Stormo Analía Romina, de Moura Lenildo, Saraiya Mona
Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; Organização Pan-Americana da Saúde/Organização Mundial da Saúde (OPAS/OMS), Brasilia, Brasil.
Oncologist. 2014 Apr;19(4):375-82. doi: 10.1634/theoncologist.2013-0318. Epub 2014 Mar 25.
Brazil's national strategy for cervical cancer screening includes using the Papanicolaou (Pap) test every 3 years among women aged 25-64 years. Comprehensive primary care services are provided through a network of primary health units, but little is known about cervical cancer-related knowledge, attitudes, and practices among health professionals and coordinators working in these facilities.
In 2011, we conducted a cross-sectional nationally representative phone survey of 1,600 primary health care units to interview one unit coordinator and one health care professional per unit (either nurse, physician, or community health worker). Responses were obtained from 1,251 coordinators, 182 physicians, 347 nurses, and 273 community health workers. Questionnaires were administered to assess health units' characteristics and capacity for cervical cancer-related services as well as health professionals' perceived effectiveness of the Pap test, preparedness to talk to women about cervical cancer, adherence with screening guidelines, and willingness to recommend human papillomavirus (HPV) vaccination to females.
Most units conducted screening (91.9%), used home visits to conduct recruitment and outreach (83.4%), and provided follow-up to women who did not return to discuss Pap test results (88.1%). Approximately 93% of health professionals stated that Pap testing was effective in decreasing death rates from cervical cancer and 65% stated that national guidelines for cervical cancer screening are very influential; 93% of nurses and physicians reported screening women annually and 75% reported beginning to screen women younger than 25 years old. Regarding HPV vaccination, almost 90% of nurses and physicians would recommend the HPV vaccine to their females patients if it were available. A larger proportion of physicians and nurses recommended the HPV vaccine to older girls (13-18 years) and women (19-26 years and even older than 26 years) than to younger girls (12 years or younger).
Although Brazil's network of primary care units has significantly increased access to cervical cancer screening, effective strategies are needed to ensure that women get screened at the appropriate ages and intervals. Additionally, this study's baseline data on HPV vaccination may be useful as Brazil embarks on a national HPV vaccination program in 2014.
巴西宫颈癌筛查国家战略包括对25至64岁女性每3年进行一次巴氏试验。通过初级卫生单位网络提供全面的初级保健服务，但对于在这些机构工作的卫生专业人员和协调员中与宫颈癌相关的知识、态度和做法了解甚少。
2011年，我们对1600个初级卫生保健单位进行了一项具有全国代表性的横断面电话调查，每个单位采访一名单位协调员和一名卫生保健专业人员（护士、医生或社区卫生工作者）。共获得1251名协调员、182名医生、347名护士和273名社区卫生工作者的回复。通过问卷调查评估卫生单位的特征和提供宫颈癌相关服务的能力，以及卫生专业人员对巴氏试验有效性的认知、与女性谈论宫颈癌的准备情况、对筛查指南的遵守情况，以及向女性推荐人乳头瘤病毒（HPV）疫苗接种的意愿。
大多数单位开展了筛查（91.9%），采用家访进行招募和宣传（83.4%），并对未返回讨论巴氏试验结果的女性进行随访（88.1%）。约93%的卫生专业人员表示巴氏试验能有效降低宫颈癌死亡率，65%表示国家宫颈癌筛查指南非常有影响力；93%的护士和医生报告每年为女性进行筛查，75%报告开始为25岁以下女性进行筛查。关于HPV疫苗接种，如果有HPV疫苗，近90%的护士和医生会向女性患者推荐。与年龄较小的女孩（12岁及以下）相比，更多的医生和护士向年龄较大的女孩（13至18岁）和女性（19至26岁甚至26岁以上）推荐HPV疫苗。
尽管巴西的初级保健单位网络显著增加了宫颈癌筛查的可及性，但仍需要有效的策略来确保女性在适当的年龄和间隔接受筛查。此外，随着巴西在2014年启动全国HPV疫苗接种计划，本研究关于HPV疫苗接种的基线数据可能会有所帮助。
