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

Institution

MSc/PhD Graduate Program, A C Camargo Hospital, São Paulo, Brazil. andrezza@ispon.com.br

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
Papillomaviridae
Papillomavirus Infections
Prognosis
Risk Factors
Uterine Cervical Neoplasms
Vaginal Smears

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

22343973