Lima Bianca Gastaldon, Barros Marilisa Berti de Azevedo
Universidade Estadual de Campinas, Faculty of Medical Sciences, Department of Collective Health - Campinas (SP), Brazil.
Rev Bras Epidemiol. 2025 Aug 4;28:e250043. doi: 10.1590/1980-549720250043. eCollection 2025.
To analyze the prevalence of early detection tests for cervical, breast, prostate, and colorectal cancers in the population of Campinas, São Paulo and the presence of social inequalities in access.
Population-based cross-sectional study using data from ISACamp 2014/15. Dependent variables were the performance of Pap smear, mammogram, prostate-specific antigen (PSA), fecal occult blood test (FOBT) and colonoscopy/sigmoidoscopy within the age ranges recommended by national guidelines. Independent variables included sex, age, schooling, income, race/skin color, and private health insurance. Prevalence and prevalence ratio adjusted for sex and age were estimated using Poisson regression. Analyses were performed using Stata 14, considering sampling weights.
The prevalence of mammography (77.7%) and Pap smear (87.8%) met the targets set by the Brazilian Ministry of Health, while FOBT (22.3%) and colonoscopy/sigmoidoscopy (21.5%) showed low coverage. PSA testing in the previous three years was reported by 55.2% of eligible men. Higher prevalence of test performance was observed among individuals with higher schooling and income levels and those with private health insurance. Inequalities varied by type of test. For instance, individuals with private health insurance had 11 and 162% higher prevalence of Pap test and colonoscopy/sigmoidoscopy, respectively, compared to those without insurance. Racial inequality was observed only for mammography.
The results indicate high coverage and lower inequalities for Pap and mammography, and low coverage with significant disparities for FOBT and colonoscopy/sigmoidoscopy. Findings highlight the need to monitor coverage and to implement public policies aimed at reducing inequities in access to cancer screening.
分析圣保罗州坎皮纳斯市人群中宫颈癌、乳腺癌、前列腺癌和结直肠癌早期检测测试的普及率以及获取检测服务方面的社会不平等现象。
基于人群的横断面研究，使用2014/15年坎皮纳斯市健康调查（ISACamp）的数据。因变量为在国家指南推荐的年龄范围内进行巴氏涂片检查、乳房X光检查、前列腺特异性抗原（PSA）检测、粪便潜血试验（FOBT）以及结肠镜检查/乙状结肠镜检查的情况。自变量包括性别、年龄、受教育程度、收入、种族/肤色以及私人医疗保险。使用泊松回归估计经性别和年龄调整后的患病率及患病率比。分析使用Stata 14软件进行，并考虑抽样权重。
乳房X光检查（77.7%）和巴氏涂片检查（87.8%）的普及率达到了巴西卫生部设定的目标，而FOBT（22.3%）和结肠镜检查/乙状结肠镜检查（21.5%）的覆盖率较低。在符合条件的男性中，有55.2%报告在过去三年中进行过PSA检测。受教育程度和收入水平较高以及拥有私人医疗保险的人群检测执行率更高。不平等情况因检测类型而异。例如，与没有保险的人相比，拥有私人医疗保险的人进行巴氏试验和结肠镜检查/乙状结肠镜检查的患病率分别高出11%和162%。仅在乳房X光检查中观察到种族不平等。
结果表明，巴氏涂片检查和乳房X光检查的覆盖率较高且不平等程度较低，而FOBT和结肠镜检查/乙状结肠镜检查的覆盖率较低且存在显著差异。研究结果凸显了监测覆盖率以及实施旨在减少癌症筛查获取方面不平等现象的公共政策的必要性。
