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Why are women with cervical cancer not being diagnosed in preinvasive phase? An analysis of risk factors using a hierarchical model.

Abstract

OBJECTIVE
To assess the risk factors for delayed diagnosis of uterine cervical lesions.
MATERIALS AND METHODS
This is a case-control study that recruited 178 women at 2 Brazilian hospitals. The cases (n = 74) were composed of women with a late diagnosis of a lesion in the uterine cervix (invasive carcinoma in any stage). The controls (n = 104) were composed of women with cervical lesions diagnosed early on (low- or high-grade intraepithelial lesions). The analysis was performed by means of logistic regression model using a hierarchical model. The socioeconomic and demographic variables were included at level I (distal). Level II (intermediate) included the personal and family antecedents and knowledge about the Papanicolaou test and human papillomavirus. Level III (proximal) encompassed the variables relating to individuals' care for their own health, gynecologic symptoms, and variables relating to access to the health care system.
RESULTS
The risk factors for late diagnosis of uterine cervical lesions were age older than 40 years (odds ratio [OR] = 10.4; 95% confidence interval [CI], 2.3-48.4), not knowing the difference between the Papanicolaou test and gynecological pelvic examinations (OR, = 2.5; 95% CI, 1.3-4.9), not thinking that the Papanicolaou test was important (odds ratio [OR], 4.2; 95% CI, 1.3-13.4), and abnormal vaginal bleeding (OR, 15.0; 95% CI, 6.5-35.0). Previous treatment for sexually transmissible disease was a protective factor (OR, 0.3; 95% CI, 0.1-0.8) for delayed diagnosis.
CONCLUSIONS
Deficiencies in cervical cancer prevention programs in developing countries are not simply a matter of better provision and coverage of Papanicolaou tests. The misconception about the Papanicolaou test is a serious educational problem, as demonstrated by the present study.

Links

  • Publisher Full Text
  • Authors

    Lourenço AV, Fregnani CM, Silva PC, Latorre MR, Fregnani JH

    Source

    International journal of gynecological cancer : official journal of the International Gynecological Cancer Society 22:4 2012 May pg 645-53

    MeSH

    Adult
    Brazil
    Case-Control Studies
    Cervical Intraepithelial Neoplasia
    Cervix Uteri
    Developing Countries
    Female
    Follow-Up Studies
    Humans
    Models, Statistical
    Neoplasm Grading
    Neoplasm Invasiveness
    Neoplasm Staging
    Papanicolaou Test
    Papillomaviridae
    Papillomavirus Infections
    Prognosis
    Risk Factors
    Uterine Cervical Neoplasms
    Vaginal Smears

    Pub Type(s)

    Comparative Study
    Journal Article

    Language

    eng

    PubMed ID

    22343973