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      Desafios à organização de programa de rastreamento do câncer do colo do útero em Manaus-AM Translated title: Challenges to the organization of a cervical cancer screening program in Manaus-AM Translated title: Desafíos para la organización de programa de rastreo de cáncer de cuello uterino en Manaus-AM

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          Abstract

          Objetivou-se identificar as características sociodemográficas das mulheres que realizam o Papanicolaou em Manaus, Amazonas, e sua associação com os motivos para realização do exame. Pesquisa exploratória incluindo 281 mulheres, que haviam realizado o Papanicolaou nos últimos cinco anos em Manaus. A maioria das entrevistadas tinha entre 18-34 anos (54%), 5-11 anos de estudo (54,4%), renda familiar mensal de até três salários mínimos (84,3%), relação estável (72,2%) e início da vida sexual entre 15-19 anos (69,4%). Os motivos para realização do Papanicolaou foram procura espontânea (66,2%), recomendação médica (23,5%) e sintomas ginecológicos (10,3%). Mulheres que receberam informação dos profissionais de saúde tiveram proporção maior de realização do exame nos últimos três anos (p=0,008). A demanda espontânea é prevalente e o atendimento oportunístico é realizado nas mulheres mais jovens, não alcançando o grupo com maior risco para o câncer. É necessário implantar estratégias de recrutamento ativo alcançando mulheres em desvantagem socioeconômica.

          Translated abstract

          The purpose was to investigate sociodemographic characteristics of women who underwent a Pap smear test in Manaus, Amazonas, Brazil, and identify the reasons why the women had the test. This exploratory study was performed with 281 women who had taken the Pap smear test within the last five years in Manaus. Most participants were between 18 to34 years old (54%), had 5 to 11 years of education (54.4%), had a monthly income of less than three minimum wage salaries (84.3%) and were in a stable relationship (72.2%), with an onset of sexual activity between the ages of 15 to19 years (69.4%). The reasons for their taking the Pap test were personal choice (66.2%), recommendation by a physician (23.5%) and gynecological symptoms (10.3%). Women who received information about the Pap test from health professionals had a greater chance of being tested within the last three years (p=0.008). Women choosing to have the exam (personal choice) are prevalent, and the opportunistic service is provided to younger women, thus not reaching the group at greater risk for cancer. It is necessary to implement active recruitment strategies to reach women in situations of socioeconomic disadvantage.

          Translated abstract

          El objetivo fue identificar las características sociodemográficas de las mujeres que se realizan la prueba de Papanicolau en Manaus, Amazonas, Brasil y su asociación con las razones de realizar el examen. La investigación exploratoria contó con la participación de 281 mujeres y evidenció que la mayoría de las encuestadas tenían entre 18-34 años (54%), de 5-11 años de escolaridad (54.4%), los ingresos mensuales de hasta tres salarios mínimos (84.3%), relación estable (72.2%) y la iniciación sexual entre los 15-19 años (69.4%). Las razones para realizar la prueba de Papanicolau fueron demanda espontánea (66.2%), indicación médica (23.5%) y síntomas ginecológicos (10.3%). Mujeres que habían recibido información de los profesionales de la salud tenían una mayor proporción de realización de la prueba en los últimos tres años (p=0.008). La demanda espontánea es prevalente y la atención oportuna es realizada en mujeres mas jóvenes. Es necesario implementar estrategias de reclutamiento activo para alcanzar a las mujeres en desventaja socioeconómica.

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          Most cited references18

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          Global Cancer Statistics, 2002

          Estimates of the worldwide incidence, mortality and prevalence of 26 cancers in the year 2002 are now available in the GLOBOCAN series of the International Agency for Research on Cancer. The results are presented here in summary form, including the geographic variation between 20 large "areas" of the world. Overall, there were 10.9 million new cases, 6.7 million deaths, and 24.6 million persons alive with cancer (within three years of diagnosis). The most commonly diagnosed cancers are lung (1.35 million), breast (1.15 million), and colorectal (1 million); the most common causes of cancer death are lung cancer (1.18 million deaths), stomach cancer (700,000 deaths), and liver cancer (598,000 deaths). The most prevalent cancer in the world is breast cancer (4.4 million survivors up to 5 years following diagnosis). There are striking variations in the risk of different cancers by geographic area. Most of the international variation is due to exposure to known or suspected risk factors related to lifestyle or environment, and provides a clear challenge to prevention.
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            The challenges of organising cervical screening programmes in the 15 old member states of the European Union.

