. 1998;27:370-6.
13. Zappa M, Visioli CB, Ciatto S, Iossa A, Paci E, Sasieni P. Lower protection of cytological screening for adenocarcinomas and shorter protection for younger women: the results of a case-control study in Florence. BJC. 2004;90:1784-6.
14. Sasieni P, Adams J, Cuzick J. Benefit of cervical screening at different ages: evidence from the UK audit. Of screening histories. BJC. 2003;89:88-93.
15. Andrae B, Kemetli L, Sparén P, Silfverdal L, Strander B, Ryd W, et al. Screening-preventable cervical cancer risks: evidence from a nationwide audit in Sweden. J Natl Cancer Inst. 2008;100:622-9.
16. Piñeros M, Cendales R, Murillo R, Wiesner C, Tovar S. Cobertura de la citología de cuello uterino y factores relacionados en Colombia, 2005. Rev Salud Pública (Bogotá). 2007;9:327-41.
17. Lazcano-Ponce EC, Moss S, Alonso P, Salmerón J, Hernández M. Cervical cancer screening in developing countries: why is it ineffective? The case of Mexico. Arch Med Res. 1999;30:240-50.
18. Lewis MJ. A situational analysis of cervical cancer in Latin America and the Caribbean. Washington D.C.: Pan American Health Organization; 2004.
19. Gamboa OA, Chicaíza L, García-Molina M, Díaz J, González M, Murillo R, et al. Cost-effectiveness of conventional cytology and HPV-DNA testing for cervical-cancer screening in Colombia. Salud Pub Mex. 2008;50:276-85.
How to Cite
1.
Murillo R, Cendales R, Wiesner C, Piñeros M, Tovar S. Effectiveness of cytology-based cervical cancer screening in the Colombian health system. biomedica [Internet]. 2009 Sep. 1 [cited 2024 May 11];29(3):354-61. Available from: https://revistabiomedica.org/index.php/biomedica/article/view/7
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