Inequalities in Pap smear screening for cervical cancer in Brazil

Prev Med. 2013 Oct;57(4):366-71. doi: 10.1016/j.ypmed.2013.06.026. Epub 2013 Jul 1.


Objective: To examine the risk factors associated with never being screened for cervical cancer (CC) in Brazil.

Methods: Using the National Household Sample Survey 2008 (PNAD), we analyzed data from 102,108 Brazilian women ages 25-64years. The patients were analyzed as having been or never having been screened with a Pap smear (Yes/No). Age-adjusted prevalence of never-screening was analyzed using a Chi-squared test. Crude and adjusted models using Poisson regression were performed.

Results: The prevalence of never-screened women for CC was 12.9%, 11.5% and 22.2% in Brazil in general, urban and rural areas, respectively. The Brazilian region with the highest prevalence of never-screening was the North (17.4%, 14.7% and 27.3% in general, urban and rural areas, respectively). The factors associated with a higher risk for never being screened were the following: poverty, younger age, lower educational level, non-white skin color, a greater number of children, no supplemental health insurance and not having visited a doctor in the past 12months.

Conclusion: Socioeconomic and demographic conditions lead to inequalities in access to Pap smear screening in Brazil. Public health policy addressing these risk groups is necessary.

Keywords: Cancer screening; Epidemiology; Health inequities; Papanicolau smear; Tumor virus infection; Uterine cervical neoplasm.

MeSH terms

  • Adult
  • Age Factors
  • Brazil / epidemiology
  • Continental Population Groups / statistics & numerical data
  • Early Detection of Cancer / statistics & numerical data*
  • Educational Status
  • Female
  • Health Care Surveys
  • Healthcare Disparities / statistics & numerical data*
  • Humans
  • Middle Aged
  • Papanicolaou Test / statistics & numerical data*
  • Poverty / statistics & numerical data
  • Rural Population / statistics & numerical data
  • Socioeconomic Factors
  • Urban Population / statistics & numerical data
  • Uterine Cervical Neoplasms / diagnosis
  • Uterine Cervical Neoplasms / prevention & control*
  • Vaginal Smears / statistics & numerical data*