            Cervical cancer incidence and mortality can be reduced substantially by organised cytological screening at 3 to 5 year intervals, as was demonstrated in the Nordic countries, the United Kingdom, the Netherlands and parts of Italy. Opportunistic screening, often proposed at yearly schedules, has also reduced the burden of cervical cancer in some, but not all, of the other old member states (belonging to the European Union since 1995) but at a cost that is several times greater. Well organised screening programmes have the potential to achieve greater participation of the target population at regular intervals, equity of access and high quality. Despite the consistent evidence that organised screening is more efficient than non-organised screening, and in spite of the Cancer Screening Recommendations of the European Council, health authorities of eight old member states (Austria, Belgium, France, Germany, Greece, Luxembourg, Portugal and Spain) have not yet started national organised implementation of screening for cervical cancer. A decision was made by the Irish government to extend their pilot programme nationally while new regional programmes commenced in Portugal and Spain. Introduction of new methods of prevention, such as HPV screening and prophylactic HPV vaccination, can reduce the burden further, but this will require a high level of organisation with particular attention needed for the maximisation of population coverage, compliance with evidence-based guidelines, monitoring of data enabling continued evaluation and improvement of the preventive programmes.
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              The impact of interventions to improve attendance in female cancer screening among lower socioeconomic groups: a review.

              To review the scientific evidence on the effectiveness of interventions to promote attendance to breast and cervical cancer screening among lower socioeconomic groups. We performed a computerized literature search looking for relevant papers published between 1997 and 2006. Papers were classified into three groups based on the type of intervention evaluated: (1) implementation of organized population screening programs; (2) different strategies of enhancing attendance within an organized program; (3) local interventions in disadvantaged populations. The available evidence supports the hypothesis that while organized population screening programs are successful in increasing overall participation rates, they may not per se substantially reduce social inequalities. Some strategies were consistently found to enhance access to screening among lower socioeconomic groups, including cost-reducing interventions (e.g. offering free tests and eliminating geographical barriers), a greater involvement of primary-care physicians and individually tailored pro-active communication that addresses barriers to screening. Evidence from studies suggests that the attendance of deprived women to cancer screening can be improved with organized screening programs tailored to their needs. The same may apply to the prevention of adverse outcomes of other health conditions, such as hypertension, hypercholesterolemia, and diabetes. Copyright 2010 Elsevier Inc. All rights reserved.
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                Author and article information

                Journal
                tce
                Texto & Contexto - Enfermagem
                Texto contexto - enferm.
                Universidade Federal de Santa Catarina, Programa de Pós Graduação em Enfermagem (, SC, Brazil )
                0104-0707
                1980-265X
                June 2012
                : 21
                : 2
                : 395-400
                Affiliations
                [02] São Paulo orgnameUniversidade de Franca orgdiv1Programa de Pós-Graduação em Promoção de Saúde Brasil wilsa.vieira@ 123456terra.com.br
                [03] São Paulo orgnameUSP orgdiv1EERP orgdiv2Departamento de Enfermagem Materno-Infantil e Saúde Pública Brasil amalmeid@ 123456eerp.usp.br
                [01] São Paulo orgnameUniversidade de São Paulo orgdiv1Escola de Enfermagem de Ribeirão Preto Brasil dinacorrea@ 123456bol.com.br
                Article
                S0104-07072012000200018 S0104-0707(12)02100218
                1f7cd90c-9c51-46f4-a529-c53cee7883a8

                This work is licensed under a Creative Commons Attribution 4.0 International License.

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                Figures: 0, Tables: 0, Equations: 0, References: 20, Pages: 6
                Categories
                Artigo Original

                Uterine cervical neoplasms,Frotis vaginal,Salud pública,Neoplasias del cuello uterino,Prevenção e controle,Teste de Papanicolaou,Saúde pública,Neoplasias do colo do útero,Prevention & control,Vaginal smears,Public health,Prevención & control

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